3 ms·

> They are legally...bound to serve their patients. In the US, with the cost of attorney-mediated access to the judicial system, this is not really a protectiv

> They are legally...bound to serve their patients. In the US, with the cost of attorney-mediated access to the judicial system, this is not really a protective constraint for the bottom 90-95% of the population against exploitation by unethical medical providers. I'm interested in discussions about data transparency: anonymized, aggregated data about the patient population seen, the outcomes, and the amount spent, per doctor or set of doctors (if multiple specialists are seen). The former data set so doctors don't start cherry-picking for best outcome patients. The latter data set so doctors can start observing the average and median standard of care, and there is more uniformity of care across the field. At the moment, only the health insurance companies have access to this kind of data.

darkerside 8y ago
I don't agree. It is a protective constraint because of the legions of trial lawyers who are happy to bring a malpractice suit, albeit mostly for their own benefit and not the patient's, due in part to the general lack of financial awareness in the poor. It doesn't come close to making anybody whole when things go wrong, but the threat of litigation certainly modifies the way medicine is practiced.
- yourapostasy 8y ago
  > ...albeit mostly for their own benefit and not the patient's, due in part to the general lack of financial awareness in the poor. > It doesn't come close to making anybody whole when things go wrong... You are advocating that the system works for a value of "works" that rises above the hurdles of incentives where the minuscule fraction that trickles down to the patient and where "the way medicine is practiced" is a lucrative enough target for the expensive litigation. If you build software systems like you advocate for course corrections in medical practice, then you'd bin every trouble ticket until it came from a "big enough" customer with a "severe enough" problem. To each their own, but I'm personally in favor of granular, incremental changes that are more manageable and responsive to the market. Waiting for litigation to change medical practices is no different than ignoring a defect in the design, implementation, and testing phases of software, and letting users find it beat down your door before fixing it. US doctors largely won't even adopt checklists yet, despite proven efficacy. It is unacceptable to have to wait for future litigation to see it adopted in mainstream medical practice.
  - darkerside 8y ago
    I'm not saying it works. I said it operates as a protective constraint. The current system undeniably prevents some cases of medical malpractice. You're talking about repairing harm done, and I'm talking about preventing harm. For the record, I agree that there are many things that could be improved in the current medical system.
    - yourapostasy 8y ago
      Point taken, thanks. Litigation does have a preventative effect, but I only see its effects at a more macro, large-scale level, like removal of Vioxx from the market. We are lacking more effective micro, local-scale incentive mechanisms to effect change more incrementally instead of waiting for a generation of doctors to pass through, or for the nuclear blast from litigation to blunt-force change the medical landscape. Just as basic hygiene was the game changer for public health and increasing median lifespans in the past several centuries, I anticipate a smaller, basic change like checklists will in hindsight materially, beneficially alter medical cost and delivery outcomes. Own technical fields faces similar challenges, so this is I suspect a very human gap.

darkerside 8y ago

I don't agree. It is a protective constraint because of the legions of trial lawyers who are happy to bring a malpractice suit, albeit mostly for their own benefit and not the patient's, due in part to the general lack of financial awareness in the poor. It doesn't come close to making anybody whole when things go wrong, but the threat of litigation certainly modifies the way medicine is practiced.

yourapostasy 8y ago
> ...albeit mostly for their own benefit and not the patient's, due in part to the general lack of financial awareness in the poor. > It doesn't come close to making anybody whole when things go wrong... You are advocating that the system works for a value of "works" that rises above the hurdles of incentives where the minuscule fraction that trickles down to the patient and where "the way medicine is practiced" is a lucrative enough target for the expensive litigation. If you build software systems like you advocate for course corrections in medical practice, then you'd bin every trouble ticket until it came from a "big enough" customer with a "severe enough" problem. To each their own, but I'm personally in favor of granular, incremental changes that are more manageable and responsive to the market. Waiting for litigation to change medical practices is no different than ignoring a defect in the design, implementation, and testing phases of software, and letting users find it beat down your door before fixing it. US doctors largely won't even adopt checklists yet, despite proven efficacy. It is unacceptable to have to wait for future litigation to see it adopted in mainstream medical practice.
- darkerside 8y ago
  I'm not saying it works. I said it operates as a protective constraint. The current system undeniably prevents some cases of medical malpractice. You're talking about repairing harm done, and I'm talking about preventing harm. For the record, I agree that there are many things that could be improved in the current medical system.
  - yourapostasy 8y ago
    Point taken, thanks. Litigation does have a preventative effect, but I only see its effects at a more macro, large-scale level, like removal of Vioxx from the market. We are lacking more effective micro, local-scale incentive mechanisms to effect change more incrementally instead of waiting for a generation of doctors to pass through, or for the nuclear blast from litigation to blunt-force change the medical landscape. Just as basic hygiene was the game changer for public health and increasing median lifespans in the past several centuries, I anticipate a smaller, basic change like checklists will in hindsight materially, beneficially alter medical cost and delivery outcomes. Own technical fields faces similar challenges, so this is I suspect a very human gap.