5 ms·

> "Hmmmm," she said, picking at her fingernails. "Not directly. Of course I always have the best interests of my patients in mind, but, you know, it's not like

by a-dub 6y ago

> "Hmmmm," she said, picking at her fingernails. "Not directly. Of course I always have the best interests of my patients in mind, but, you know, it's not like they'll pay more if I prescribe Lexapro instead of Zoloft. They won't come back more often or refer more friends. So I'd sorta just be, like, donating this money if I paid you for this thing, right?" this is the problem. the incentives in healthcare are messed up. doctors are paid for their time, not for their outcomes. if a patient comes in and is prescribed a therapy, and they don't have to come back, the doctor should receive more than if the patient returns because the therapy had an issue.

vasco 6y ago
Maybe we should also pay programmers based on outcome then, and you get less if your % of bugs is higher than the team average, sounds like a great idea, eh? Maybe a day without pay if you bring down the live service? I'm pretty sure this wouldn't work. The first place to put it in place, be it a hospital or a tech company, would just have most people quit. Sometimes things are hard and people need to know the business has got their backs as long as they try their best. Reducing pay on bad outcomes is institutional blame culture on overdrive.
inopinatus 6y ago
If you paid doctors by individual outcome then the incentives would be even more messed up, since no-one would want the tough or ambiguous cases. This is opposite of the desired outcome, which is that the best doctors see the hardest cases. Always pay professionals for their time. Patients are not widgets.
GordonS 6y ago
I was horrified when I read that line too. I have this crazy idea that most doctors go into the medical profession because they want to help people - her attitude is awful, IMO.
thehappypm 6y ago
Between the lines, the real doctor perspective here is "Medicine A, which I have been seeing success with for decades, is (according to this site) less effective than Medicine B. I really trust Medicine A, so I don't think this is enough of a nudge to make me change my mind necessarily."

by a-dub 6y ago

vasco 6y ago

Maybe we should also pay programmers based on outcome then, and you get less if your % of bugs is higher than the team average, sounds like a great idea, eh? Maybe a day without pay if you bring down the live service? I'm pretty sure this wouldn't work. The first place to put it in place, be it a hospital or a tech company, would just have most people quit. Sometimes things are hard and people need to know the business has got their backs as long as they try their best. Reducing pay on bad outcomes is institutional blame culture on overdrive.

inopinatus 6y ago

If you paid doctors by individual outcome then the incentives would be even more messed up, since no-one would want the tough or ambiguous cases. This is opposite of the desired outcome, which is that the best doctors see the hardest cases. Always pay professionals for their time. Patients are not widgets.

GordonS 6y ago

I was horrified when I read that line too. I have this crazy idea that most doctors go into the medical profession because they want to help people - her attitude is awful, IMO.

thehappypm 6y ago

Between the lines, the real doctor perspective here is "Medicine A, which I have been seeing success with for decades, is (according to this site) less effective than Medicine B. I really trust Medicine A, so I don't think this is enough of a nudge to make me change my mind necessarily."