Heart surgeons refuse difficult operations to avoid poor mortality ratings • Hacker News Board

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

#171

Post by walshemj » Sat, Apr 21, 2018, 9:27 PM UTC

killjoywashere wrote: post #52

walshemj wrote: post #33

Earlier quoted context omitted.

Do not Doctors Surgeons disclose the potential errors and things that might go wrong in the US? I have had several ops in the last 18 months in the UK and they always go though what can go wrong and tell you the odds.

There's generally a consent process but the patient is often in no position to decline or comprehend what they're signing. In the case of heart surgery, or even a catheterization procedure, they may not be conscious to consent.

Well when I had my ops they always (in the UK) go through what can go wrong and the odds - my major one had a long list of possible outcomes the surgeon (cheerfully ) ended on 1/5000 chance of death.

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

#172

Post by jpatokal » Sat, Apr 21, 2018, 9:36 PM UTC

finaliteration wrote: post #167

emodendroket wrote: post #103

Earlier quoted context omitted.

When I was fresh out of a school I worked in a call center for a while. One of the most important metrics (and everything you did was measured) was the average length of each call. So it was common practice, when you got cases that basically were going to be long calls or ones you probably couldn't actually resolve (e.g., "I want the service back on but cannot pay"), to deliberately upset the customers so that they w…

I worked in a call center, as well, but they didn’t prioritize call length as a metric/KPI. Their number one KPI was “first call resolution”, meaning even if it took an hour as long as the problem was resolved the call was considered a success. I feel like it was a much healthier way to measure call center performance.

One support team I used to work with prioritized "first touch resolution" for email cases as well, so the agents would answer every case with a 16-page DYI flowchart listing every single possible problem and its resolution. KPIs are hard...

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

#173

Post by zzbzq » Sat, Apr 21, 2018, 9:48 PM UTC

narrator wrote: post #53

They need to add a difficulty correlated metric to the statistics. Maybe BMI and age? I am sure IVF clinics wouldn't offer the procedure to anyone over 35 if the rather detailed statistics they are required to report didn't also include the patient's age.

Rather than try to figure out some classification criteria, use a predictions market.

Have surgeons predict their own chance of success. Preferably, gather multiple second++ opinions for each case.

The difficulty of the surgery is based on some combination of the different surgeon's predictions.

A surgeon's stats would then be based on his successful and unsuccessful surgeries, weighted against the difficulty.

Using this method, not only can you still rank the surgeons based on the successes of their surgeries, but also on the accuracy of their predictions, which will be in larger sample size and also perhaps a better indicator of their mastery of medical knowledge.

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

#174

Post by dfox » Sat, Apr 21, 2018, 9:53 PM UTC

JulianMorrison wrote: post #96

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

That only really applies when you're measuring side effects though, and not the actual thing intended. In this case they should have had a metric that took into account the estimated prior probability of a good outcome given an ordinary surgeon.

The problem is that in many cases, including this, you cannot directly measure the intended thing in any meaningful way. Your example is just another indirection which is still certainly somewhat playable and in addition involves estimation from insufficient input data (also known as guessing ;)).

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

#175

Post by viraptor » Sat, Apr 21, 2018, 9:54 PM UTC

tajen wrote: post #154

emodendroket wrote: post #101

Earlier quoted context omitted.

Perhaps the patient should have the right to decide what that threshold is for themselves rather than having the information hidden from them.

It’s a known Freakonomics effect that doctors treat themselves much less in case of cancer. They don’t want to just prolong their life if it’s only going to be painful longer, because they know the probabilities and the outcomes better.

> because they know the probabilities and the outcomes better.

Probabilities and outcomes, or the process? Patients do get pretty good estimates and information these days. They don't have a good idea what chemo feels like though and what people think about the side effects. Doctors get that from seeing their patients.

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

#176

Post by Retra » Sat, Apr 21, 2018, 10:09 PM UTC

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.

Some doctors have high mortality records because they specialize in treating deadly diseases. And you'd rather be treated by a doctor who has only ever treated non-fatal ones? Well, that'll work if you never have anything worse than a common cold.

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

#177

Post by dfox » Sat, Apr 21, 2018, 10:11 PM UTC

skookumchuck wrote: post #84

One possibility is to offer the surgeons more money for difficult surgeries, and more money for a successful outcome, to balance out the reputational risk to the surgeon.

How do you estimate the difficulty in a way that does not involve wrong incentives on the part of the surgeon or whoever is doing the estimation when money is involved?

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

#178

Post by viraptor » Sat, Apr 21, 2018, 10:15 PM UTC

salawat wrote: post #60

loceng wrote: post #32

Earlier quoted context omitted.

Yes, the system is horrendous and broken. There should be complete oversight and full transparency for self-regulation purposes, which includes ongoing learning and education, and get lawyers involved once the self-regulating is found to be inadequate - such as a surgeon who repeatedly makes the same mistakes and hasn't bothered to learn or care to improve their skills, or prevented from continuing. From my own strug…

This is one thing that still amazes me to this day. It's like doctor's stop thinking after they get their degree. Whenever I've visited a doc within the past few years I have noticed that instead of actually getting to know someone as a patient, many act as if they are a quick reference book. This is especially horrifying when you consider that there is a non-trivial portion of the population that exist outside of th…

> Nowadays, I'm usually making Doctors aware of advancements in their field... Scary stuff.

Are you taking about your cases? Because keeping on top of the narrow score that's currently relevant to you is a different level of time investment than keeping on top of everything happening in the field, after already learning a large part of it, and keeping in mind current treating guidelines which lag behind research.

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

#179

Post by viraptor » Sat, Apr 21, 2018, 10:19 PM UTC

trumped wrote: post #46

Mononokay wrote: post #43

Earlier quoted context omitted.

"I don't appreciate the service they provide and they're terrible people !!!" "Okay, we won't serve you if you're just going to trash us." "EVIL HOW DARE YOU!"

I meant if you left a bad review somewhere else... Of course someone should not go back where they don't like to go....

That only works if you have more than one choice available.

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

#180

Post by jack9 » Sat, Apr 21, 2018, 10:25 PM UTC

calcifer wrote: post #143

2skep wrote: post #102

What would you prefer? A surgeon who expects a poor outcome of your surgery: a)decides to not operate on you? b)decides to operate on you nonetheless? I am in camp a

I'm definitely in camp B. 90% chance of dying on the table beats a 100% chance of dying without the surgery, every single time.

Quality of life matters in most of these marginal cases. If they are going to give you the Konno procedure (scrape extra tissue out of a thickened ventricle), there's tons of things that can go wrong OTHER than death. Death is assured, either way, for everyone.