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Mortality patterns for patients hospitalized during cardiology meetings (2016)
- curiousObject 3y agoHigh-risk patients with heart failure and cardiac arrest hospitalized in teaching hospitals had lower 30-day mortality when admitted during dates of national cardiology meetings. A rare case of meetings proving beneficial? But why?
- malaya_zemlya 3y agoMy guess, they delay risky procedures until senior doctors get back from the conference
- MattRix 3y agoThis is not it, they were measuring 30-day mortality, not just mortality during the exact days of the conference.
- JamisonM 3y agoEven with 30-day mortality this can be the case, heart patients I am sure do survive risky procedures and die two weeks later because of complications due to the procedure fairly regularly. (Not that I have an opinion on the root cause here.)
- Knee_Pain 3y agoWho knows. Maybe all the old doctors are gone for the meetings and only the young ones with more up to date knowledge are left to treat patients? To even suggest a causal link we would need soooo much data that nobody has right now
- Detrytus 3y agoI would say that doctors who attend conferences have more up to date knowledge than those who don't, regardless of age.
- dmitrij 3y agoSometimes when the boss is away the team works better. At least, that is the case with my team. I don't really know why. Because I really think I am not a bad boss. But apparently either I am or they just don't need one and I am in the end a distraction.
- rafapras 3y agoMaybe coordination costs are lower when the boss is away? So more time is spent focusing on the task in the short term. And consequences would show up latter? When my boss went on maternity leave , the first 2 months were a breeze then things started getting harder.
- wddkcs 3y agoThis would seem to apply to health outcomes being cited in the thread as well. Yes, if we shut down all hospitals tomorrow, less people would die in the short term. Presumably that affect diminishes and reverses relatively soon.
- analog31 3y agoIt would be worth looking into the seniority of the doctors attending the meetings. This is purely anecdotal, but my town hosts some meetings and conventions, including doctors, and I've been hired by those events as a musician. I'm always struck by how young the attendees are. They look like kids. It may be that meetings are more of an attraction for people trying to build their careers, make connections, and have a free vacation, whereas the senior doctors are happy to stay at home and man the fort, plus they have the usual obligations of older workers, such as families. This is also the case at my techie day job: Most of the interest in attending meetings is among the junior engineers.
- karl_gluck 3y agoWow, the exact opposite of what I might have guessed from the title. Does this mean percutaneous coronary intervention [PCI] is over-applied, or something else?
- Enginerrrd 3y agoHard to say without more details, though it's certainly plausible. There's other possibilities though. Like if the timing of other interventions is being delayed until the cardiologist is able to see the patient instead of deferring to a less specialized physician.
- k__ 3y agoSo, it's better that a random physician does something now than waiting for a cardiologist doing the best thing too late?
- Enginerrrd 3y agoNo, not necessarily. There's no indication of that whatsoever. The point was just that there's insufficient information to conclude much of anything about why this was observed. It could also be that PCI is over applied leading to increased mortality.
- chapium 3y agoRisky procedures likely scheduled around when the cardiologist is available
- JHorse 3y agoCould it just be that doctors who attend these meetings are more career (and less patient) focused than their compatriots?
- brobdingnagians 3y agoIf I'm not mistaken, I think attendance at conferences is sometimes required as hours to keep up to date in medical practice. Not sure though.
- sieste 3y agoCould it be that the conferences take place at a time of year where mortality due to cardiac events is higher, e.g. in summer? Maybe I missed it, but I don't think they controlled for time of year.
- Swizec 3y agoThe author of this study talks about time of year in a later podcast, iirc. They did control for time of year (maybe in a later study) and found no effect. source: https://freakonomics.com/podcast/what-happens-to-patients-when-thousands-of-cardiologists-leave-town/ https://freakonomics.com/podcast/what-happens-to-patients-wh...
- arpowers 3y agoThey suggest mortality is lower during meetings because: "the intensity of care provided during meeting dates is lower and that for high-risk patients with cardiovascular disease, the harms of this care may unexpectedly outweigh the benefits." Not sure if they accounted for delayed surgeries in the study.
- mankyd 3y ago> Not sure if they accounted for delayed surgeries in the study. That's sort of what I am wondering. Perhaps it just delays the inevitable - the patient is gravely ill is is going to die if they don't perform _potentially_ life-saving surgery. The surgery, is of course risky. The conference delays the surgery, so the patient's surgery or other high risk procedures are delayed. This gives the patient a few more days of being ill, but doesn't probabilistically change the outcome of actually undergoing the procedure.
- MattRix 3y agoThey appear to be already accounting for that since they are measuring 30-day mortality for acute conditions. They’re saying it’s possible the reduced mortality is due to the high risk procedures actually being unnecessary.
- prepend 3y agoBut they don’t account for patients going to other hospitals and dying there instead.
- oaktrout 3y agoAs an argument to illustrate why 30 day mortality isnt a long enough period, imagine this scenario: you have a cancer that has a 90% chance of killing you in one year. You will be cured if you get the surgery tomorrow, but the surgery has a 30% mortality rate. In one month, 30% or those who got the surgery will die, where all those who didn't get the surgery will still be alive. In one year, 70% of those who got the surgery live, whereas only 10% who didn't get the surgery are alive.
- brd529 3y agoRemember this is from 2016
- herodotus 3y agoIt has been speculated for some time that fewer patients die when hospitals are on strike. See for example: https://www.psychologytoday.com/ca/blog/slightly-blighty/201510/why-do-patients-stop-dying-when-doctors-go-strike https://www.psychologytoday.com/ca/blog/slightly-blighty/201...
- ozSofi 3y agoWhen people die during a surgery they die immidiately, but when their lives get extended after a surgery, it only happens years later.
- beebmam 3y agoSpeaking as someone with a health care worker in the family who just went on strike, I think this makes a lot of sense. When hospital workers go on strike, it often forces the hospital to go on diversion, leading to other hospitals taking on all new patients, who are usually in some form of medical crisis and have a higher chance of dying than stabilized patients already under care. Thus, it makes sense that a hospital which has workers that go on strike have a lower death rate on average.
- somenameforme 3y agoThe article mentions controlling for this in numerous ways. It was looking at elective surgeries, as well as county wide mortality rates and not just a single hospital. That said, in the elective surgery cases it could well be a spin on what you're mentioning and people just deferred their surgeries until after the strike. You'd think surely they also controlled for this, though.
- lostlogin 3y agoWhere I am, diversion wouldn’t help. The system is nationalised so all the hospitals would strike.
- tmpz22 3y agoAs someone dealing with elder care of multiple family members I also believe mental anguish caused by medical environments, including insurance and billing in the US, and the dismissiveness of hospice care (you’re taking too long to die, speed it up or transition to a lower form of care) doesn’t help the matter. Modern medicine is a miracle but struggles to evolve beyond many immediate hurdles. In an extreme minority of cases it can be better to avoid traditional intake methods.
- thenerdhead 3y agoAnother reason why doing “something” is not always the right thing to do. https://en.m.wikipedia.org/wiki/Iatrogenesis https://en.m.wikipedia.org/wiki/Iatrogenesis
- timmaxw 3y agoSummarizing: > In teaching hospitals, mortality was lower among high-risk patients with heart failure or cardiac arrest admitted during meeting dates (P < .001) No mortality differences existed for low-risk patients in teaching hospitals or high- or low-risk patients in nonteaching hospitals [or high-risk patients with AMI in teaching hospitals] So in the specific case of teaching hospitals with high-risk patients with heart failure or cardiac arrest, the normal treatment is making things worse. Outside of that special case, the cardiology meetings don't seem to have any effect (positive or negative). This could mean that the normal treatment is useless. Or it could mean that the hospital is doing a good job of planning around the cardiology meeting -- e.g. delaying non-urgent treatment until the next day, while ensuring there are still enough doctors on staff for the urgent cases.
- Scoundreller 3y agoI completely misunderstood the headline and thought it was about people/patients at the meetings themselves that got hospitalized. What happens when you have an acute cardiac issue surrounded by hundreds of cardiologists?
- tough 3y agoThere's a similar effect in place due to most operations being monday 9am not on weekends, so a lot of more people die during those skewing stats
- ChrisMarshallNY 3y agoI had a friend tell me of an old doctor of his. He said his doctor (an internist) was attending a medical conference for allergists, in the Bahamas. About 500 doctors attended. This doctor was fearfully allergic to peanuts. Like, anaphylactic allergic. He had an anaphylactic reaction to something he ate, during the main speaker banquet. He died. Surrounded by 500 allergists.
- rightbyte 3y agoThe joke is to never get sick in the hospital employee restaurant for the ultimate bystander effect experience. Or too many cooks, I guess.
- lostlogin 3y agoI saw some sort of collapse at a medical school. Loads of people went to help. At the time we wondered how that went, with half trained students on the loose.
- GuB-42 3y agoFrom my experience, it was more "too many cooks" than the ultimate bystander effect. I saw someone feel unwell at a party, nothing serious, just a drink too much, but half of the room happened to work in healthcare, and half of the room came to help. As expected it went all over the place, until a relative (also a doctor) came in, ousted the crowd and took proper care of the poor guy.
- draw_down 3y ago[dead]
- tpoacher 3y agoI mean, fair enough. Just because you're an immunologist doesn't mean you carry spare adrenaline, antihistamines, inhalers, and steroid infusions in your fanny pack at conventions. All they can do is call an ambulance. It's a bit like expecting a hacker to hack a network without their laptop. (bit weird if HE didn't have his epipen on him though ...)
- oaktrout 3y agoA 2018 article by the same author with a similar theme: https://www.ahajournals.org/doi/10.1161/jaha.117.008230 https://www.ahajournals.org/doi/10.1161/jaha.117.008230 Interestingly, there were no differences in the number of procedures performed on meeting and nonmeeting days (it's not the surgeries that are killing people). The hypothesis that I find most interesting is that the cardiologists who are at the meetings spend less time caring for patients and more time doing research, hence they aren't as good at caring for patients.
- 13of40 3y agoI've never been to one of those conferences, so just a second hand anecdote: A couple of years ago some friends of ours invited us to lunch with a couple of their relatives who were in town for a cardiology conference. They (the relatives) were both stout* people, technicians of some kind rather than doctors, and the husband was super hung over from the previous night. Anyway, they told us all about how the sessions at these things were pretty dry, but the after party was always a drunken, hours long slurry of alcohol and aorta-clogging food, and it was so ludicrously un-heart-healthy that it was a running gag. So I'm wondering if the people who opt to go to those things tend to perform differently in their work than the ones who stay home and live quieter lives? (*I only mention this because a few days after we had lunch, the husband apparently had a heart attack while he was driving, pulled off to the side, and died.)
- mhb 3y agoComment from Marginal Revolution by someone who sounds knowledgeable: "To start with there is a significant problem with the article. Cardiac surgeons don't go to cardiology meetings and don't perform the type of interventions mentioned in the article. Interventional cardiologists are not cardiac surgeons. The recurrent mislabeling of the specialty involved is yet another example of the slipshod treatment and lack of understanding of science and medicine in the lay press which makes for an ill-informed public." https://marginalrevolution.com/marginalrevolution/2023/08/86443.html?commentID=160636865 https://marginalrevolution.com/marginalrevolution/2023/08/86...