Can Good Doctors Be Bad for Your Health? • Hacker News Board

Re: Can Good Doctors Be Bad for Your Health?

#11

Post by xiaoma » Mon, Nov 23, 2015, 4:07 PM UTC

jpmattia wrote: post #7

> Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. It's disappointing that the conflict-of-interest is not better recognized. Asking a surgeon if you need surgery? Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?

>Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?

Yes. I expect lives to be put ahead of economic gain. Someone lacking the ethical backbone to do this should never even be admitted to medical school.

Re: Can Good Doctors Be Bad for Your Health?

#12

Post by [deleted] » Mon, Nov 23, 2015, 4:09 PM UTC

xiaoma wrote: post #11

jpmattia wrote: post #7

> Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. It's disappointing that the conflict-of-interest is not better recognized. Asking a surgeon if you need surgery? Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?

>Do you really expect a person under a pile of medical-school debt to give you an unbiased answer? Yes. I expect lives to be put ahead of economic gain. Someone lacking the ethical backbone to do this should never even be admitted to medical school.

[deleted]

Re: Can Good Doctors Be Bad for Your Health?

#13

Post by mirimir » Mon, Nov 23, 2015, 4:11 PM UTC

I highly recommend Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer (2008) by Shannon Brownlee.

When you have a hammer, everything looks like a nail. That's especially so when you're deep in debt from buying that hammer, and can earn huge speaking fees through promoting the brand to your peers.

Re: Can Good Doctors Be Bad for Your Health?

#14

Post by m52go » Mon, Nov 23, 2015, 4:18 PM UTC

mirimir wrote: post #13

I highly recommend Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer (2008) by Shannon Brownlee. When you have a hammer, everything looks like a nail. That's especially so when you're deep in debt from buying that hammer, and can earn huge speaking fees through promoting the brand to your peers.

#iatrogenics

Nassim Taleb discusses this concept from a broader perspective in Antifragile.

Re: Can Good Doctors Be Bad for Your Health?

#15

Post by wfo » Mon, Nov 23, 2015, 4:20 PM UTC

jpmattia wrote: post #7

> Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. It's disappointing that the conflict-of-interest is not better recognized. Asking a surgeon if you need surgery? Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?

Yes absolutely. People are capable of looking past economic concerns when the lives of another are at stake and we should absolutely expect them to in this case. What's disappointing is the notion that we've sunk so low in our expectations of humanity that we even assume doctors are constantly calculating min/max selfish economic expectation when they advise their patients.

Luckily while some doctors are scam artists the vast majority of them have a sense of duty that transcends "maximize profits".

Re: Can Good Doctors Be Bad for Your Health?

#16

Post by m52go » Mon, Nov 23, 2015, 4:23 PM UTC

jpmattia wrote: post #7

> Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. It's disappointing that the conflict-of-interest is not better recognized. Asking a surgeon if you need surgery? Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?

You raise a good point though. Ethically, it's expected, but even ethical people are known to be drawn by greed on occasion.

That's why the incentive-structure needs to be flipped to be outcome-driven, not treatment-driven...

Re: Can Good Doctors Be Bad for Your Health?

#17

Post by mamon » Mon, Nov 23, 2015, 4:25 PM UTC

jpmattia wrote: post #7

> Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. It's disappointing that the conflict-of-interest is not better recognized. Asking a surgeon if you need surgery? Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?

I wouldn't link that to money issue. Rather than that I would say: "When all you have is hammer, everything looks like nail". Surgeons try to solve all the problems, including changing a light-bulb, by surgery, psychiatrists by psychotherapy, traditional Chinese medicine adepts by acupuncture.

Re: Can Good Doctors Be Bad for Your Health?

#18

Post by pmiller2 » Mon, Nov 23, 2015, 4:41 PM UTC

jpmattia wrote: post #7

> Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. It's disappointing that the conflict-of-interest is not better recognized. Asking a surgeon if you need surgery? Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?

The scenario of the person "under a pile of medical-school debt" isn't what's being looked at here. The study behind the article is looking at senior cardiologists, who, presumably, have paid off their student loans already.

What we're looking at here isn't economic conflict of interest, but simple bias. Doing things feels better than not doing things, so they do it. Experience might even work against them because we're biased to remember the good outcomes from things rather than consider carefully the general success rate of a procedure.

Re: Can Good Doctors Be Bad for Your Health?

#19

Post by lordCarbonFiber » Mon, Nov 23, 2015, 4:42 PM UTC

jpmattia wrote: post #7

> Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. It's disappointing that the conflict-of-interest is not better recognized. Asking a surgeon if you need surgery? Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?

You're completely missing the actual conflict of interest, balance the creed of 'do not harm' with the reality of protecting themselves from the patients. No one wants to be sued for 'not doing enough' and stick of a potential malpractice suite makes the already incentivized extra procedures make a lot more sense.

For once the larger problems don't lie with the system (although they certainly aren't helping), but rather the disgusting culture we have built up surrounding medical care and expectations. When your obese octogenarian grandmother dies the first thought shouldn't be litigation because the doctor didn't "run enough tests".

Re: Can Good Doctors Be Bad for Your Health?

#20

Post by moistgorilla » Mon, Nov 23, 2015, 4:43 PM UTC

When I was 19 I was diagnosed with something called hydronephrosis. It's effect on my kidney function wasn't significant but my parents took me to see one of the most famous urologists (I think the hospital was in philadelphia) anyway. I don' remember the specifics but the doctor immediately recommended invasive surgery. My father then took me to another urologist he knew from a friend's recommendation. This doctor said that there was no reason to have surgery yet. The kidney with the hydronephrosis had something like 4% below utilization rate that was normal and that we should wait. We decided to follow the second doctors advice and do regular checkups every year and the problem actually just went away.

The most amazing thing about this experience was when we called 3 weeks in advance to cancel the appointment for surgery the nurse got angry with us and said something along the lines of "You actually dare to waste the doctor's time?". It was very surreal.

TLDR: Don't get pressured into getting surgery, go get second opinions.