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> ...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

> ...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'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.