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Why Some Doctors Purposely Misdiagnose Patients

201 points by rrauenza 7y ago

eigen 7y ago
A: $
Iv 7y ago
Could we add "in the US" to the medical news that may not be that relevant in other countries?
- nosianu 7y ago
  Here in Germany we occasionally have similar headline making cases and scandals. We also have similar incentives, since how you make money as a doctor is the same basic principle.
- elevenoh 7y ago
  The incentives are fked in canada as well. More, short visits that align with high cost billing codes. And a high % of doctors are walking medical maladies themselves that don't read research studies even in their own field. Simply focused on bill high, follow procedural algorithm, don't lose job/get sued.
- chimeracoder 7y ago
  > Could we add "in the US" to the medical news that may not be that relevant in other countries? The incentives are misaligned in many other countries, including Germany and the UK. This article focuses on examples in the US, but as noted elsewhere in these comments, there are plenty of articles that show examples of similar perverse treatment incentives in other countries.
  - socialdemocrat 7y ago
    Except nowhere are the incentives as screwed up as in the US. Sure a doctor does have a financial incentive to not always do what is best for you anywhere in the world. But in most places this concern competes strongly with a sense of moral duty. In the US you have companies which have no scrupulous because they don't see or know the patients they screw over, actively push and incentives doctors to work against the interests of their patients. The prevalence of companies paying doctors to prescribe certain pills or suggest certain procedures seem to me more of an American problem. At least in my home country I highly doubt such an arrangment would even be legal. I mean this just fits in with the opioid crisis in the US. Where medical companies would basically send young prostitutes to doctors to try to persuade them to push their drugs. Yes this is a fact. These companies hired young pretty women, which frequently slept with the doctors they were supposed to influence. The companies made billions while patients died left and right from their drugs. I cannot think of anywhere in the developed world where anything remotely as horrible has been going on in the health care sector. While everybody has challenges in their health care sector, everything pales compared to what is going on in the US. Greed as completely taken over.
- jmkni 7y ago
  We had a similar case recently in Northern Ireland, a Neurologist who performed hundreds of needless procedures, and that was under the NHS so ¯\_(ツ)_/¯ - https://www.bbc.co.uk/news/uk-northern-ireland-50481781 https://www.bbc.co.uk/news/uk-northern-ireland-50481781
coder1001 7y ago
Your typical case of measuring a doctor's success by the number of EGGs and the likes that his patients do! Wrong incentives = unexpected outcomes!
- voiper1 7y ago
  Seems similar (or the same as) the cobra effect https://en.wikipedia.org/wiki/Cobra_effect https://en.wikipedia.org/wiki/Cobra_effect
- thepete2 7y ago
  Similar to Goodhart's law: When a measure becomes a target it ceases to be a good measure [0]. You see it everywhere and it usually happens when we try to quantify a quality (like "competence"...) [0] https://en.wikipedia.org/wiki/Goodhart%27s_law https://en.wikipedia.org/wiki/Goodhart%27s_law
r_singh 7y ago
The medical industry has the biggest conflict of interest I have seen in any industry. It's actually bad for doctors if preventive healthcare takes off the way it should, we all eat healthy, balanced diets and exercise to take care of our bodies and mind. That coupled with genetic diversity, ignorance of their customers and relative ignorance of the practitioners itself (we still don't know more than we know) could truly be a recipe for disaster. My celiac was misdiagnosed for pharyngitis for long, and since I've stopped taking any doctor very seriously. I read A LOT, visit a bunch of doctors (preferably leading to specialists) and ask a lot of questions before deciding what course of action I want to take. Luckily, in India, doctors don't charge as much (~$20-40) per session.
- xiaq 7y ago
  > The medical industry has the biggest conflict of interest I have seen in any industry. It's actually bad for doctors if preventive healthcare takes off the way it should, we all eat healthy, balanced diets and exercise to take care of our bodies and mind. Not in countries with a national health system, where the government is incentivized to keep people healthy in order to reduce cost.
  - r_singh 7y ago
    Haven't experienced this so don't know as much, but yes, does make sense (in theory, at least).
  - catalogia 7y ago
    The government may have that incentive, but what about the individual doctors who are actually examining patients and diagnosing people? Do these employees truly share their employer's desire to cut costs? I don't really believe that doctors are keeping people sick on purpose to keep demand for their profession high, but if that were going on, I don't think socialized healthcare would necessarily erase that incentive. There are plenty of government and private sector workers who try to preserve their own jobs to the detriment of the whole.
    - 7y ago
jonplackett 7y ago
TLDR; Money
elevenoh 7y ago
I for one cannot wait for my ai primary physician.
- rahuldottech 7y ago
  Sure. Until the AI makes mistakes and you get seriously harmed but you find that you can't really blame anyone because you were warned not to blindly trust the AI in the ToS.
  - elevenoh 7y ago
    Run it though a consortium of privacy-preserving, for profit ai at low cost vs. a set of humans? I know which I'd choose. If warning or outlier condition identified, double check w/ alternative means if sought.
- tomerico 7y ago
  And who would pay for that AI physician? Hospitals and other for profit corporation. It’s hard to believe that a less transparent, more centralized system could only have positive effects. The problem is in the US incentive structure, not with the doctors.
  - elevenoh 7y ago
    A for profit company out of X. For some co's the data may be worth making it free.
- mikecsh 7y ago
  Great! Let me hook you up with the latest medical AI technology. Actually, let me hook you up with all of the latest medical AIs, throw your symptoms at them and let them treat all you ailments. And add to that, all the latest medical robotics, and we'll take the surgeons and intensivists, interns, and nurses away. Good luck with that, I'm sure you will be much happier and healthier when the current AI tries to decide whether you are acutely dying of hypercalcaemia or a cardiac tamponade and Marshalls the robots to save you. \s For all the faults and failings of doctors (read: humans), I find many Hacker Newsers vastly oversimplify what doctors do and vastly overinflate what AI is able to do now, or will be able to do in the next ten, twenty, or even 30 years. It's great that we not have some AI that can diagnose a stroke better than a radiologist on a CT scan. But it can't tell you the scan also shows a space occupying lesion. Or hydroencephaly. Or an extra dural haematoma. Or any other intracranial pathology. And that's about the state of the art. I welcome new diagnostic aids as I think most clinicians do, but I would take the fleshy system we have of human healthcare providers and suspect that will be the case for a good while yet. Disclaimer: am doctor and engineer
vivekd 7y ago
I was keeping an open mind about this doctor, until I read that two other doctors were willing to testify they had thought he was misdiagnosing patients. Its notoriously hard to get doctors to testify against each other at a malpractice case and the fact that doctors who worked with him were Ing to come in on their own accord is damming
tsukurimashou 7y ago
I think some "industries" shouldn't work as a normal business, health, education, law / police. They just don't work as a business and will end up corrupt because money.
- frockington1 7y ago
  Education hasn't gone well publicly so far in America. I'm not sure completely private is the answer but something needs to change. Government funding has led to massive amounts of money being spent for negligible results. Agree on health, law / police though
  - tsukurimashou 7y ago
    I can only speak for France but the education system is beyond saving at this point.
  - Thlom 7y ago
    But isn't the problem with public schools in the US that the funding comes from taxes in the school district itself, so ppor districts will get a underfunded school while rich districts get a well funded school? Anyway, the school system should be changed dramatically everywhere. The current paradigm is hurting children and should be abolished.
    - claudeganon 7y ago
      The problem with schools in the US is and has always been segregation. The problem is that local versus federal control of schools allows local politicians to bow to the deranged, racist fears of upper class parents, as opposed to policies, like integrative bussing, that actually improved outcomes.
      - lotsofpulp 7y ago
        Forcing integration, which would mean forcing people to live in certain places and not be able to send their kids to private schools) is less likely to succeed than efforts to structurally reduce income/wealth gap (aka wealth transfer from rich to poor).
raxxorrax 7y ago
In Germany there is a strange policy for hospitals. If you do not do a minimal amount of operations of a certain kind (e.g. hip replacements), you loose the admittance to do any further surgeries of the same kind. The incentive was probably to focus competency to certain hospitals, but you can imagine how this plays out in reality. Especially people not familiar about medical necessities should always get a second opinion. Otherwise you might end up with an extra hip or something like that. At least it begins to be common knowledge that hospitals do operate too often. Still, with all its problems, and there are many, I certainly would prefer to be operated in any country of the EU compared to the US. Not because of capabilities of doctors, but to me it seems US health care as a example how private business can be worse than governmental services. Common market mechanisms don't work if your life depends on it. It is just about extracting the most amount of money from suffering and this article describes a problem to which there is no solution in my opinion.
- sneak 7y ago
  This reminds me of a classic, which, it seems to me, should apply to surgeons as much as anyone: When all you have is a hammer, everything looks like a nail.
- qaq 7y ago
  "in any country of the EU" thats a very broad statement. A poor eastern EU country will not have remotely the level of surgeons and facilities that say The Johns Hopkins Hospital has this would be true even for many richest EU countries.
  - slumdev 7y ago
    People with gold-plated health insurance and/or millions in reserve will receive better care in the US. The average schmuck will not. Hopkins probably isn't in-network for him even if he works across the street from it.
    - runako 7y ago
      > Hopkins probably isn't in-network for him even if he works across the street from it. Hopkins probably isn't in-network for a lot of people who physically work in the hospital every day. Custodial, cleaning, security, etc. often are contractors and therefore do not have access to employee benefits of their platinum-level customers.
outime 7y ago
I had much more success researching my own health problems than by visiting any doctor (and have seen a lot, unfortunately). As a bonus, I learned a lot about the body and the mind. I see misdiagnosis happening at a very high rate but I also understand they don’t have the time and/or energy to dig very deep into each patient and they do fine (money and respect-wise) by doing the bare minimum so many don’t try to fight it by e.g. setting up their own consultation and trying to do better (not necessarily making less money). Of course, a bunch of exceptions can be found and they do shine a lot, but the average doctor isn’t going to be helpful after the very typical and simple checks don’t yield anything and they’ll happily prescribe things that won’t actually help you. That’s been my experience in at least couple european countries. Edit: typo
- AnIdiotOnTheNet 7y ago
  In my experience the situation in the US is about on par, only with very few shining exceptions. I never bother to see a physician unless I'm fairly confident there's something going on I can't fix and I have a good idea of what it is and isn't. The alternative is spending 20 minutes talking to someone filling out forms on a PC and pretending to listen before working as quickly as possible to get you out of their office. Oh, you have some kind of acid-related chest pain? We'll just prescribe a proton pump inhibitor for the rest of your life rather than worry about fixing anything, thank you come again. Hell, when I was a child and my thyroid failed physicians spent 2 years telling my mother that I was just lazy. My symptoms were so textbook that a coworker of hers diagnosed hypothyroidism, sight unseen, from the mere description. Even so, she had to demand they perform the incredibly simple blood test to confirm. Needless to say, I have very little respect for physicians in general.
- ssully 7y ago
  I think it's very important for people to be proactive about their out health and care, but I think listening and working with your primary care doctor is just as important. If you don't think your doctor is helpful or listening then you probably need to find a new doctor.
  - rurp 7y ago
zouhair 7y ago
Ah, good old Dr Knock[0] [0]: https://en.wikipedia.org/wiki/Knock_(play) https://en.wikipedia.org/wiki/Knock_(play)
ubermonkey 7y ago
It's orthogonal to the linked story, but I attended a dinner the other night where the presentation was on advances in MS research. The speaker, an MS researcher and clinician, noted among other things that we've been really really wrong about how many folks in the US have multiple sclerosis - like, by a factor of 2. There are lots of reasons for this, but it's not JUST the lack of easy diagnostic tests. Until relatively recently, there were NO real therapies for MS, so doctors were hesitant to make the pronouncement. Add to this that a diagnosis of MS would qualify as a pre-existing condition, and would prevent the patient from getting health insurance (pre-Obamacare, anyway), and would absolutely put the kibosh on life insurance. So there were real world consequences, and they were therefore hesitant.
- joshgel 7y ago
  I think part of it, but also not the entire story. Take cancer, for example. The treatment is so toxic (potentially deadly) that we want to make sure that our diagnosis is as close to 100% as possible. To the point where if you want to transfer where you get your chemotherapy, the new place will insist that you bring not just the biopsy report that shows that you have cancer, but the actual 'slides', the actual biopsy tissue for them to independently evaluate. Contrast this with MS where there is virtually no therapy (until recently), the tests themselves are very expensive (multiple MRIs over time) and the tests aren't even that much better than just talking to the patient and examining them. But, both the MRIs and the clinical exams/interviews require multiple visits, sometimes with years of monitoring in between to truly make the diagnosis. The system just doesn't incent this type of care and certainly doesn't reimburse it very well. Patients want answers and answers now. Doctors are hurried. Insurances change so you have to change networks, etc, etc, etc.
  - fao_ 7y ago
    > The treatment is so toxic (potentially deadly) that we want to make sure that our diagnosis is as close to 100% as possible. I think you're ignoring how obscure some symptoms of cancer are, though. My cousin went back and forth with the doctor about a recurring cough, for 3 or 4 years. It turned out to be bowel cancer, and while they did treat it, it was too late by the time anyone in the medical system thought of that. The only indication that would point them towards bowel cancer, was the medical history of her family, her grandmother had it too. She was rather young as well, late 20s/early 30s, so they just didn't consider it.
reverend_gonzo 7y ago
In order to counter these risks, we prefer going to doctors and hospitals that are so busy (and highly regarded) they don’t have time for bullshit. Of course it helps being in a large city with many options and excellent insurance. Without this, I’d probably be getting g second and third opinions constantly.
- smt88 7y ago
  Don't you worry that very busy hospitals will treat you more anonymously and/or make more mistakes?
tmamic 7y ago
This problem is the biggest in dentistry. Most dentists are perfectly capable of providing the correct diagnosis. Unfortunately, even if and when they are, there are obstacles: - Weak incentives to provide an accurate diagnosis - Strong incentives to provide a particular inaccurate diagnosis Giving a correct diagnosis often means investing more resources, as well as continuously investing in education and tooling. If the patient doesn’t see the difference between a correct diagnosis and “probably correct diagnosis” then they will react the same in both cases. This situation where every diagnosis is perceived as the same, an examination is one of the least profitable services provided by dentists and, naturally, falls into the problem of “adverse selection.” Some dentists recognise the opportunity of giving the wrong diagnosis to get a higher benefit. Be it by keeping or winning over the patient or by leaving room for the ability to recommend costly treatments. The results of this are: - Patients on average get a less correct diagnosis - Dentists earn little to nothing for their diagnostic work
- cptskippy 7y ago
  It goes beyond correct diagnosis with Dentistry. Even with a correct diagnosis there are often multiple methods of treatment that vary dramatically in terms of recovery and cost. More often then not the Dentist recommends a costly treatment and doesn't even provide alternatives. I've seen dentist offices that were just cavity filling mills that filled anything remotely resembling a cavity and using three different methods of pain management during the procedure. The dentist literally had rows of chairs in the same room getting cavities filled. I've sat in a dentist's chair and been told I had a cavity that needed and could be filled that day. Unfortunately I was not in a position to pay for the procedure so I deferred. I saved up the $$$ needed and returned at my next appointment prepared to have it filled only to be told I didn't have any cavities. When I was a kid, you didn't get braces until you lost all your baby teeth, now Dentists have started recommending braces for children as young as 4 with the expectation that they'll need braces again as a teen.
  - tmamic 7y ago
    You are absolutely right. Dentists are able to recommend wrong therapy plans without patients knowing. Even when a patient gets the correct diagnosis, they can be recommended drastically different therapy plans. This happens because there are many ways to solve the same medical problem. Depending on the financial capacity of the patient and the desired quality which is most commonly measured by the length of durability or visual appearance, as well as other factors. Another related issue is the aesthetic dental work paid for by the patient, which can cause the need for more treatments down the line. All these decisions influence the health of the patient in a way they aren’t able to fully comprehend, and they rely on dentists as experts to advise them. Generally, advice and diagnosis are not separate. This creates a venue for unethical behaviour. For example, dentists might resort to recommending "tools from their toolbox.” In your case, it was fillings. When you buy a hammer, suddenly everything looks like a nail. The results of all this are: - Patients get suboptimal/wrong health treatments - Treatments are still performed long after there are better approaches available - Dentists are less able to give the right advice
socialdemocrat 7y ago
Many focus on the doctor, and surely his moral compass was off. But from a birds eye perspective the primary problem here is companies paying doctors to recommend certain pills and procedures. This can make a doctor which was semi-decent and quickly turn him into a greedy immoral person. I don't think it should be legal for companies to pay doctors to promote their products. Do anyone disagree?
- programmertote 7y ago
  My wife is a resident. She used to intern at PCP clinics and was invited by her supervisor (a physician) to one of the dinners hosted by pharma companies (Sanofi, if I remember correctly). The dinner was a feast. The doc invited everyone in her clinic and their immediate family members. We had Shirmps, Lobster, Wagyu beef (I know it's a redundant word, but that's how it's known in the US), lamb to our fill. Sanofi rep footed the bill (and asked us to sign our names on a sheet when we arrived). Experiencing that dinner and seeing my host family mom (a practicing psychiatrist in the US for a private psychiatry hospital) getting food every week from pharma reps, makes me feel disgusted about the connection between doctors and pharma companies in the US.
  - pnw_hazor 7y ago
    I have MDs in the family too, their continuing education classes are sponsored (free) and with feasts provided as well. Lawyers have to pay for our required continuing education classes. Sponsored courses and retreats are clearly a conflict of interest for MDs. Also, as lawyer, I remain shocked and saddened to see how US medical providers have abandoned patient privacy in the wake of the US opioid crisis. Patients prescribed any controlled substance are now put on registers that almost any state actor (or local police) can review at will. US MDs have thrown their patients under the bus because they (or their colleagues) were (lazily/blindly/greedily) writing too many opioid prescriptions.
    - lotsofpulp 7y ago
      How are doctors responsible for laws passed by state legislators (who tend to be lawyers) requiring doctors to use PDMPs?
mlang23 7y ago
Our medical system is completely wrong. Doctors should get payed for the time their patients are healthy. As soon as they fall ill, payment should stop until they are well again.
- zdragnar 7y ago
  So patients who have difficult to treat illnesses or low chances of survival don't get treated at all? "Healthy" is also a bit of a misnomer, as there are plenty of (currently) incurable conditions that require treatment not to improve, but to keep from getting worse. For those people, healthy is either not achievable, or is a very different state of being than others.
- banads 7y ago
  What about people who consciously (or unconsciously) live extremely unhealthy lifestyles?
  - ativzzz 7y ago
    They get to pay an "unhealthy lifestyle tax".
    - banads 7y ago
      What about the corporations that push addictive and poisonous food with massive multi hundred million dollar marketing campaigns targeting children?
      - mlang23 7y ago
        Maybe the "free market" isn't such a good idea after all...
- refurb 7y ago
  Sounds great, but wouldn't that system incentivize doctors to claim patients are "healthy", even when they aren't? "Let's go ahead and schedule your MRI for January. I've almost hit my "health patients" target this year and wouldn't want to mess that up"
foobar_ 7y ago
Just like mechanics of vehicles.
yboris 7y ago
Q: "Is it Worth Getting an Annual Physical Exam?" A: "No" https://nutritionfacts.org/video/is-it-worth-getting-an-annual-physical-exam/ https://nutritionfacts.org/video/is-it-worth-getting-an-annu...
Allower 7y ago
Starting off with a stupid story made me close this instantly, get to the point faster.
dboreham 7y ago
A benefit of "socialized medicine", provided the government is not corrupt, is that medical practice can be evidence driven. E.g. compare rates for wisdom teeth extraction and tonsillectomy between the US and UK.
MichaelMoser123 7y ago
didn't they give the hippocratic oath? doesn't that count for anything?
rafaelvasco 7y ago
Jesus. How corrupted people are becoming. And if there's one type of people that absolutely can get corrupted are doctors. They're dealing with lives after all. The implications can result in death or at least a lot of suffering;
a_rahmanshah 7y ago
This is getting very common in India
azeotropic 7y ago
This actually sounds like an honest (mis?)diagnosis. Confusing migraine and temporal lobe epilepsy is not a particularly egregious mistake, and the two conditions often occur together. A number of anti-seizure medications are prescribed to prevent migraines.
Fezzik 7y ago
The other side of the coin is that there are lot of (or at least some) doctors who will “misdiagnose” a patient to get them appropriate treatments that insurance would otherwise not pay for. Personally, I had a number of very large lipomas on my body that no insurance would normally ever cover the removal of as they were cosmetic and socially stigmatizing and not dangerous to my health. My doctor filled out all the necessary forms with the proper magic language and my insurance paid the bill. These are simple, 10 minute, outpatient medical procedures that require a knife and $.25 of numbing agent. I could have done it myself if I could buy something OTC to numb myself. Not all doctors are just looking to pad their billables.

201 points by rrauenza 7y ago

eigen 7y ago

A: $

Iv 7y ago

Could we add "in the US" to the medical news that may not be that relevant in other countries?

nosianu 7y ago
Here in Germany we occasionally have similar headline making cases and scandals. We also have similar incentives, since how you make money as a doctor is the same basic principle.
elevenoh 7y ago
The incentives are fked in canada as well. More, short visits that align with high cost billing codes. And a high % of doctors are walking medical maladies themselves that don't read research studies even in their own field. Simply focused on bill high, follow procedural algorithm, don't lose job/get sued.
chimeracoder 7y ago
> Could we add "in the US" to the medical news that may not be that relevant in other countries? The incentives are misaligned in many other countries, including Germany and the UK. This article focuses on examples in the US, but as noted elsewhere in these comments, there are plenty of articles that show examples of similar perverse treatment incentives in other countries.
- socialdemocrat 7y ago
  Except nowhere are the incentives as screwed up as in the US. Sure a doctor does have a financial incentive to not always do what is best for you anywhere in the world. But in most places this concern competes strongly with a sense of moral duty. In the US you have companies which have no scrupulous because they don't see or know the patients they screw over, actively push and incentives doctors to work against the interests of their patients. The prevalence of companies paying doctors to prescribe certain pills or suggest certain procedures seem to me more of an American problem. At least in my home country I highly doubt such an arrangment would even be legal. I mean this just fits in with the opioid crisis in the US. Where medical companies would basically send young prostitutes to doctors to try to persuade them to push their drugs. Yes this is a fact. These companies hired young pretty women, which frequently slept with the doctors they were supposed to influence. The companies made billions while patients died left and right from their drugs. I cannot think of anywhere in the developed world where anything remotely as horrible has been going on in the health care sector. While everybody has challenges in their health care sector, everything pales compared to what is going on in the US. Greed as completely taken over.
jmkni 7y ago
We had a similar case recently in Northern Ireland, a Neurologist who performed hundreds of needless procedures, and that was under the NHS so ¯\_(ツ)_/¯ - https://www.bbc.co.uk/news/uk-northern-ireland-50481781 https://www.bbc.co.uk/news/uk-northern-ireland-50481781

coder1001 7y ago

Your typical case of measuring a doctor's success by the number of EGGs and the likes that his patients do! Wrong incentives = unexpected outcomes!

voiper1 7y ago
Seems similar (or the same as) the cobra effect https://en.wikipedia.org/wiki/Cobra_effect https://en.wikipedia.org/wiki/Cobra_effect
thepete2 7y ago
Similar to Goodhart's law: When a measure becomes a target it ceases to be a good measure [0]. You see it everywhere and it usually happens when we try to quantify a quality (like "competence"...) [0] https://en.wikipedia.org/wiki/Goodhart%27s_law https://en.wikipedia.org/wiki/Goodhart%27s_law

r_singh 7y ago

The medical industry has the biggest conflict of interest I have seen in any industry. It's actually bad for doctors if preventive healthcare takes off the way it should, we all eat healthy, balanced diets and exercise to take care of our bodies and mind. That coupled with genetic diversity, ignorance of their customers and relative ignorance of the practitioners itself (we still don't know more than we know) could truly be a recipe for disaster. My celiac was misdiagnosed for pharyngitis for long, and since I've stopped taking any doctor very seriously. I read A LOT, visit a bunch of doctors (preferably leading to specialists) and ask a lot of questions before deciding what course of action I want to take. Luckily, in India, doctors don't charge as much (~$20-40) per session.

xiaq 7y ago
> The medical industry has the biggest conflict of interest I have seen in any industry. It's actually bad for doctors if preventive healthcare takes off the way it should, we all eat healthy, balanced diets and exercise to take care of our bodies and mind. Not in countries with a national health system, where the government is incentivized to keep people healthy in order to reduce cost.
- r_singh 7y ago
  Haven't experienced this so don't know as much, but yes, does make sense (in theory, at least).
- catalogia 7y ago
  The government may have that incentive, but what about the individual doctors who are actually examining patients and diagnosing people? Do these employees truly share their employer's desire to cut costs? I don't really believe that doctors are keeping people sick on purpose to keep demand for their profession high, but if that were going on, I don't think socialized healthcare would necessarily erase that incentive. There are plenty of government and private sector workers who try to preserve their own jobs to the detriment of the whole.
  - 7y ago

jonplackett 7y ago

TLDR; Money

elevenoh 7y ago

I for one cannot wait for my ai primary physician.

rahuldottech 7y ago
Sure. Until the AI makes mistakes and you get seriously harmed but you find that you can't really blame anyone because you were warned not to blindly trust the AI in the ToS.
- elevenoh 7y ago
  Run it though a consortium of privacy-preserving, for profit ai at low cost vs. a set of humans? I know which I'd choose. If warning or outlier condition identified, double check w/ alternative means if sought.
tomerico 7y ago
And who would pay for that AI physician? Hospitals and other for profit corporation. It’s hard to believe that a less transparent, more centralized system could only have positive effects. The problem is in the US incentive structure, not with the doctors.
- elevenoh 7y ago
  A for profit company out of X. For some co's the data may be worth making it free.
mikecsh 7y ago
Great! Let me hook you up with the latest medical AI technology. Actually, let me hook you up with all of the latest medical AIs, throw your symptoms at them and let them treat all you ailments. And add to that, all the latest medical robotics, and we'll take the surgeons and intensivists, interns, and nurses away. Good luck with that, I'm sure you will be much happier and healthier when the current AI tries to decide whether you are acutely dying of hypercalcaemia or a cardiac tamponade and Marshalls the robots to save you. \s For all the faults and failings of doctors (read: humans), I find many Hacker Newsers vastly oversimplify what doctors do and vastly overinflate what AI is able to do now, or will be able to do in the next ten, twenty, or even 30 years. It's great that we not have some AI that can diagnose a stroke better than a radiologist on a CT scan. But it can't tell you the scan also shows a space occupying lesion. Or hydroencephaly. Or an extra dural haematoma. Or any other intracranial pathology. And that's about the state of the art. I welcome new diagnostic aids as I think most clinicians do, but I would take the fleshy system we have of human healthcare providers and suspect that will be the case for a good while yet. Disclaimer: am doctor and engineer

vivekd 7y ago

I was keeping an open mind about this doctor, until I read that two other doctors were willing to testify they had thought he was misdiagnosing patients. Its notoriously hard to get doctors to testify against each other at a malpractice case and the fact that doctors who worked with him were Ing to come in on their own accord is damming

tsukurimashou 7y ago

I think some "industries" shouldn't work as a normal business, health, education, law / police. They just don't work as a business and will end up corrupt because money.

frockington1 7y ago
Education hasn't gone well publicly so far in America. I'm not sure completely private is the answer but something needs to change. Government funding has led to massive amounts of money being spent for negligible results. Agree on health, law / police though
- tsukurimashou 7y ago
  I can only speak for France but the education system is beyond saving at this point.
- Thlom 7y ago
  But isn't the problem with public schools in the US that the funding comes from taxes in the school district itself, so ppor districts will get a underfunded school while rich districts get a well funded school? Anyway, the school system should be changed dramatically everywhere. The current paradigm is hurting children and should be abolished.
  - claudeganon 7y ago
    The problem with schools in the US is and has always been segregation. The problem is that local versus federal control of schools allows local politicians to bow to the deranged, racist fears of upper class parents, as opposed to policies, like integrative bussing, that actually improved outcomes.
    - lotsofpulp 7y ago
      Forcing integration, which would mean forcing people to live in certain places and not be able to send their kids to private schools) is less likely to succeed than efforts to structurally reduce income/wealth gap (aka wealth transfer from rich to poor).

raxxorrax 7y ago

In Germany there is a strange policy for hospitals. If you do not do a minimal amount of operations of a certain kind (e.g. hip replacements), you loose the admittance to do any further surgeries of the same kind. The incentive was probably to focus competency to certain hospitals, but you can imagine how this plays out in reality. Especially people not familiar about medical necessities should always get a second opinion. Otherwise you might end up with an extra hip or something like that. At least it begins to be common knowledge that hospitals do operate too often. Still, with all its problems, and there are many, I certainly would prefer to be operated in any country of the EU compared to the US. Not because of capabilities of doctors, but to me it seems US health care as a example how private business can be worse than governmental services. Common market mechanisms don't work if your life depends on it. It is just about extracting the most amount of money from suffering and this article describes a problem to which there is no solution in my opinion.

sneak 7y ago
This reminds me of a classic, which, it seems to me, should apply to surgeons as much as anyone: When all you have is a hammer, everything looks like a nail.
qaq 7y ago
"in any country of the EU" thats a very broad statement. A poor eastern EU country will not have remotely the level of surgeons and facilities that say The Johns Hopkins Hospital has this would be true even for many richest EU countries.
- slumdev 7y ago
  People with gold-plated health insurance and/or millions in reserve will receive better care in the US. The average schmuck will not. Hopkins probably isn't in-network for him even if he works across the street from it.
  - runako 7y ago
    > Hopkins probably isn't in-network for him even if he works across the street from it. Hopkins probably isn't in-network for a lot of people who physically work in the hospital every day. Custodial, cleaning, security, etc. often are contractors and therefore do not have access to employee benefits of their platinum-level customers.

outime 7y ago

I had much more success researching my own health problems than by visiting any doctor (and have seen a lot, unfortunately). As a bonus, I learned a lot about the body and the mind. I see misdiagnosis happening at a very high rate but I also understand they don’t have the time and/or energy to dig very deep into each patient and they do fine (money and respect-wise) by doing the bare minimum so many don’t try to fight it by e.g. setting up their own consultation and trying to do better (not necessarily making less money). Of course, a bunch of exceptions can be found and they do shine a lot, but the average doctor isn’t going to be helpful after the very typical and simple checks don’t yield anything and they’ll happily prescribe things that won’t actually help you. That’s been my experience in at least couple european countries. Edit: typo

AnIdiotOnTheNet 7y ago
In my experience the situation in the US is about on par, only with very few shining exceptions. I never bother to see a physician unless I'm fairly confident there's something going on I can't fix and I have a good idea of what it is and isn't. The alternative is spending 20 minutes talking to someone filling out forms on a PC and pretending to listen before working as quickly as possible to get you out of their office. Oh, you have some kind of acid-related chest pain? We'll just prescribe a proton pump inhibitor for the rest of your life rather than worry about fixing anything, thank you come again. Hell, when I was a child and my thyroid failed physicians spent 2 years telling my mother that I was just lazy. My symptoms were so textbook that a coworker of hers diagnosed hypothyroidism, sight unseen, from the mere description. Even so, she had to demand they perform the incredibly simple blood test to confirm. Needless to say, I have very little respect for physicians in general.
ssully 7y ago
I think it's very important for people to be proactive about their out health and care, but I think listening and working with your primary care doctor is just as important. If you don't think your doctor is helpful or listening then you probably need to find a new doctor.
- rurp 7y ago

zouhair 7y ago

Ah, good old Dr Knock[0] [0]: https://en.wikipedia.org/wiki/Knock_(play) https://en.wikipedia.org/wiki/Knock_(play)

ubermonkey 7y ago

It's orthogonal to the linked story, but I attended a dinner the other night where the presentation was on advances in MS research. The speaker, an MS researcher and clinician, noted among other things that we've been really really wrong about how many folks in the US have multiple sclerosis - like, by a factor of 2. There are lots of reasons for this, but it's not JUST the lack of easy diagnostic tests. Until relatively recently, there were NO real therapies for MS, so doctors were hesitant to make the pronouncement. Add to this that a diagnosis of MS would qualify as a pre-existing condition, and would prevent the patient from getting health insurance (pre-Obamacare, anyway), and would absolutely put the kibosh on life insurance. So there were real world consequences, and they were therefore hesitant.

joshgel 7y ago
I think part of it, but also not the entire story. Take cancer, for example. The treatment is so toxic (potentially deadly) that we want to make sure that our diagnosis is as close to 100% as possible. To the point where if you want to transfer where you get your chemotherapy, the new place will insist that you bring not just the biopsy report that shows that you have cancer, but the actual 'slides', the actual biopsy tissue for them to independently evaluate. Contrast this with MS where there is virtually no therapy (until recently), the tests themselves are very expensive (multiple MRIs over time) and the tests aren't even that much better than just talking to the patient and examining them. But, both the MRIs and the clinical exams/interviews require multiple visits, sometimes with years of monitoring in between to truly make the diagnosis. The system just doesn't incent this type of care and certainly doesn't reimburse it very well. Patients want answers and answers now. Doctors are hurried. Insurances change so you have to change networks, etc, etc, etc.
- fao_ 7y ago
  > The treatment is so toxic (potentially deadly) that we want to make sure that our diagnosis is as close to 100% as possible. I think you're ignoring how obscure some symptoms of cancer are, though. My cousin went back and forth with the doctor about a recurring cough, for 3 or 4 years. It turned out to be bowel cancer, and while they did treat it, it was too late by the time anyone in the medical system thought of that. The only indication that would point them towards bowel cancer, was the medical history of her family, her grandmother had it too. She was rather young as well, late 20s/early 30s, so they just didn't consider it.

reverend_gonzo 7y ago

In order to counter these risks, we prefer going to doctors and hospitals that are so busy (and highly regarded) they don’t have time for bullshit. Of course it helps being in a large city with many options and excellent insurance. Without this, I’d probably be getting g second and third opinions constantly.

smt88 7y ago
Don't you worry that very busy hospitals will treat you more anonymously and/or make more mistakes?

tmamic 7y ago

This problem is the biggest in dentistry. Most dentists are perfectly capable of providing the correct diagnosis. Unfortunately, even if and when they are, there are obstacles: - Weak incentives to provide an accurate diagnosis - Strong incentives to provide a particular inaccurate diagnosis Giving a correct diagnosis often means investing more resources, as well as continuously investing in education and tooling. If the patient doesn’t see the difference between a correct diagnosis and “probably correct diagnosis” then they will react the same in both cases. This situation where every diagnosis is perceived as the same, an examination is one of the least profitable services provided by dentists and, naturally, falls into the problem of “adverse selection.” Some dentists recognise the opportunity of giving the wrong diagnosis to get a higher benefit. Be it by keeping or winning over the patient or by leaving room for the ability to recommend costly treatments. The results of this are: - Patients on average get a less correct diagnosis - Dentists earn little to nothing for their diagnostic work

cptskippy 7y ago
It goes beyond correct diagnosis with Dentistry. Even with a correct diagnosis there are often multiple methods of treatment that vary dramatically in terms of recovery and cost. More often then not the Dentist recommends a costly treatment and doesn't even provide alternatives. I've seen dentist offices that were just cavity filling mills that filled anything remotely resembling a cavity and using three different methods of pain management during the procedure. The dentist literally had rows of chairs in the same room getting cavities filled. I've sat in a dentist's chair and been told I had a cavity that needed and could be filled that day. Unfortunately I was not in a position to pay for the procedure so I deferred. I saved up the $$$ needed and returned at my next appointment prepared to have it filled only to be told I didn't have any cavities. When I was a kid, you didn't get braces until you lost all your baby teeth, now Dentists have started recommending braces for children as young as 4 with the expectation that they'll need braces again as a teen.
- tmamic 7y ago
  You are absolutely right. Dentists are able to recommend wrong therapy plans without patients knowing. Even when a patient gets the correct diagnosis, they can be recommended drastically different therapy plans. This happens because there are many ways to solve the same medical problem. Depending on the financial capacity of the patient and the desired quality which is most commonly measured by the length of durability or visual appearance, as well as other factors. Another related issue is the aesthetic dental work paid for by the patient, which can cause the need for more treatments down the line. All these decisions influence the health of the patient in a way they aren’t able to fully comprehend, and they rely on dentists as experts to advise them. Generally, advice and diagnosis are not separate. This creates a venue for unethical behaviour. For example, dentists might resort to recommending "tools from their toolbox.” In your case, it was fillings. When you buy a hammer, suddenly everything looks like a nail. The results of all this are: - Patients get suboptimal/wrong health treatments - Treatments are still performed long after there are better approaches available - Dentists are less able to give the right advice

socialdemocrat 7y ago

Many focus on the doctor, and surely his moral compass was off. But from a birds eye perspective the primary problem here is companies paying doctors to recommend certain pills and procedures. This can make a doctor which was semi-decent and quickly turn him into a greedy immoral person. I don't think it should be legal for companies to pay doctors to promote their products. Do anyone disagree?

programmertote 7y ago
My wife is a resident. She used to intern at PCP clinics and was invited by her supervisor (a physician) to one of the dinners hosted by pharma companies (Sanofi, if I remember correctly). The dinner was a feast. The doc invited everyone in her clinic and their immediate family members. We had Shirmps, Lobster, Wagyu beef (I know it's a redundant word, but that's how it's known in the US), lamb to our fill. Sanofi rep footed the bill (and asked us to sign our names on a sheet when we arrived). Experiencing that dinner and seeing my host family mom (a practicing psychiatrist in the US for a private psychiatry hospital) getting food every week from pharma reps, makes me feel disgusted about the connection between doctors and pharma companies in the US.
- pnw_hazor 7y ago
  I have MDs in the family too, their continuing education classes are sponsored (free) and with feasts provided as well. Lawyers have to pay for our required continuing education classes. Sponsored courses and retreats are clearly a conflict of interest for MDs. Also, as lawyer, I remain shocked and saddened to see how US medical providers have abandoned patient privacy in the wake of the US opioid crisis. Patients prescribed any controlled substance are now put on registers that almost any state actor (or local police) can review at will. US MDs have thrown their patients under the bus because they (or their colleagues) were (lazily/blindly/greedily) writing too many opioid prescriptions.
  - lotsofpulp 7y ago
    How are doctors responsible for laws passed by state legislators (who tend to be lawyers) requiring doctors to use PDMPs?

mlang23 7y ago

Our medical system is completely wrong. Doctors should get payed for the time their patients are healthy. As soon as they fall ill, payment should stop until they are well again.

zdragnar 7y ago
So patients who have difficult to treat illnesses or low chances of survival don't get treated at all? "Healthy" is also a bit of a misnomer, as there are plenty of (currently) incurable conditions that require treatment not to improve, but to keep from getting worse. For those people, healthy is either not achievable, or is a very different state of being than others.
banads 7y ago
What about people who consciously (or unconsciously) live extremely unhealthy lifestyles?
- ativzzz 7y ago
  They get to pay an "unhealthy lifestyle tax".
  - banads 7y ago
    What about the corporations that push addictive and poisonous food with massive multi hundred million dollar marketing campaigns targeting children?
    - mlang23 7y ago
      Maybe the "free market" isn't such a good idea after all...
refurb 7y ago
Sounds great, but wouldn't that system incentivize doctors to claim patients are "healthy", even when they aren't? "Let's go ahead and schedule your MRI for January. I've almost hit my "health patients" target this year and wouldn't want to mess that up"

foobar_ 7y ago

Just like mechanics of vehicles.

yboris 7y ago

Q: "Is it Worth Getting an Annual Physical Exam?" A: "No" https://nutritionfacts.org/video/is-it-worth-getting-an-annual-physical-exam/ https://nutritionfacts.org/video/is-it-worth-getting-an-annu...

Allower 7y ago

Starting off with a stupid story made me close this instantly, get to the point faster.

dboreham 7y ago

A benefit of "socialized medicine", provided the government is not corrupt, is that medical practice can be evidence driven. E.g. compare rates for wisdom teeth extraction and tonsillectomy between the US and UK.

MichaelMoser123 7y ago

didn't they give the hippocratic oath? doesn't that count for anything?

rafaelvasco 7y ago

Jesus. How corrupted people are becoming. And if there's one type of people that absolutely can get corrupted are doctors. They're dealing with lives after all. The implications can result in death or at least a lot of suffering;

a_rahmanshah 7y ago

This is getting very common in India

azeotropic 7y ago

This actually sounds like an honest (mis?)diagnosis. Confusing migraine and temporal lobe epilepsy is not a particularly egregious mistake, and the two conditions often occur together. A number of anti-seizure medications are prescribed to prevent migraines.

Fezzik 7y ago

The other side of the coin is that there are lot of (or at least some) doctors who will “misdiagnose” a patient to get them appropriate treatments that insurance would otherwise not pay for. Personally, I had a number of very large lipomas on my body that no insurance would normally ever cover the removal of as they were cosmetic and socially stigmatizing and not dangerous to my health. My doctor filled out all the necessary forms with the proper magic language and my insurance paid the bill. These are simple, 10 minute, outpatient medical procedures that require a knife and $.25 of numbing agent. I could have done it myself if I could buy something OTC to numb myself. Not all doctors are just looking to pad their billables.