How Doctors Die • Hacker News Board

Re: How Doctors Die

#141

Post by anigbrowl » Mon, Dec 05, 2011, 9:24 PM UTC

nroach wrote: post #137

anigbrowl wrote: post #124

Earlier quoted context omitted.

I don't think they do it consciously, but doctors try to sell you on their philosophies for healthcare. No, doctors try to make you as fully aware as possible of the options available to you, so that you or your heirs don't turn around and sue them later for 'withholding information that could have saved your life' or something along those lines. Arguably, these suits are motivated in part by the need to defray the e…

"Lawsuits" are an easy scapegoat, but it's probably not a significant driving factor. For example, Texas has very strict tort reform laws which basically make it impossible to sue a doctor for malpractice. But defensive medicine hasn't faded at all in the four years since those laws took effect. Structurally, our system is designed to over-treat. With co-pays, insurance, subsidized care, and contractual discounts, pa…

I agree lawsuits are not the primary or even a major driver of costs, but every doctor I've met worries about them, and I was responding to speculation about what motivates doctors as individuals.

As for Texas, you're quite right - indeed, medical costs seem to have risen since the 'reforms' were put in place: http://www.dayontorts.com/tort-reform-medical-malpractice-to... - according to a tort lawyer, but consistent with everything else I've read on the subject.

Re: How Doctors Die

#142

Post by vacri » Mon, Dec 05, 2011, 9:33 PM UTC

rasur wrote: post #117

angelbob wrote: post #112

Earlier quoted context omitted.

I suspect he meant it, too.

So then why do it in a hospital parking lot? Sounds more like a really excessive cry for help to me.

It depends on the particulars of the story. Perhaps he was hospital-bound. Perhaps he had to visit the hospital so frequently that one day on the way in, he just couldn't handle it anymore.

Re: How Doctors Die

#143

Post by vacri » Mon, Dec 05, 2011, 9:39 PM UTC

tptacek wrote: post #105

The CPR example that's used throughout the article is a bit weird, isn't it? Isn't CPR performed when someone has no heartbeat? What does it matter if you crack their ribs? It's only painful if the person survives. I'm not debating whether people should attempt to prolong their lives with aggressive chemo, just picking a nit.

CPR is done on unconscious people who are not breathing. They may have no heartbeat, or it may be an irregular one. CPR shouldn't be done on someone that can feel the pain at the moment of the ribs breaking, correct.

Re: How Doctors Die

#144

Post by vacri » Mon, Dec 05, 2011, 9:43 PM UTC

DanBC wrote: post #91

vacri wrote: post #44

Earlier quoted context omitted.

Science is rigorous, repeatable observation . Double-blind studies and null hypotheses are excellent ways to achieve this. But case studies and low n studies are also informative - and are science. That science can only be control groups and null hypotheses is a myth. Try and tell the medical fraternity that case studies should be eliminated because they hold no meaningful result and you'll be laughed out of the room…

Case studies are lousy because they are not rigorous, and often have not had any meaningful result. See also knee arthroscopy for patients with osteo arthritis - many of these surgeries were performed before a trial with a control group was possible. That trial found that people who got the sham surgery did as well as the people who got the real surgery. Case studies are lousy, often harmful, medicine.

The thing is that you read case studies with this caveat in mind, recognising that they're statistically flawed. When you don't have better information available, case studies and low n studies give some direction, some previously observed information.

Re: How Doctors Die

#145

Post by gbak » Mon, Dec 05, 2011, 10:06 PM UTC

For some reason the site is down and the cache link on google takes a while to load. For everyone that wants to read it I created a public Google Docs file with the article. You can access it here:

https://docs.google.com/document/d/1yL1659zNXQ7M9uXIcRrcu9dJ...

Re: How Doctors Die

#146

Post by bh42222 » Mon, Dec 05, 2011, 10:10 PM UTC

marquis wrote: post #118

bh42222 wrote: post #72

Earlier quoted context omitted.

For me #1 is easy. Screw writing and reading, instead travel around the word, jump from planes, swim with sharks and die in months. 100% better then daily visits to a hospital for a handful of years. What I, and a lot of people like me, are doing now by not doing #1 is gambling we'll get to do it in the future. This is an easily lost gamble, but oh well.

That sounds great but dying doesn't leave you with a lot of energy to do these things for long.

I think the point is that the treatment leaves you with a ton less energy and hunger and power, etc. Otherwise there really is no point in skipping the treatment.

Re: How Doctors Die

#147

Post by jasonwatkinspdx » Mon, Dec 05, 2011, 10:14 PM UTC

defdac wrote: post #21

Tonight I will tell the mother of our child that if I reason in any way that resembles this article she should slap me in face and tell me to fight for my life. For my daughter and my own sake. In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later. I want all the tub…

"For my daughter and my own sake."

Your family is your business, but I have watched both friends and family die fighting hard in the ICU. It would not have been my choice to watch them, nor for them to go through that for the sake of myself.

Fighting for the sake of fighting alone has no value.

Watching a loved one suffer is agonizing.

Re: How Doctors Die

#148

Post by lmkg » Mon, Dec 05, 2011, 10:15 PM UTC

dmgottlieb wrote: post #103

celticninja wrote: post #101

Earlier quoted context omitted.

Re:saddling their family with huge expenses, this is a fairly unique problem in 1st world healthcare situations, in that it mainly applies to people in the US. In most other developed nations healthcare and bankruptcy do not go hand in hand.

But the money is just as wasted no matter who pays it.

This statement is both true, and irrelevant, because who bears the burden is very important for the individual making the decision. What's being weighed is not "are the resources used to keep me alive being efficiently allocated," but rather, "will my spouse and children be irrevocably bankrupted."

Re: How Doctors Die

#149

Post by kalid » Mon, Dec 05, 2011, 10:27 PM UTC

gwern wrote: post #122

kalid wrote: post #116

Earlier quoted context omitted.

I don't think reading studies is the only way either, but I don't think most of us have questioned what makes us happy outside of soceity's default settings (money/fame/toys/vacations). People make all sorts of tradeoffs which are non-optimal: * Extra commute to a better job with $XX,XXX more for +1 hour/day of travel (less time for good food with family/friends) * Move away from good family/friends to pursue better…

In case people think kalid is making it up, the first one is the 'commuting paradox': http://ftp.iza.org/dp1278.pdf (or http://www.businessweek.com/magazine/content/05_08/b3921127.... )

Thanks for the link! I remember reading that study somewhere. A salient part of the article:

"This is what economists call "the commuting paradox." Most people travel long distances with the idea that they'll accept the burden for something better, be it a house, salary, or school. They presume the trade-off is worth the agony. But studies show that commuters are on average much less satisfied with their lives than noncommuters. A commuter who travels one hour, one way, would have to make 40% more than his current salary to be as fully satisfied with his life as a noncommuter, say economists Bruno S. Frey and Alois Stutzer of the University of Zurich's Institute for Empirical Research in Economics. People usually overestimate the value of the things they'll obtain by commuting -- more money, more material goods, more prestige -- and underestimate the benefit of what they are losing: social connections, hobbies, and health. "Commuting is a stress that doesn't pay off," says Stutzer."

Re: How Doctors Die

#150

Post by jasonwatkinspdx » Mon, Dec 05, 2011, 10:42 PM UTC

cjy wrote: post #127

cturner wrote: post #114

Earlier quoted context omitted.

Greece has socialised healthcare, as do the rest of the European countries circling the drain. http://en.wikipedia.org/wiki/Health_care_in_Greece It's worth noting that the US health model isn't a free-market system - the state links health care to employment, which distorts the market away from individual private health ownership, and creates patterns that make it easy for costs to creep up. The US health care model…

How is the state linking health care to employment? My understanding is that health care is linked to employment because of the adverse selection problem that occurs in a free market of individual health insurance. Can you elaborate on why you consider this to be the government's fault?

The adverse selection can be solved a different way: legislate that health plans have to be open to all comers and regulate price differentiation to a few key cost drivers that are politically viable (eg smoking).