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They suggest mortality is lower during meetings because: "the intensity of care provided during meeting dates is lower and that for high-risk patients with car

They 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 ago
  They 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 ago
    But they don’t account for patients going to other hospitals and dying there instead.
  - oaktrout 3y ago
    As 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.
  - yellowapple 3y ago
    Now I'm curious about mortality rates in the weeks following a conference. "Lemme try this neat trick I learned..."
- Swizec 3y ago
  > The conference delays the surgery, so the patient’s surgery or other high risk procedures are delayed. My understanding from listening to the author’s podcast, is that this is the proposed mechanism. There is a percentage of patients who were going to get better on their own anyway. But if they receive urgent care, it may cause harm. The conclusion seems to be that there is a measurable percentage of patients who got surgery but didn’t need it and thus suffered greater harm than if they had been left alone. Because heart attacks are so critical, medical staff errs on the side of action instead of waiting. This seems reasonable, but may in fact be bad. it’s a good podcast: https://freakonomics.com/podcast/what-happens-to-patients-when-thousands-of-cardiologists-leave-town/ https://freakonomics.com/podcast/what-happens-to-patients-wh...
IG_Semmelweiss 3y ago
To understand why, i think you have to know 2 data points 1) The first date (and then-current surgery schedule) at the point when the conference dates where announced. 2) The date (and then-current surgery schedule) at the point, when the doctor booked his/her travel plans. Both lists and dates will help you understand if changes in information also resulted in the changes of mortality (by rescheduling hard cases to a later date, for example).
boringuser2 3y ago
Honestly, I've been trying with the idea that most medicine is actually just straight up actively harming people in complex ways. Note: I said most, there are obvious exceptions.
- JHorse 3y ago
  I like that framing. Personally, I've always thought of doctors as "professional educated guessers"
  - Scoundreller 3y ago
    A problem is that the inputs are so heterogenous. Hard to avoid "Garbage in, garbage out" in the input-process-output cycle.
- michaelmrose 3y ago
  This is complete and utter nonsense. The "exceptions" are 99% of medicine. Almost all of medicine is applying strategies we know on average improve outcomes as well as we know how and as well as that clinician is able to within the scope of the time given. If you don't know this is likely that you haven't had much need of medicine. I you had you would know better. This isn't to say outcomes are always good our knowledge is imperfect, people are imperfect, and not every situation has a good answer.
  - robwwilliams 3y ago
    Emphasis—“on average” and yet often applied deep into both tails of unknown distributions. “Complete and utter nonsense” also ignores many inconvenient truths about medical care today and of course in the not-so-distant past. Medical history should temper the tone.
    - michaelmrose 3y ago
      > I've been trying with the idea that most medicine is actually just straight up actively harming people in complex ways. This says that most medicine is harmful full stop. This is conspiracy theory thinking. It is not far off from I've been thinking maybe the earth really is flat. Most medicine is setting broken legs, dispensing antibiotics for infections, prescribing insulin for diabetes. In other words interventions that are straightforwardly positive. It is only when the situation is already dire and outcomes are already poor that intervention is sometimes negative and even then we are often discussing whether an intervention at 72 resulted in the person dying then instead of 74 wherein the person would have died thrice over between 60 and 72 and been crippled between. Yes I too read about both the era where we thought bad smells caused disease and disdained hand washing AND modern end of life care which is oft pointless this doesn't mean medicine is mostly harmful. Words have meanings and the posters are nonsense as you know.
Detrytus 3y ago
Delayed surgeries are precisely what they mean by "lower intensity of care".
contravariant 3y ago
Alternatively people who suffered acute heart conditions while a cardiologist was not available were simply not hospitalized, they're dead.
- jprete 3y ago
  What mechanism do you think might cause that connection?

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 ago
They 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 ago
  But they don’t account for patients going to other hospitals and dying there instead.
- oaktrout 3y ago
  As 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.
- yellowapple 3y ago
  Now I'm curious about mortality rates in the weeks following a conference. "Lemme try this neat trick I learned..."
Swizec 3y ago
> The conference delays the surgery, so the patient’s surgery or other high risk procedures are delayed. My understanding from listening to the author’s podcast, is that this is the proposed mechanism. There is a percentage of patients who were going to get better on their own anyway. But if they receive urgent care, it may cause harm. The conclusion seems to be that there is a measurable percentage of patients who got surgery but didn’t need it and thus suffered greater harm than if they had been left alone. Because heart attacks are so critical, medical staff errs on the side of action instead of waiting. This seems reasonable, but may in fact be bad. it’s a good podcast: https://freakonomics.com/podcast/what-happens-to-patients-when-thousands-of-cardiologists-leave-town/ https://freakonomics.com/podcast/what-happens-to-patients-wh...

IG_Semmelweiss 3y ago

To understand why, i think you have to know 2 data points 1) The first date (and then-current surgery schedule) at the point when the conference dates where announced. 2) The date (and then-current surgery schedule) at the point, when the doctor booked his/her travel plans. Both lists and dates will help you understand if changes in information also resulted in the changes of mortality (by rescheduling hard cases to a later date, for example).

boringuser2 3y ago

Honestly, I've been trying with the idea that most medicine is actually just straight up actively harming people in complex ways. Note: I said most, there are obvious exceptions.

JHorse 3y ago
I like that framing. Personally, I've always thought of doctors as "professional educated guessers"
- Scoundreller 3y ago
  A problem is that the inputs are so heterogenous. Hard to avoid "Garbage in, garbage out" in the input-process-output cycle.
michaelmrose 3y ago
This is complete and utter nonsense. The "exceptions" are 99% of medicine. Almost all of medicine is applying strategies we know on average improve outcomes as well as we know how and as well as that clinician is able to within the scope of the time given. If you don't know this is likely that you haven't had much need of medicine. I you had you would know better. This isn't to say outcomes are always good our knowledge is imperfect, people are imperfect, and not every situation has a good answer.
- robwwilliams 3y ago
  Emphasis—“on average” and yet often applied deep into both tails of unknown distributions. “Complete and utter nonsense” also ignores many inconvenient truths about medical care today and of course in the not-so-distant past. Medical history should temper the tone.
  - michaelmrose 3y ago
    > I've been trying with the idea that most medicine is actually just straight up actively harming people in complex ways. This says that most medicine is harmful full stop. This is conspiracy theory thinking. It is not far off from I've been thinking maybe the earth really is flat. Most medicine is setting broken legs, dispensing antibiotics for infections, prescribing insulin for diabetes. In other words interventions that are straightforwardly positive. It is only when the situation is already dire and outcomes are already poor that intervention is sometimes negative and even then we are often discussing whether an intervention at 72 resulted in the person dying then instead of 74 wherein the person would have died thrice over between 60 and 72 and been crippled between. Yes I too read about both the era where we thought bad smells caused disease and disdained hand washing AND modern end of life care which is oft pointless this doesn't mean medicine is mostly harmful. Words have meanings and the posters are nonsense as you know.

Detrytus 3y ago

Delayed surgeries are precisely what they mean by "lower intensity of care".

contravariant 3y ago

Alternatively people who suffered acute heart conditions while a cardiologist was not available were simply not hospitalized, they're dead.

jprete 3y ago
What mechanism do you think might cause that connection?