4 ms·

The thing is, in many cases you don't need to know if the diagnosis is correct, so long as the results are directionally correct. If the outcome is an improveme

The thing is, in many cases you don't need to know if the diagnosis is correct, so long as the results are directionally correct. If the outcome is an improvement in health, that meets your threshold for value delivered, hence payment rendered. I think there are many cases when you don't need to be smarter than the other person to benefit from their expertise. You can take it a step further and make the distinction between absolute value versus perceived/relative value -- if we have a patient with cancer, absolute value might mean destroying all cancer cells (which is an absolute metric but extremely hard to model). But perceived value might be "feeling better". It's important to make this distinction particularly in healthcare because absolute benefits and relative benefits are extremely important. Hospice/end-of-life care is a good example of this (as is the cancer example above). Most people would prefer relative or perceived comfort as opposed to absolute results that only end up prolonging a painful process. Outside of healthcare, for another example example, you don't need to understand engineering and tension dynamics in order to appreciate that the second floor of your home support you and your roof doesn't cave in on itself. I don't have examples on hand, but in medicine we've had cases where people do some logical variation of "the right thing for the wrong reasons." I.e., rituals that correlate with healthy outcomes because there is some not-yet-understood principle at play (i.e, you don't need to understand germ theory to benefit from cleanliness rituals). I think this is one of those logical conundrums which falls into the trap of "in theory, in practice". The artificial constraints around the problem space result in artificial logical conundrums.

IggleSniggle 5y ago
It is a balancing act, to be sure, regarding "feeling better" vs "less sick". Hospice care is indeed very important. It can go too far in this direction, however, and I have real sympathy for docs that get it "wrong" in either direction (too much "comfort" or too much "let's give you more years"). Notably: the prescription opioid epidemic is a great example of how this can go wrong in the opposite direction of healthcare providers valuing "relative" benefit vs "absolute" benefit. My spouse is a primary care provider, and there was a period a couple decades ago where the prevailing wisdom was "if a patient says they are in pain, they are in pain, and you treat that pain. We are experts in medicine, but the patient is the expert of their own perception." This is still a complicated issue today, but there are clearly outcomes where we can make people "feel better" all the way to an early grave. For the terminally ill, it seems absolutely appropriate to me to let the patient guide whether they wish to accelerate their death in exchange for quality of life. But "terminally ill" is often not such a black and white issue...we are all eventually mortal. If things like heroin don't inspire a sense of horror or dread, then we just aren't speaking the same language. I, for one, don't want to live in a world where the human priority-at-large is everyone defining "living" as maximizing pleasure until their death. For the hedonists, I get why this makes a certain nihilistic sense, but I think the horror of the reality of it outweighs any momentary benefit. In the very abstract, maybe it doesn't really matter one way or the other. In the concrete day-to-day reality of it, it's absolutely awful to see anyone struggling with any kind of addiction, out of control of their own lives...sometimes because they got on a treadmill-to-death on the _expert_ advice of someone trying to "help them out."

IggleSniggle 5y ago

It is a balancing act, to be sure, regarding "feeling better" vs "less sick". Hospice care is indeed very important. It can go too far in this direction, however, and I have real sympathy for docs that get it "wrong" in either direction (too much "comfort" or too much "let's give you more years"). Notably: the prescription opioid epidemic is a great example of how this can go wrong in the opposite direction of healthcare providers valuing "relative" benefit vs "absolute" benefit. My spouse is a primary care provider, and there was a period a couple decades ago where the prevailing wisdom was "if a patient says they are in pain, they are in pain, and you treat that pain. We are experts in medicine, but the patient is the expert of their own perception." This is still a complicated issue today, but there are clearly outcomes where we can make people "feel better" all the way to an early grave. For the terminally ill, it seems absolutely appropriate to me to let the patient guide whether they wish to accelerate their death in exchange for quality of life. But "terminally ill" is often not such a black and white issue...we are all eventually mortal. If things like heroin don't inspire a sense of horror or dread, then we just aren't speaking the same language. I, for one, don't want to live in a world where the human priority-at-large is everyone defining "living" as maximizing pleasure until their death. For the hedonists, I get why this makes a certain nihilistic sense, but I think the horror of the reality of it outweighs any momentary benefit. In the very abstract, maybe it doesn't really matter one way or the other. In the concrete day-to-day reality of it, it's absolutely awful to see anyone struggling with any kind of addiction, out of control of their own lives...sometimes because they got on a treadmill-to-death on the _expert_ advice of someone trying to "help them out."