6 ms·

When you want to race automobiles but you aren't an F1 driver there are leagues that will accommodate you. But not everyone is equally rich. How do you ensure

When you want to race automobiles but you aren't an F1 driver there are leagues that will accommodate you. But not everyone is equally rich. How do you ensure that it's driving skill that determines the winner, rather than who is willing to spend more money on a better car? You make a rule that says there are no rules about how much a car can cost, but that anyone can buy the winner's car at the end of a race for $X. I can't help but think that a similar law might not be helpful. Make doctors and hospital administrators randomly subjected to these devices in a mostly-not-invasive procedure where sterile water is flown over the devices and then onto a finger-prick. In both cases making people have true skin-in-the-game is the solution to the problem.

knolax 7y ago
So now we have filthy instruments and dead doctors?
- msandford 7y ago
  Because the doctors are unable to influence the policies and procedures of the places they work? If anyone can affect change in a hospital it's the doctors.
  - rscho 7y ago
    You obviously are not working in healthcare, to say that.
the_pwner224 7y ago
That would have potentially serious permanent and irreversible consequences. It's much different from losing $200k by having to sell your car at the end of the race. And there are various factors that affect the sterility of the instruments, some of which are out of the doctors' control. It is not OK to give a doctor HIV just because the maintenance people didn't service the machine correctly, causing it to output clean-looking but infected instruments.
- msandford 7y ago
  But it's OK to do that to a patient because "reasons"? Why are the doctors more important than the patients? The harm to patients is serious, permanent and irreversible too. Your argument doesn't seem to make sense to me.
  - a_t48 7y ago
    The argument is that it's not okay to do in either case, I believe. There's a risk in either case, but the possible exposure to patients is necessary (they need a possibly life saving procedure), whereas the risk to doctors is not necessary (they don't need to be cut open). You'd have to prove that increasing the risk of doctor infection would lead to a lower rate of patient infection. That seems unlikely, just from the fact that the doctor himself could be a vector for infecting a patient. You're also endangering anyone else the doctor comes in contact with in their personal life.
    - msandford 7y ago
      > You'd have to prove that increasing the risk of doctor infection would lead to a lower rate of patient infection. The point isn't to infect doctors. The point is to make them (potentially) subject to the tools they're about to use as a way to ensure that they are sufficiently involved in designing and overseeing the systems that ultimately move the needle on patient outcomes. When things are done sufficiently well these kinds of steps aren't necessary. We don't make the engineering team that designs a bridge walk/drive across it first because bridges have an exceedingly low failure rate and the failures that do happen aren't infant mortality (you designed it wrong) they're old (you maintained it wrong).
- DoctorOetker 7y ago
  So who is best positioned to know which factors are out of the doctor's control? a tax payer? or the doctor? this system would in fact quickly result in attention to these factors out of their control. a lot of people think increased discussion means bad news it's not because a measure increases the amount of discussion that it can't be a good measure, if it helps unearth the actual problems
wilg 7y ago
This is a fantastic idea and is the same principle behind NASA's policy of tossing a pseudorandomly selected aerospace engineer's child into the space shuttle before each liftoff to improve reliability.
- DoctorOetker 7y ago
  Before rockets, people thought cannon would enable space travel (think Jules Vernes). And in medieval times, to prevent corruption by unscrupulous cannon builders from building impressive but unreliable cannons (which tended to explode, just like rockets), the cannon builder had to sit on the cannon for the demonstration firing. The GP's proposal, while a bit over the top, would actually at least change the coffee talk between doctors from flaunting their last acquisitions (boats, cars, ...) back to medicine... if it would ever be put into practice. Suddenly they would conjure myriads of verification systems to ensure for example that their employer or stock manager wasn't secretly recycling disposables and having them repackaged... Edit: spelling correction, thank you
  - wilg 7y ago
    I can think of lots of systems that would theoretically have a minor positive effect at great ethical and human cost. That is not helpful! Also, the way you're talking about seems super dismissive of these people, so it seems a lot more like a fancy way of saying you don't like or value doctors than a useful discussion. Also, you seem to know a lot about cannons but not how the word is spelled.
    - DoctorOetker 7y ago
      my prejudice is not so much against doctors, but more against surgeons, FYI
      - wilg 7y ago
        It's good to admit that, thanks! I do think it's probably easier to come up with solutions in this space checking that bias more carefully.
serf 7y ago
I think that you're talking about the Lemons races. To be clear -- this mechanic (forced sale of vehicle) is not common in auto-racing. Very few sanctioning bodies do this, and they're all bottom-barrel (funding wise) groups like the Lemons endurance events or derby-style cars that aren't expected to have any longevity, anyway. Also, that mechanic has been cheated numerous times. Since the Lemons series doesn't hold the car in escrow or in any other financially or legally binding manner it's up to the seller to be polite and abide by the rules. Plenty of people haven't. They're not usually welcomed back as drivers', they just move to another team and cheat there, instead. The real way to do what you're trying to achieve (create a fair place for those with limited budget to compete in) in automobile racing is by strict classing rules and strict scrutineering. A good example of this is SCCA Solo autocross racing. It's extraordinarily cheap to compete in, and highly competitive. This is achieved through strict rules, tons of bureaucracy, and the threat of tattle-tales in the form of competing teams or drivers. I don't know how that moral can be related back to surgery, but I do believe the Lemons' style of fairness-by-threat-of-sale is flawed.
- msandford 7y ago
  It's fairness by having to put your money where your mouth is. Do you attest that your car didn't cost more than $5k? OK great! Sell it for that. Do you as an administrator attest that the instruments are clean? Perfect! We're going to use them on you. Doctor, would you be willing to have this knife used on yourself? No? Well who better to get to the bottom of the problem than the people who can grind a hospital to a halt?
msandford 7y ago
Seems like some folks have missed the point. The idea isn't "hey let's infect doctors because it's their fault!" It is self-evident that enough care is not currently taken on washing instruments. Or else we wouldn't hear about these kinds of things. If instrument washing was 99.9999% effective there wouldn't be a problem needing solving. So what kind of feedback mechanism would be strong enough to get the doctors and hospital administrators to really be interested in the absolute level of quality of the cleaning and sterilization process? I don't know for sure, but I can say that anything that ties people's own personal outcomes to those of the folks they're supervising tends to get better results. I (obviously?) don't want doctors or administrators to get horrible diseases for fun. What I want is for them to exercise an appropriate level of oversight and care. I went to school for Electrical Engineering and while doing so I heard stories about people that went to work for GE designing things for MRI machines. Those people then were the first ones who had to test out the machines as people before they were allowed to be used on other people. I can't help but think that this kind of a policy makes people willing to double, triple and quadruple check their work when their own lives are on the line. Similarly by making the people who should be exercising significant oversight (but seemingly aren't) subject to the results of the processes that they have designed it's very, very likely that they will do all the things that they need to do in order to ensure that their outcomes will be what we all expect: boring. That might mean that pay has to go up, or that minimum cleaning times need to be specified or that better inspection methods need to be utilized or any one of another dozen things. If a doctor wouldn't be willing to use an instrument on themselves that they're going to use on another person I have a hard time understanding how they are adhering to their oath of "first do no harm" and I can't help but feel that anyone managing doctors should be similarly bound.
- Frqy3 7y ago
  From the article, it sounds like the surgeons are already well aware of the risk from improper cleaning, but don't care enough to push for a systemic solution, instead relying on "workarounds" when it is their own family member under the knife. > Except when an important person or a doctor’s family member is on the table, that is. “They call and say, ‘Dr. Jones’ wife is having surgery,’”
jacobwilliamroy 7y ago
I always thought the mechanics were competing, not the racers. Tv stations try to hype up drivers but I just find the racing really boring to watch. However, engineering a car that goes really, reallly, reallllly fast is something I get a lot of amusement from observing. So randomly forcing teams to be separated from their cars seems almost cruel. Like, how do we even know that the buyer has the expertise to maintain it or make it go faster? What if they can't even comprehend the technology, so they just run it till it breaks and then toss it on the scrap heap?
- redis_mlc 7y ago
  Michael Schumacher was said to be one 1 second faster than any other driver. To beat him, you would need a new engine designed and built (about $500 million.) Danica Patrick won a single race (Japan) in her career of 116 IndyCar races and was eventually "retired" because she couldn't win often enough.
jessaustin 7y ago
There seems to be some argument about how common this is for auto racing, but a similar scheme is the foundation of horse racing. Most thoroughbred races in USA (but essentially none of the ones you see on network TV) are "claiming" races. Any particular claiming race has a particular claiming price, e.g. $10,000. Before the race is run, any licensed trainer with sufficient money in his account for the deposit may claim any horse in the race. If the horse starts the race, it belongs to that trainer (or some other owner whom she or he represents) at the end of the race. That's true no matter how the horse performs or even if it survives the race. This complicated scheme is used in order to ensure relatively balanced fields, which is important for wagering. If favorites are too heavily favored, then no one will bet. So, you can enter a horse worth $25k in a $10k claiming race, and you'll have a great chance of winning, but you'll also have a great chance of selling your horse for much less than it's worth. The concept of "skin in the game" is fine, but I'm not sure this cascading infection scheme is the way to go. For one thing, physicians are rarely in charge of cleaning equipment. They have other expertise.
- oh_sigh 7y ago
  What happens if multiple people claim the same horse?
  - jessaustin 7y ago
    The racing office performs a "shake", which is pouring numbered beads out of a bottle, to randomly choose one.

knolax 7y ago

So now we have filthy instruments and dead doctors?

msandford 7y ago
Because the doctors are unable to influence the policies and procedures of the places they work? If anyone can affect change in a hospital it's the doctors.
- rscho 7y ago
  You obviously are not working in healthcare, to say that.

the_pwner224 7y ago

That would have potentially serious permanent and irreversible consequences. It's much different from losing $200k by having to sell your car at the end of the race. And there are various factors that affect the sterility of the instruments, some of which are out of the doctors' control. It is not OK to give a doctor HIV just because the maintenance people didn't service the machine correctly, causing it to output clean-looking but infected instruments.

msandford 7y ago
But it's OK to do that to a patient because "reasons"? Why are the doctors more important than the patients? The harm to patients is serious, permanent and irreversible too. Your argument doesn't seem to make sense to me.
- a_t48 7y ago
  The argument is that it's not okay to do in either case, I believe. There's a risk in either case, but the possible exposure to patients is necessary (they need a possibly life saving procedure), whereas the risk to doctors is not necessary (they don't need to be cut open). You'd have to prove that increasing the risk of doctor infection would lead to a lower rate of patient infection. That seems unlikely, just from the fact that the doctor himself could be a vector for infecting a patient. You're also endangering anyone else the doctor comes in contact with in their personal life.
  - msandford 7y ago
    > You'd have to prove that increasing the risk of doctor infection would lead to a lower rate of patient infection. The point isn't to infect doctors. The point is to make them (potentially) subject to the tools they're about to use as a way to ensure that they are sufficiently involved in designing and overseeing the systems that ultimately move the needle on patient outcomes. When things are done sufficiently well these kinds of steps aren't necessary. We don't make the engineering team that designs a bridge walk/drive across it first because bridges have an exceedingly low failure rate and the failures that do happen aren't infant mortality (you designed it wrong) they're old (you maintained it wrong).
DoctorOetker 7y ago
So who is best positioned to know which factors are out of the doctor's control? a tax payer? or the doctor? this system would in fact quickly result in attention to these factors out of their control. a lot of people think increased discussion means bad news it's not because a measure increases the amount of discussion that it can't be a good measure, if it helps unearth the actual problems

wilg 7y ago

This is a fantastic idea and is the same principle behind NASA's policy of tossing a pseudorandomly selected aerospace engineer's child into the space shuttle before each liftoff to improve reliability.

DoctorOetker 7y ago
Before rockets, people thought cannon would enable space travel (think Jules Vernes). And in medieval times, to prevent corruption by unscrupulous cannon builders from building impressive but unreliable cannons (which tended to explode, just like rockets), the cannon builder had to sit on the cannon for the demonstration firing. The GP's proposal, while a bit over the top, would actually at least change the coffee talk between doctors from flaunting their last acquisitions (boats, cars, ...) back to medicine... if it would ever be put into practice. Suddenly they would conjure myriads of verification systems to ensure for example that their employer or stock manager wasn't secretly recycling disposables and having them repackaged... Edit: spelling correction, thank you
- wilg 7y ago
  I can think of lots of systems that would theoretically have a minor positive effect at great ethical and human cost. That is not helpful! Also, the way you're talking about seems super dismissive of these people, so it seems a lot more like a fancy way of saying you don't like or value doctors than a useful discussion. Also, you seem to know a lot about cannons but not how the word is spelled.
  - DoctorOetker 7y ago
    my prejudice is not so much against doctors, but more against surgeons, FYI
    - wilg 7y ago
      It's good to admit that, thanks! I do think it's probably easier to come up with solutions in this space checking that bias more carefully.

serf 7y ago

I think that you're talking about the Lemons races. To be clear -- this mechanic (forced sale of vehicle) is not common in auto-racing. Very few sanctioning bodies do this, and they're all bottom-barrel (funding wise) groups like the Lemons endurance events or derby-style cars that aren't expected to have any longevity, anyway. Also, that mechanic has been cheated numerous times. Since the Lemons series doesn't hold the car in escrow or in any other financially or legally binding manner it's up to the seller to be polite and abide by the rules. Plenty of people haven't. They're not usually welcomed back as drivers', they just move to another team and cheat there, instead. The real way to do what you're trying to achieve (create a fair place for those with limited budget to compete in) in automobile racing is by strict classing rules and strict scrutineering. A good example of this is SCCA Solo autocross racing. It's extraordinarily cheap to compete in, and highly competitive. This is achieved through strict rules, tons of bureaucracy, and the threat of tattle-tales in the form of competing teams or drivers. I don't know how that moral can be related back to surgery, but I do believe the Lemons' style of fairness-by-threat-of-sale is flawed.

msandford 7y ago
It's fairness by having to put your money where your mouth is. Do you attest that your car didn't cost more than $5k? OK great! Sell it for that. Do you as an administrator attest that the instruments are clean? Perfect! We're going to use them on you. Doctor, would you be willing to have this knife used on yourself? No? Well who better to get to the bottom of the problem than the people who can grind a hospital to a halt?

msandford 7y ago

Seems like some folks have missed the point. The idea isn't "hey let's infect doctors because it's their fault!" It is self-evident that enough care is not currently taken on washing instruments. Or else we wouldn't hear about these kinds of things. If instrument washing was 99.9999% effective there wouldn't be a problem needing solving. So what kind of feedback mechanism would be strong enough to get the doctors and hospital administrators to really be interested in the absolute level of quality of the cleaning and sterilization process? I don't know for sure, but I can say that anything that ties people's own personal outcomes to those of the folks they're supervising tends to get better results. I (obviously?) don't want doctors or administrators to get horrible diseases for fun. What I want is for them to exercise an appropriate level of oversight and care. I went to school for Electrical Engineering and while doing so I heard stories about people that went to work for GE designing things for MRI machines. Those people then were the first ones who had to test out the machines as people before they were allowed to be used on other people. I can't help but think that this kind of a policy makes people willing to double, triple and quadruple check their work when their own lives are on the line. Similarly by making the people who should be exercising significant oversight (but seemingly aren't) subject to the results of the processes that they have designed it's very, very likely that they will do all the things that they need to do in order to ensure that their outcomes will be what we all expect: boring. That might mean that pay has to go up, or that minimum cleaning times need to be specified or that better inspection methods need to be utilized or any one of another dozen things. If a doctor wouldn't be willing to use an instrument on themselves that they're going to use on another person I have a hard time understanding how they are adhering to their oath of "first do no harm" and I can't help but feel that anyone managing doctors should be similarly bound.

Frqy3 7y ago
From the article, it sounds like the surgeons are already well aware of the risk from improper cleaning, but don't care enough to push for a systemic solution, instead relying on "workarounds" when it is their own family member under the knife. > Except when an important person or a doctor’s family member is on the table, that is. “They call and say, ‘Dr. Jones’ wife is having surgery,’”

jacobwilliamroy 7y ago

I always thought the mechanics were competing, not the racers. Tv stations try to hype up drivers but I just find the racing really boring to watch. However, engineering a car that goes really, reallly, reallllly fast is something I get a lot of amusement from observing. So randomly forcing teams to be separated from their cars seems almost cruel. Like, how do we even know that the buyer has the expertise to maintain it or make it go faster? What if they can't even comprehend the technology, so they just run it till it breaks and then toss it on the scrap heap?

redis_mlc 7y ago
Michael Schumacher was said to be one 1 second faster than any other driver. To beat him, you would need a new engine designed and built (about $500 million.) Danica Patrick won a single race (Japan) in her career of 116 IndyCar races and was eventually "retired" because she couldn't win often enough.

jessaustin 7y ago

There seems to be some argument about how common this is for auto racing, but a similar scheme is the foundation of horse racing. Most thoroughbred races in USA (but essentially none of the ones you see on network TV) are "claiming" races. Any particular claiming race has a particular claiming price, e.g. $10,000. Before the race is run, any licensed trainer with sufficient money in his account for the deposit may claim any horse in the race. If the horse starts the race, it belongs to that trainer (or some other owner whom she or he represents) at the end of the race. That's true no matter how the horse performs or even if it survives the race. This complicated scheme is used in order to ensure relatively balanced fields, which is important for wagering. If favorites are too heavily favored, then no one will bet. So, you can enter a horse worth $25k in a $10k claiming race, and you'll have a great chance of winning, but you'll also have a great chance of selling your horse for much less than it's worth. The concept of "skin in the game" is fine, but I'm not sure this cascading infection scheme is the way to go. For one thing, physicians are rarely in charge of cleaning equipment. They have other expertise.

oh_sigh 7y ago
What happens if multiple people claim the same horse?
- jessaustin 7y ago
  The racing office performs a "shake", which is pouring numbered beads out of a bottle, to randomly choose one.