Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Can Good Doctors Be Bad for Your Health?

nytimes.com

Post reply on HN
Print view View original

41–50 of 73 posts

Re: Can Good Doctors Be Bad for Your Health?

#41

Post by nonbel »

pdonis wrote: post #30
nonbel wrote: post #9

Earlier quoted context omitted.

The authors suggest it is due to a reduced number of unnecessary treatments: >"Our results echo paradoxical findings documented during a labor strike by Israeli physicians in 2000, in which hundreds of thousands of outpatient visits and elective surgical procedures were cancelled, but by many accounts mortality rates dramatically fell during the year.27 Similar reports of decreased mortality during physician labor st…

> What they should have done is plot mortality by week so we can see if there is a sudden dip around the conference dates. Agreed, this would be a better test of what they are claiming.

The day of week probably matters as well. For example, the conferences will always span a weekend, giving a biased sample of days. I think it is a mistake to try interpreting this data without considering it as a timeseries.

Re: Can Good Doctors Be Bad for Your Health?

#43

Post by jlg23 »

lordCarbonFiber wrote: post #19
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 rat…

That. Exactly that. That goes so far that even when it is only the choice between the original pharmaceutical product and a generic, doctors will think twice out of fear to be sued if something goes wrong. I have one very scientifically inclined doctor in my family who fully understands that the chance of a generic being less effective is negligible. But, depending on the patient, she will prescribe the much more expensive original. Financially she does not profit from this at all, writing a prescription can be billed in her country but the height of the bill does not depend on the price of the prescribed medicine.

Re: Can Good Doctors Be Bad for Your Health?

#44

Post by conorh »

I've posted about this before - my wife is a highly specialized surgeon. This article really only scratches the surface of the issues with surgery around the US, as a software developer working in a pretty transparent and open industry I'm always horrified at how surgeons practice in the US. In my opinion the core of the problem is the lack of transparency in the entire system. There are just very few pressures for surgeons to really improve like they should have to. If, as a surgeon at a academic center, you want to just cruise along, no problem, you can just publish a few papers each year, be nice to patients, and you will be considered a leader in your field - even if you have terrible outcomes. There is little to no data out there to help patients objectively evaluate a surgeon, and to force surgeons to become better.

Speaking of things that I found strange - my wife was blown away at her current practice because for every operation they 'pair-surgeon' full time. This seemed very normal to me, but outside of surgeon training this is considered bizarre - when she tells other surgeons they ask her if it is something to do with billing! (it is not, they can't bill for the second surgeon). She loves it of course, it forces her to up her game and gives her someone she can bounce her thoughts off of during the surgery. I've asked her if she could go visit another surgeon in another facility somewhere and work along side them for a few days to learn, but because of the red-tape and state licensing, this is extremely difficult. The cross seeding of surgical expertise becomes glacially slow after your initial training in residency, you pretty much hope you were trained well and stumble along with a bit of help here and there.

Re: Can Good Doctors Be Bad for Your Health?

#46

Post by iheartmemcache »

palimpsests wrote: post #40
iheartmemcache wrote: post #26

Earlier quoted context omitted.

Medical doctors are like auto-mechanics or, to make a more HN-relatable comparison, software engineers trying to debug a program. Except there's a little more schooling, a lot more rigor with boards examinations, and you don't really have the full source-code available to debug. Just like in any profession, you're going to have crappy auto-mechanics who'll just pull up the ODB-II code and perform patch-work without r…

> a little more schooling ... after getting a bachelor's degree (3-5 years) a general practitioner takes at the bare minimum 7 years of schooling and internship. Surgeon far more than that. One can work as a professional software engineer without ever attending any university.

Yes, I do believe I addressed that-- "". (Though I'd argue a residency is far more time-intensive than a traditional "internship", and after you pass USMLE S3 you're a board-certified Medical Doctor until your 10 year card comes up)

My point was that you're going to have hacks at any sort of field which involves operational mechanics, or for that matter any craft that involves a mastery of a skill. I'm a life-long tennis player. Competent enough to hold my own against a recreational player pretty safely, but cognizant enough to know I'm not Roger Federer. If we were to graph any trade/craft/art/profession practitioner, I'd imagine "good" (for any metric of good) can be depicted by a normal Gaussian plot. You'll have geniuses, hacks, and average folk.

Re: Can Good Doctors Be Bad for Your Health?

#47

Post by wrsh07 »

Is it possible that top doctors are just taking on the most challenging cases?

The implicit "explanation" [which seems testable and currently unverified] is that senior cardiologists attempt more interventions [eg angioplasties], and each intervention carries some risk.

It could be true, but why report something that wasn't in the paper?

Re: Can Good Doctors Be Bad for Your Health?

#48

Post by aggieben »

doki_pen wrote: post #32
aggieben wrote: post #22

I really wish people would quit treating doctors as unquestionable authorities on health. Rather, they should be treated as consultants - expertise for hire - who should be able to give good answers to most questions, but should expect to have to defend their recommendations, and can sometimes be wrong.

Doctors act like authorities and get upset with patients when they disagree with treatment.

I don't keep asking for advice from those kinds of doctors.

Re: Can Good Doctors Be Bad for Your Health?

#49

Post by dbroockman »

conorh wrote: post #44

I've posted about this before - my wife is a highly specialized surgeon. This article really only scratches the surface of the issues with surgery around the US, as a software developer working in a pretty transparent and open industry I'm always horrified at how surgeons practice in the US. In my opinion the core of the problem is the lack of transparency in the entire system. There are just very few pressures for s…

Full transparency could have negative unintended consequences. For example, if surgeons knew their success rate were public, they would be incentivized to take easier cases. Who would take a difficult case if they knew it would constitute a bad mark on their record almost for sure?

Fundamentally, the issue is that it's impossible to observe for any given patient if that patient's outcome would have been better with a different surgeon. This is the same challenge we face with evaluating drugs: many more people who take aspirin survive than those who take anti-cancer drugs, but this likely reflects the kind of person who is taking each (people with headaches vs. people who have been diagnosed with cancer). To solve the problem there's no way around randomized trials. So, one idea would be to randomly assign patients to surgeons.

(Transparency might still be better on net, but important to keep these issues in mind.)

Re: Can Good Doctors Be Bad for Your Health?

#50

Post by TheCoelacanth »

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.

The gold standard for ethical behavior isn't to magically not let bias affect you when making decisions. It's to identify conflicts of interest and avoid them. Someone who knowingly allows a conflict of interest to exist is behaving unethically, no matter how hard they try to avoid letting their bias affect their decision.
Post reply on HN