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Heart surgeons refuse difficult operations to avoid poor mortality ratings

telegraph.co.uk

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Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#111

Post by xab9 »

drewg123 wrote: post #17

It was not heart surgery, but after being diagnosed with lung cancer, my mother had one of her lungs removed by a surgeon who assured us he'd be able to get all the cancer. She had a miserable, painful recovery that I would not wish on anybody. Within a week or two of her recovering to the point where she could walk short distances, the cancer was found in her other lung and went on to kill her within a few more mont…

I always tell myself that modern medicine is a gamble. No medicine at all is a death sentence though.

I work with software and we gotta give estimates in hours (because the managers didn't like complexity numbers), you know, like add a dropown to the search page or whatnot and I say yeah sure, it's simple, one hour... and then I end up in prehistoric spaghetti land for two days.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#112

Post by PerfectElement »

Numberwang wrote: post #45

It's sad to hear this when it's totally unnecessary. Hear disease has been a solved problem for decades. Just compare the rates of disease for vegans with the general population.

I wouldn't make blanket statements about a vegan diet because there are several types of diets that are compatible with a vegan lifestyle. I can eat Oreos and peanut butter all day and still be vegan.

You must be referring to a whole food plant-based diet, which has been shown effective in the prevention and reversal of heart disease[1][2].

[1] https://www.ornish.com/wp-content/uploads/Intensive-lifestyl... [2] http://dresselstyn.com/JFP_06307_Article1.pdf

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#113

Post by dooglius »

waterhouse wrote: post #83
cs702 wrote: post #30

It's Goodhart's Law in action, this time with deadly consequences: "When a measure becomes a target, it ceases to be a good measure."[a] [a] https://en.wikipedia.org/wiki/Goodhart%27s_law

Some guy wrote a taxonomy of Goodhart's Law cases. This would be the "Adversarial Goodhart" case: "When you optimize for a proxy, you provide an incentive for adversaries to correlate their goal with your proxy, thus destroying the correlation with your goal." https://www.lesserwrong.com/posts/EbFABnst8LsidYs5Y/goodhart...

The first example on that page, "Regressional Goodhart", is totally wrong. If U measures V plus some noise X, assuming V and X form a bivariate normal distribution, then the conditional expectation of V is maximized by selecting the greatest U. In fact, the conditional expectation is linear in U.

Not sure how much stock I can put into the rest of the article given this. Goodhart's Law can seemingly only apply if the variables are highly non-normal, or are negatively correlated (e.g. worse doctors are more likely to refuse the difficult operations than good doctors).

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#114

Post by brandonmenc »

samfisher83 wrote: post #20

Sports athletes do this. For example players won't attempt end of the quarter half court shots since that will lower their percentages, or QBs taking sacks to not lower their QB ratings. What they do in sports is keep advanced stats. Instead of just giving a pure mortality rating have mortality rating, by surgery type.

Guarantee QBs are doing everything possible to avoid being sacked, and would gladly give up rating points in exchange for not being hit.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#115

Post by martyvis »

In Australia, we have a neurosurgeon Charlie Teo that is well known for operating on "inoperable" brain tumours. While he has a lot of respect in the general community, to many of his surgical peers he is seen as a reckless maverick. I would think his stats on average are bad, but because he will tackle outliers he has won the support of the people that matter - his patients.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#116

Post by Numberwang »

PerfectElement wrote: post #112
Numberwang wrote: post #45

It's sad to hear this when it's totally unnecessary. Hear disease has been a solved problem for decades. Just compare the rates of disease for vegans with the general population.

I wouldn't make blanket statements about a vegan diet because there are several types of diets that are compatible with a vegan lifestyle. I can eat Oreos and peanut butter all day and still be vegan. You must be referring to a whole food plant-based diet, which has been shown effective in the prevention and reversal of heart disease[1][2]. [1] https://www.ornish.com/wp-content/uploads/Intensive-lifestyl... [2] http:…

Yes, you are correct.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#117

Post by sowbug »

kazinator wrote: post #44
cs702 wrote: post #30

It's Goodhart's Law in action, this time with deadly consequences: "When a measure becomes a target, it ceases to be a good measure."[a] [a] https://en.wikipedia.org/wiki/Goodhart%27s_law

Low mortality is a good damned measure. I don't want to be operated on some yahoo surgeon who unconditionally operates regardless of risk and has a high mortality track record as a result.

You say that as if you had a choice. The point of the article is that you don't. That yahoo doctor is the only one willing to operate on you. The rest -- presumably the smart ones -- are playing the game to win, so they'll sit out this turn, because you're a bad bet.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#118

Post by smsm42 »

fc003153 wrote: post #73
cs702 wrote: post #30

It's Goodhart's Law in action, this time with deadly consequences: "When a measure becomes a target, it ceases to be a good measure."[a] [a] https://en.wikipedia.org/wiki/Goodhart%27s_law

I'm not so sure Goodhart's Law is correct. For example, if I target a high win percentage, is win percentage, then, not a good measure? Mortality rates are a pretty good measure for surgeons. The problem here is that they are inflating their measure by cherry picking. edit: Some measures should be targeted, the problem here is that it is done in an non genuine way

Goodhart law deals with proxies - i.e. measures not of direct target, which is hard to measure, but of something that is easy to measure, and you consider it related to the actual target. If you need wins and measure wins, wins are not a proxy and thus Goodhart law does not apply. But if, say, it were hard for you to count wins in soccer for some reason, and you measured time spent with the ball per player instead, thinking that if players own the ball all the time, they surely going to win eventually - you'd get a team that is engaged in pointless passing around instead of actually scoring goals.

For surgeons, the direct target is for the patient to get better - or at least live longer and with higher quality of life. Proxy is the measure of a mortality of a specific surgeon. It is not a direct target - as the surgeon can achieve zero mortality by not doing any surgery at all, but his patients would die of suffer from the lack of treatment.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#119

Post by iovrthoughtthis »

cs702 wrote: post #30

It's Goodhart's Law in action, this time with deadly consequences: "When a measure becomes a target, it ceases to be a good measure."[a] [a] https://en.wikipedia.org/wiki/Goodhart%27s_law

Came here to say this.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#120

Post by manigandham »

kazinator wrote: post #44
cs702 wrote: post #30

It's Goodhart's Law in action, this time with deadly consequences: "When a measure becomes a target, it ceases to be a good measure."[a] [a] https://en.wikipedia.org/wiki/Goodhart%27s_law

Low mortality is a good damned measure. I don't want to be operated on some yahoo surgeon who unconditionally operates regardless of risk and has a high mortality track record as a result.

The point is that if you are already dying then you would prefer the surgery instead of doing nothing. The doctors seem to have no problem with actually doing the work but don't like their stats ruined, which is rather disconcerting given the consequences.

Your comment also shows that patients are just as much of an issue by focusing on the metric more than the cases involved.

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