5 ms·

I worked for the "Father of Robotic Surgury" and once in a company-wide meting he said "The general public would be pretty happy with the average surgeons resul

I worked for the "Father of Robotic Surgury" and once in a company-wide meting he said "The general public would be pretty happy with the average surgeons results, but they would be horrified by the below average surgeons results". Their goal was to bridge that gap with robotics.

AStonesThrow 2y ago
Like bridging it in this sense? https://en.wikipedia.org/wiki/Brooklyn_Bridge#Culture https://en.wikipedia.org/wiki/Brooklyn_Bridge#Culture
Calavar 2y ago
I'm not a surgeon myself, but when I was in medical school the program director of our local general surgery residency told me that in terms of hand skills 90% of surgeons are more or less average, 10% are masters, and 10% are horrific. (So basically a bell curve with very thin tails.) He also said the correlation between test scores and surgical hand skills was pretty week.
- fsckboy 2y ago
  >correlation between test scores and surgical hand skills was pretty week even if hand skills is orthogonal to test scores, test scores could still be highly correlated with outcomes
- deleted 2y ago
  [deleted]
- MichaelZuo 2y ago
  That adds up to 110%…
  - kinggrowler 2y ago
    He's a surgeon, not a mathematician.
    - throwaway127482 2y ago
      Lol literal first four words of the comment said he's not a surgeon
      - SlightlyLeftPad 2y ago
        He’s a brick layer, not a linguist.
  - rscho 2y ago
    Which must make it the most MD comment I've seen in a long time. It's hilarious!
  - solardev 2y ago
    That's just the normal level of performance people expect of their doctors, 24 hours a day, 8 days a week.
- 3eb7988a1663 2y ago
  How much of surgery is based on dexterity vs knowledge/attention-to-detail? I sort of assumed that most operations are basic plumbing (A connects to B) while there are a few specialized domains that require exquisite deftness.
  - rscho 2y ago
    The question is too general. Depends a lot on the kind of surgery you're doing. I guess the answer you're looking for is that anyone could be a surgeon, but not for all kinds of surgery. Also 'basic plumbing' with no room for error is not an easy thing at all.
  - Tade0 2y ago
    I'm just relaying what my friend who is studying to become a doctor told me, but by his account there's a wealth of techniques for each procedure or even parts of it, like tying up the dangling bits after kidney removal. Ultimately it boils down to what a given surgeon practiced in their career.
  - iancmceachern 2y ago
    Most complex or endoscopic surgeries are (dependent on dexterity)
  - iancmceachern 2y ago
    It's more in that if you improperly connect a to b someone dies, and it's not just a snap fit like a pipe. You need to do things like suture two blood vessels together, using pliers (not the technical term), inside a dark box lit up by a tube, while looking at an upside down TV image of what's going on.
    - devilbunny 2y ago
      It doesn’t have to be upside down; you can just rotate the camera to any angle you like.
- thaumasiotes 2y ago
  > (So basically a bell curve with very thin tails.) Is this a concept that exists? I thought "thin tailed" and "fat tailed" were defined by contrast to a normal distribution.
  - Ma8ee 2y ago
    I don't think that "Bell curve" should be interpreted strictly as a Gaussian in this context, but more literally as a curve with a shape resembling a bell.
  - rscho 2y ago
    From a doc, it was just a figure of speech. Most docs have no idea what a statistical distribution is.
  - Unlisted6446 2y ago
    I'm pretty sure, yes? Cauchy distribution and student-t have fatter tails than a standard normal distribution.
  - hydrogen7800 2y ago
    Kurtosis[0] is a term I came across when dealing with random vibration analysis, but I understand very little if it. The idea of "moments"[1] of various orders to describe a shape of distribution is interesting in general. It sounds analogous to Fourier series, describing a shape/graph with a series of values. [0]https://en.m.wikipedia.org/wiki/Kurtosis https://en.m.wikipedia.org/wiki/Kurtosis [1]https://en.m.wikipedia.org/wiki/Moment_(mathematics) https://en.m.wikipedia.org/wiki/Moment_(mathematics)
    - thaumasiotes 2y ago
      That says exactly the same thing I just said: > Excess kurtosis, typically compared to a value of 0, characterizes the “tailedness” of a distribution. A univariate normal distribution has an excess kurtosis of 0. Negative excess kurtosis indicates a platykurtic distribution, which doesn’t necessarily have a flat top but produces fewer or less extreme outliers than the normal distribution. For instance, the uniform distribution (ie one that is uniformly finite over some bound and zero elsewhere) is platykurtic. On the other hand, positive excess kurtosis signifies a leptokurtic distribution. The Laplace distribution, for example, has tails that decay more slowly than a Gaussian, resulting in more outliers. (Emphasis added.) You can't have a bell curve with thin tails, because a bell curve has standard tails by definition.
hibikir 2y ago
It's not just that there are low performers, but that systems aren't always built to send them to do something else quickly. When my mom need her second urgent brain surgery, one of the nurses, a friend of a friend, warned us that one of the surgeons on staff that night had dreadful results with basically any procedure. and that if we were stuck with him, that refusing the surgery until another one was able to come in. If the floor nurses know, the head on neurology knows, and yet, they were still OK letting them operate. Any functioning system just has to eject surgeons that get bad outcomes. It's not as if they have to stop practicing medicine, but move to something a little less dangerous.
- Calavar 2y ago
  I agree with the sentiment. The specifics of the implementation are hard. When it comes to bad doctors, I think a lot of people in the medical field would agree "you know one when you see one." But when you're talking about putting professional restrictions on someone, you need objective criteria. The naive way, counting up bad outcomes, leads to a system where surgeons are incentivized to decline any case that looks technically difficult or where the patient has lots of preexisting conditions that put them at risk for complications after the surgery. We already see this to a degree in transplant surgery, where outcomes are followed closely to avoid wasting organs. That said, I think true incompetence is pretty rare. I can't think of a single doctor I 've worked with professionally where I'd be concerned if I found out they were taking care of one of my immediate family.
  - marbro 2y ago
    I want surgeons to decline any case that looks technically difficult. A better surgeon should handle those cases. I want them to decline cases where lots of preexisting conditions that put them at risk for complications after the surgery, too. I'm worried about surgeons who never decline cases, who are eager to cut and maximize profits. We need more malpractice lawsuits so that surgeons become more willing to decline cases.
    - Calavar 2y ago

AStonesThrow 2y ago

Like bridging it in this sense? https://en.wikipedia.org/wiki/Brooklyn_Bridge#Culture https://en.wikipedia.org/wiki/Brooklyn_Bridge#Culture

Calavar 2y ago

I'm not a surgeon myself, but when I was in medical school the program director of our local general surgery residency told me that in terms of hand skills 90% of surgeons are more or less average, 10% are masters, and 10% are horrific. (So basically a bell curve with very thin tails.) He also said the correlation between test scores and surgical hand skills was pretty week.

fsckboy 2y ago
>correlation between test scores and surgical hand skills was pretty week even if hand skills is orthogonal to test scores, test scores could still be highly correlated with outcomes
deleted 2y ago
[deleted]
MichaelZuo 2y ago
That adds up to 110%…
- kinggrowler 2y ago
  He's a surgeon, not a mathematician.
  - throwaway127482 2y ago
    Lol literal first four words of the comment said he's not a surgeon
    - SlightlyLeftPad 2y ago
      He’s a brick layer, not a linguist.
- rscho 2y ago
  Which must make it the most MD comment I've seen in a long time. It's hilarious!
- solardev 2y ago
  That's just the normal level of performance people expect of their doctors, 24 hours a day, 8 days a week.
3eb7988a1663 2y ago
How much of surgery is based on dexterity vs knowledge/attention-to-detail? I sort of assumed that most operations are basic plumbing (A connects to B) while there are a few specialized domains that require exquisite deftness.
- rscho 2y ago
  The question is too general. Depends a lot on the kind of surgery you're doing. I guess the answer you're looking for is that anyone could be a surgeon, but not for all kinds of surgery. Also 'basic plumbing' with no room for error is not an easy thing at all.
- Tade0 2y ago
  I'm just relaying what my friend who is studying to become a doctor told me, but by his account there's a wealth of techniques for each procedure or even parts of it, like tying up the dangling bits after kidney removal. Ultimately it boils down to what a given surgeon practiced in their career.
- iancmceachern 2y ago
  Most complex or endoscopic surgeries are (dependent on dexterity)
- iancmceachern 2y ago
  It's more in that if you improperly connect a to b someone dies, and it's not just a snap fit like a pipe. You need to do things like suture two blood vessels together, using pliers (not the technical term), inside a dark box lit up by a tube, while looking at an upside down TV image of what's going on.
  - devilbunny 2y ago
    It doesn’t have to be upside down; you can just rotate the camera to any angle you like.
thaumasiotes 2y ago
> (So basically a bell curve with very thin tails.) Is this a concept that exists? I thought "thin tailed" and "fat tailed" were defined by contrast to a normal distribution.
- Ma8ee 2y ago
  I don't think that "Bell curve" should be interpreted strictly as a Gaussian in this context, but more literally as a curve with a shape resembling a bell.
- rscho 2y ago
  From a doc, it was just a figure of speech. Most docs have no idea what a statistical distribution is.
- Unlisted6446 2y ago
  I'm pretty sure, yes? Cauchy distribution and student-t have fatter tails than a standard normal distribution.
- hydrogen7800 2y ago
  Kurtosis[0] is a term I came across when dealing with random vibration analysis, but I understand very little if it. The idea of "moments"[1] of various orders to describe a shape of distribution is interesting in general. It sounds analogous to Fourier series, describing a shape/graph with a series of values. [0]https://en.m.wikipedia.org/wiki/Kurtosis https://en.m.wikipedia.org/wiki/Kurtosis [1]https://en.m.wikipedia.org/wiki/Moment_(mathematics) https://en.m.wikipedia.org/wiki/Moment_(mathematics)
  - thaumasiotes 2y ago
    That says exactly the same thing I just said: > Excess kurtosis, typically compared to a value of 0, characterizes the “tailedness” of a distribution. A univariate normal distribution has an excess kurtosis of 0. Negative excess kurtosis indicates a platykurtic distribution, which doesn’t necessarily have a flat top but produces fewer or less extreme outliers than the normal distribution. For instance, the uniform distribution (ie one that is uniformly finite over some bound and zero elsewhere) is platykurtic. On the other hand, positive excess kurtosis signifies a leptokurtic distribution. The Laplace distribution, for example, has tails that decay more slowly than a Gaussian, resulting in more outliers. (Emphasis added.) You can't have a bell curve with thin tails, because a bell curve has standard tails by definition.

hibikir 2y ago

It's not just that there are low performers, but that systems aren't always built to send them to do something else quickly. When my mom need her second urgent brain surgery, one of the nurses, a friend of a friend, warned us that one of the surgeons on staff that night had dreadful results with basically any procedure. and that if we were stuck with him, that refusing the surgery until another one was able to come in. If the floor nurses know, the head on neurology knows, and yet, they were still OK letting them operate. Any functioning system just has to eject surgeons that get bad outcomes. It's not as if they have to stop practicing medicine, but move to something a little less dangerous.

Calavar 2y ago
I agree with the sentiment. The specifics of the implementation are hard. When it comes to bad doctors, I think a lot of people in the medical field would agree "you know one when you see one." But when you're talking about putting professional restrictions on someone, you need objective criteria. The naive way, counting up bad outcomes, leads to a system where surgeons are incentivized to decline any case that looks technically difficult or where the patient has lots of preexisting conditions that put them at risk for complications after the surgery. We already see this to a degree in transplant surgery, where outcomes are followed closely to avoid wasting organs. That said, I think true incompetence is pretty rare. I can't think of a single doctor I 've worked with professionally where I'd be concerned if I found out they were taking care of one of my immediate family.
- marbro 2y ago
  I want surgeons to decline any case that looks technically difficult. A better surgeon should handle those cases. I want them to decline cases where lots of preexisting conditions that put them at risk for complications after the surgery, too. I'm worried about surgeons who never decline cases, who are eager to cut and maximize profits. We need more malpractice lawsuits so that surgeons become more willing to decline cases.
  - Calavar 2y ago