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Speaking as someone whose father was a physician, I feel a few of your comments are unfounded. Generally, I think there must be a way to hold most problematic
by studentrob 10y ago
Speaking as someone whose father was a physician, I feel a few of your comments are unfounded.
Generally, I think there must be a way to hold most problematic doctors accountable while not causing excessive burdens for most good doctors. Also, any system will not be perfect, and the goal should be to maximize the health of most patients.
> it's a problem of "business as usual." It's a thousand doctors following procedures with a 0.1% error rate and 999 thinking, "nothing bad's happened to me so I must be doing everything fine,"
I see no evidence of this, and I doubt you have the audacity to say this in the presence of your own physicians.
> they could each reduce that to a 0.001% error rate with a simple checklist or by actually washing their hands
I'm not sure where you live where doctors do not wash their hands, or how you know that they do not, but wherever I have been, doctors wash their hands vigorously. Infection in hospitals is common. Everything needs to be super sterile. It's more than just washing hands. Everything needs to be packaged air tight and used once in one part of the body, and then thrown away. It's already much more involved than you're suggesting.
Doctors complete between 11 and 16 years of training [1]
Doctors spend an average of 60 hours working per week. They work on average 1.5 times more than the average American [2]
Doctors have too many patients and too little time.
They are already well educated and don't have time for checklists to remind them of every little detail they learned during their 10-year long training program. They don't sleep much and don't get paid very well for the debt that they incur.
Many doctors got into the field because they want to help people.
My father was a physician until 2004ish, and the stress induced by bureaucracy nearly killed him. He was a great doctor. You're suggesting making the system more complex. I'm saying, that's going to make patient care worse, not better.
If you choose to look only at court cases and do not read medical research, then trust is required in this system. Any procedural changes should be vetted by researchers using the scientific method, not bureaucrats who seek to make unscientific sweeping changes based on anecdotes to further their own political careers.
> Put another way, if you put someone's life in your hands and you're not focusing a significant percentage of your efforts on procedures designed to radically reduce risk, then you're engaged in gross negligence.
This is the job of a doctor. They focus on reducing risks to your health.
The solution isn't to add arbitrary checklists and make doctors more busy. The solution is to use the scientific method to add doctors, make our population healthier and capable of maintaining their own health, and reduce the load of patients per doctor.
> So my medical malpractice reform would make medicine more like other industries with far better safety records. It would include a requirement that hospitals post their mistakes on their front door as people walk in.
At first you argue against tort reform and then you argue for it.
I think things like Zocdoc will help good doctors be recognized and allow patients to self select their level of care. Reviews are just one thing. It's a complicated system that needs to balance many factors in order to maximize patient health.
[1] https://www.google.com/search?client=ubuntu&channel=fs&q=how+long+do+doctors+go+to+school&ie=utf-8&oe=utf-8 https://www.google.com/search?client=ubuntu&channel=fs&q=how...
[2] https://www.google.com/search?safe=off&client=ubuntu&hs=o9p&channel=fs&q=how+many+hours+do+doctors+work&oq=how+many+hours+do+doctors+work https://www.google.com/search?safe=off&client=ubuntu&hs=o9p&...
- IndianAstronaut 10y ago>Doctors have too many patients and too little time. Thanks in part to artificial caps by the AMA.
- firebones 10y ago> They are already educated and don't have time for checklists to remind them of every little detail they learned during their 10-year long training program. Medicine is not a static field. Evidence-based guidelines and checklists save time, money and lives. Time: because over-worked docs already have a hard time keeping up with new standards and guidelines. Money: because best practices reduce errors and poor outcomes, and ultimately reduce malpractice premiums. Lives: because good medicine is based on evidence that reduces harm, and not based statically on what was learned at the start of a career. If you want to hold the most problematic doctors accountable, do away with the tort reform that protects them. The faster the incompetents are driven out (and not just relegated to a state with lower standards and more protection), the better we'll all be. Overwork contributes to all kinds of problems, but it's not an excuse to avoid practices shown to produce better outcomes. It's roughly equivalent to a coder saying "I shouldn't have to run unit tests because I'm already working 60 hours a week and have 16 years of experience, and I got into this field because I like to write code." There are other ways to attack the cost of education and the doctor supply, but they are slow to gain traction because of professional protectionism.
- stanleyt 10y agoAre you familiar with the work of Atul Gawande (a surgeon) and related work around checklists? [1] I would highly recommend you take a look at those and see if you still feel the same way about checklists. They are not about minimizing physicians' training & expertise. They're about procedural rigor, process standardization, and reducing inevitable human error. They're about shifting mental loads away from "rote" or "routine" tasks which are amenable to checklists and instead over to those complex thought processes that really need the specialized years of training. I don't think people are trying to suggest doctors are maliciously saying "XYZ error rate is good enough, we don't need to do better", but more that there is some ego at play in the reactionary shunning of checklists, when in fact checklists can be a relatively easy way to produce better outcomes. [1] http://www.nature.com/news/hospital-checklists-are-meant-to-save-lives-so-why-do-they-often-fail-1.18057 http://www.nature.com/news/hospital-checklists-are-meant-to-...