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Education and Healthcare Suck for the Same Reasons
- deleted 2y ago[deleted]
- gsf_emergency 2y ago>"The way forward lies in open-source initiatives, crowdfunded projects, and collaborative efforts that prioritize human outcomes over institutional metrics." Is it me, or does it feel like developing software for BigCorp sucks for at least these reasons too? That said, there's also the Baumol cost disease: in certain service industries, productivity increases are difficult to make (or even measure, really). We've tried to automate teaching and healthcare (&art!), but the results are mixed.. https://en.wikipedia.org/wiki/Baumol_effect https://en.wikipedia.org/wiki/Baumol_effect
- card_zero 2y agoInteresting, that puts doctors and teachers in the same boat as artists and police officers.
- dghlsakjg 2y agoPart of it may be that we have already done the easy parts of making medicine and education efficient. I can watch a lecture from a world class professor on my bus ride, or get an alert from my watch if I have an arrhythmia. If I want to ask the professor a question, or figure out why I have an arrhythmia I need to get personal attention and that is much harder.
- gsf_emergency 2y agoDefinitely (imho)! For more entertainment in this direction, consider looking at the not-very-conclusive back&forth between SSC (a healthcare practioner) & Robin Hanson (a theorist) on the effectiveness of healthcare spending. [It's telling that the practioner is in the house that believes that healthcare spending has been mostly effective.. re: SSC is saying that "the easy parts are still there?"] https://www.astralcodexten.com/p/highlights-from-the-comments-on-hanson https://www.astralcodexten.com/p/highlights-from-the-comment...
- gdjskshh 2y agoIt's fairly well accepted [citation needed?] that the most effective form of academic education is private tutoring by skilled tutors. We're (possibly) on the cusp of that being accessible to everyone via LLMs. In that brave new world schools need to shift towards a focus on development of personal character. MDs, at least those that you speak to in person, need to focus on bedside manner.
- gsf_emergency 2y agoYou don't think Aldous Huxley would be dandy with android MD's ;)?
- 082349872349872 2y agoDo people wind up in (what we would call) hospital in BNW, or do they get given an overdose* of soma while the next one gets decanted? * compare George V's last moments (time, manner, and place; especially time) I'd call it an influence, except it happened 4 years after BNW was published.
- gsf_emergency 2y agoI hadn't read Island but I'd like to imagine those kin of Hugin/Munin are cyborg MDs :) >Farnaby awakens on the island with a leg injury, hearing a myna bird screaming "Attention" Here Aldous seems to have gone beyond merely reacting to neoEdwardism..
- 082349872349872 2y agoHuh, found it at https://gutenberg.ca/ebooks/huxleya-island/huxleya-island-00-e.html https://gutenberg.ca/ebooks/huxleya-island/huxleya-island-00... So far reminding me a bit (in backstory) of https://en.wikipedia.org/wiki/The_Twenty-One_Balloons https://en.wikipedia.org/wiki/The_Twenty-One_Balloons
- gsf_emergency 2y ago
- donatj 2y agoI have talked about it here a couple times before but my last couple doctors have generally spent more time typing than talking to me. They've become more stenographer than physician. I have lamented how the need for record keeping has seemingly interfered with actual … listening and empathy. They're just typing away on the computer, and I have even had one Google my symptoms and pull up WebMD. The new piece to this story and in stark contrast - my wife and I recently had a child and our pediatrician is genuinely fantastic. Friendly, helpful, and actively listens to our concerns. It frankly gives me hope that such physician-ing is still possible in today's system. I don't know what it's going to take to get us back to a reasonable place, but I am frankly kind of hopeful for like some sort of AI note taker so that the doctor could be the human in the room again.
- freddie_mercury 2y agoThe need for record keeping isn't what has interfered with listening and empathy. Courts manage to have record keeping without the judge typing constantly. It just takes money. Either hiring someone to type for the doctor or paying the doctor enough that they can spend non-patient time typing up record keeping notes. In practice, just like with air lines, people's revealed preference is for low cost over great service.
- EdwardDiego 2y agoAI scribes is one of the few good uses of LLMs I'm seeing in the healthcare space currently. My doctor loves it, and have to agree the one he's using does a great job of transcribing and summarising. And the one we're offering in my company is getting a lot of love from doctors for very similar reasons, and how much time it saves them.
- sofixa 2y ago> I don't know what it's going to take to get us back to a reasonable place, but I am frankly kind of hopeful for like some sort of AI note taker so that the doctor could be the human in the room again Doctolib (premier healthcare startup in France, expanding into Italy and Germany, the vast majority of healthcare appointments happen via them) have an AI scribe project in public beta which seems to be working very well.
- shermantanktop 2y agoIf I never hear a manager utter “if you can’t measure it, you can’t manage it” again, it’ll be too soon. It’s one thing to suffer from a blinkered, reductive view of the world. It’s another thing to be proud of it.
- BurningFrog 2y agoWhats are some ways to manage unmeasurable things?
- dghlsakjg 2y agoEmpathy, trust, and experience.
- tmpz22 2y agoLeadership, humility, kindness
- nier 2y agoCoherence, balance, taste.
- DiscourseFan 2y agoone, two, three
- Almondsetat 2y agoLive, laugh, love
- lazystar 2y agoby having a vision of an ideal future
- deleted 2y ago[deleted]
- __MatrixMan__ 2y agoI think a lot of these harms could be mitigated by involving practitioners in metric selection. Let the staff pick a metric to focus on this quarter. Next quarter pick a different one. It's optimizing for the same number for ages which leads to the myopia, so lets find a balance re: how fresh we keep them.
- rsoto2 2y agoThere's always some dumb "futuristic" education/health solution when countless of countries do it better than the USA in both of these and they didn't have some big tech douchebag running the show. FUND education. Elect people that care about community and education not profits and reducing taxes for the rich(majority of both Rs and Ds) We live in a society, we are supposed to act civilized first, then throw AI tech solutions at problems. The problem is we do not act civilized, at least rich people and corps don't and rob society of basic funding. Look at food in schools big corps have regulatory capture and can put whatever shit in front of kids and get a stamp from the FDA. Unregulated hyper-concentration of wealth is going to look like and endless funnel to the richer classes and education won't get better even if you can throw some cheap ollama based tools at it.
- debacle 2y agoWe fund both education and healthcare at a much higher rate than the rest of the developed world. Funding is unequivocally not the problem.
- donatj 2y agoI don't think the problem is lack of funds. I live in the same district I attended thirty years ago, and my daughter will soon attend. It's a very well-to-do district, and funding per student is comparatively through the roof. Every kid has their own laptop. Small class sizes, smaller than when I attended. Smart boards and all that jazz. Test scores and the graduation rate have significantly decreased since I attended. The problem is more fundamental than lack of funds. It's what we're teaching and how. Throwing money at the problem blindly has not helped.
- rayiner 2y agoBaltimore spends more money per student than the rich suburb where I grew up. But the school district is probably run worse than the one in the Bangladeshi village where my dad grew up. At least in my dad’s village there is a motivating fear because there is no welfare state to support these kids after they learn nothing in school: https://katv.com/news/nation-world/23-baltimore-schools-have-zero-students-proficient-in-math-state-test-results-reveal-maryland-comprehensive-assessment-program-department-of-education-statistics-school-failures https://katv.com/news/nation-world/23-baltimore-schools-have...
- tptacek 2y agoI wish singleminded focus on measurable outcomes was the problem we have with US healthcare.
- throwaway14356 2y agofrom what i understand beds are really expensive where with beds we mean nurses and with expensive we mean profitable.
- hehbot 2y agoThe article isn't wrong, but mostly reads as one big truism. Until we have an actionable alternative to metrics-based systems, they are here to stay.
- deleted 2y ago[deleted]
- zharknado 2y agoFwiw early childhood education (pre-k) is a slam dunk, one of the highest ROÍ investments a society can make in its people. Yes it can be studied longitudinally and it does make a marked difference.
- debacle 2y agoI was being very nitpicky about the ideas shared here before I remembered that BetterSchooling is not a US institution, and so is not talking about US problems. In the US, only the title mostly applies.
- nine_zeros 2y agoHow about a quality and happy customer metric? How about a quality patient care metric? How about a metric which asks patients if they felt that the doctor could spend adequate time with them? How about a metric that measures how long it takes from a phone call to see the doctor? Ultimately, a lot of metric measuring management is not measuring what customers are asking for. They are only measuring BS that looks good to layers of management, with questionable value produced. No wonder people have become cynical and unhappy. Our institutions have forgotten to serve the people they are taking money and time from.
- Fomite 2y agoThis is not necessarily easy. For example, one of the metrics that patients in my field often advocate for is a stochastic, noisy signal at the end of a long causal chain. It's an important metric, but it's one that's very hard to actually use. But it's one that feels straightforward: Death.
- nine_zeros 2y ago> For example, one of the metrics that patients in my field often advocate for is a stochastic, noisy signal at the end of a long causal chain. But it's one that feels straightforward: Death. Which is why this is a dumb metric. You don't need to measure time to death. You need to measure time to response and time that the patient got with the doctor. And then, build systems that minimize mttr and maximize time with patient. To minimize mttr, hire more doctors who can be available. To maximize time with each patient, hire more doctors. Ultimately you need to have the right intent to begin with. And the right intent is to not measure the time to death. It is to measure the time to help and to make sure doctors get all the help in minimizing the time to help.
- otteromkram 2y agoFeel free to start with HEDIS and then move along to whichever healthcare quality metric group strikes your fancy next! https://www.ncqa.org/hedis/measures/ https://www.ncqa.org/hedis/measures/
- cyberax 2y ago> Take ApniPathshala, for instance – they're creating learning pods where children can engage in truly self-directed learning Yeah, children now spend days looking at Youtube hip-hop videos, learning nothing. > Rethink Metrics In other words: "The victims of our 'non-education' approach crater on standardized tests. So we must destroy the standardized tests"
- anothernewdude 2y agoBecause private alternatives exist, and therefore the wealthy and powerful have no reason to make public education or healthcare work. (Except for long-sighted views that they seem to lack, possibly because their education is also pretty bad.)
- whaaaaat 2y agoThe giant, terrible, AI generated header image isn't doing anything to support the page. IMO, either hire an artist for a sketch or remove the image. Seeing people standing around a classroom... hospital?... as amputees and weird shaped people in a space that's too large for them is very disquieting and distracting from the piece later on.
- aboardRat4 2y agoI liked this image.
- whaaaaat 2y agoWhy? What about it spoke to you? Was it the messed up human anatomy? The letters and numbers being misformed? The lack of faces? The weird choice of unnecessary detail and bizarre scale?
- ChaitanyaSai 2y agoAgreed, the scaling is because of the CMS. Changed the image
- dw_arthur 2y agoWhy are they using an AI image for an article complaining about human autonomy being taken out of education and healthcare? People just don't get it.
- throwaway14356 2y agodidn't give it much thought but couldn't you eventually run schools and universities on a percentage of student income tax (and remove all other sources) combined with a periodic questionnaire (for life) how [?????] one thinks their education was. probably a bad idea but it gets me to ponder long term measurements
- dghlsakjg 2y agoThis assumes that schools are run purely for the future profitable careers of students. If you were a dean deciding what to invest in, would you ever give the teaching school more money? Would the medical school ever train another tropical disease specialist?
- throwaway14356 2y agoi wonder, is that specialist suppose to not make money their entire career? I think actually good education would allow them to do all kinds of things. I do feel the raw idea is bad then added the survey to measure [????] say quality of life kind of things. If a school produces somewhat useful people who are really happy it seems to merit more funding. The economy may die if everyone has a good life
- dghlsakjg 2y ago> i wonder, is that specialist suppose to not make money their entire career? I think actually good education would allow them to do all kinds of things. School teachers and tropical disease specialists both make money, but they often make less money than others with similar educations. If a school is judged on future earnings it will optimize around that, and the predictable outcome to such an incentive is that programs that lead to lower paying careers will suffer.
- throwaway14356 2y agowouldn't the scarcity increase the value? Why would we want people to study things we don't need and not study things in high demand? I wonder what the real cost is. My school does about 80:1 in diplomas:jobs every year. I got the job :) no one else did but they didn't do anything wrong. They just wasted years and money both their own and public funds.
- intended 2y ago0) Metrics sure as heck aren’t the issue, because we already have metrics which tell us what to do. There are entire basic fields of economics, sociology and math which have told us how to order these industries to get better outcomes. Since the Scottish widows fund. 1) Healthcare in the USA sucks because politics prevents you from remembering how insurance works. The most basic of basic financial calculations, the advantages of a large pool to absorb risk, vs smaller pools. 2) Education has different reasons for being problematic, and it’s not just in the USA. The USA has only caught up to the problems in the rest of the developing world, having never had to content with these problems before.
- low_tech_love 2y agoHonest question: do you think this article would be worse off without that horrendous image at the start? In other words, was it necessary for the author to add a horror-movie drawing of a hellish hospital within a distorted reality full of misshapen demons in order to make their point?
- ChaitanyaSai 2y agoPoint taken. Used a different image.
- aaron695 2y ago[dead]
- aboardRat4 2y ago>Return to First Principles We must reconnect with the fundamental purpose of these institutions. Hmmm... I suspect this guy has some misguided picture of what the first principles are. Last time I checked, the first principle of healthcare was "make sure as many wounded soldiers get back to the front line", and the first principle of healthcare was "don't let hordes of poor teenagers roam the streets and earn their booze and alcohol with pretty crime and prostitution by keeping them busy somewhere".
- nutanc 2y agoI think it all boils down to goals. If we need a standard health care and standard education, we will need standardization. If we need to handle special personal cases, we need special treatment. Things can be improved, but frankly I am amazed at how process oriented our education and health care has become. Follow the steps specified by a school, get the minimum marks specified, that means you have learnt the basic skill set needed by you to function in society. If you need to learn extra, there are other channels available. Same thing with health care. A patient shows some numbers, treat those numbers. If something feels off, the doctor takes the call. That's why we still have human doctors and not AI. Also, one major difference between education and health care, in education the customer is different from the one who pays. So the goals get differently from the start(make my kid the best mathematician-parent(paying), I want to be a footballer-kid). So who should the school listen to :)
- from-nibly 2y ago> Also, one major difference between education and health care, in education the customer is different from the one who pays. That's actually the same in education and healthcare. And probably the real root of the issues with both. I don't pay for health care I pay for insurance. In fact I don't really pay for that. My company pays for it. I just have to throw some money in the money pit when my employer pays and when I go to get care. I don't get to choose my healthcare, and I don't get to choose the procedures. Hospitals pair up with insurance companies and stay with them. The hospitals work for the insurance companies. When you pay for health insurance you are essentially paying a monthly fee to get healthcare from a specific company. The more they treat the more money they make, because if they over treat and they don't make enough money they just raise rates. You don't have a choice to switch to a new provider. Heck you can't even change your plan except once a year in November. It's the same thing as stuff that's free. You aren't the customer you are the product.
- nutanc 2y agoOk. Guess its different in the US when compared to India. Looks like US system does tie your hands down when it comes to healthcare based on your explanation.
- arp242 2y ago> Both healthcare and education faced similar pressures in the 20th century. As knowledge expanded exponentially, systems needed to scale up to serve more people. The solution? Standardization. Create protocols, establish benchmarks, develop universal procedures. It worked – sort of. I'm not so sure standardisation due to scaling is really as the cause of this. None of the problems the author points out are really novel observations; I've been hearing this sort of thing my entire adult life, 25 years now. So why doesn't anything change? I suspect the cause is more a lack of trust in people, as well as a fear of things going wrong. Maybe that comes out of scaling: no one really knows what anyone is doing and everyone is a "stranger". So we have all these controls because we don't trust the nurses to nurse, the teachers to teach, etc. I feel this matters because without identifying the cause, you're not going to find a solution, which is probably to think of ways to increase trust, and to increase societal acceptance that sometimes things go wrong and that's okay, because sometimes the cure is worse than the disease. I'm not really sure how to go about that though – a big part of the problem are toxic media outlets that will abuse any incident to attack $disfavoured_politician without regard for truth or fairness. The incentives for politicians are pretty skewed. I don't think that "self-directed learning pods" or "community-funded clinics" are really the path forward. It all sounds very nice, but you can't really run the entire country's system on this for a number of reasons. Sounds more of a libertarian pipe dream than anything else.
- entropyneur 2y agoNot really. Education sucks because it doesn't scale. Every single child needs to be educated and educating them takes thousands (or tens of thousands) of hours of teacher work. Meanwhile an average person probably requires only tens of hours of doctor work in teir lifetime. Imagine doctors having to treat people by a roomful (even if they were pre-sorted by vaguely similar diagnosis). That would suck indeed.
- huijzer 2y ago> The Tyranny of Metrics For people interested in this, I can recommend Tory Sutherland's book or interviews with him on YouTube. Tory is also consistently arguing that businesses and governments are too focused on metrics.
- lurking15 2y agoThe worst metric obsession that defines things now is stock price, which really went into overdrive with the financialization of the 70s~80s. Of course financialization was downstream of the money supply and people seeking out returns on their savings in inflationary environments (modern economic theory that thinks never-ending inflation is just a law we must all accept and conform to), which is used a way to finance big government.
- sorrythanks 2y agokill all quants
- deleted 2y ago[deleted]
- Jhyrachy 2y agoI'm a surgeon; healthcare sucks because people have unrealistic expectation of what it's actually possible and politicians have no interests in defending healthcare workers but they actually double down bashing on them every chance they get. Since health-care became a commodity, we lost touch about what it really is and what it can really do.
- jmye 2y agoI’m so tired of people who don’t know anything about healthcare opining confidently about it. Pretending that the issues in care are metrics and not stupid fee-for-service incentives (ignoring the myriad Rx issues and system failures) and an abject failure to improve the supply of providers is ridiculous nonsense.