4 ms·

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

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
    > I want surgeons to decline any case that looks technically difficult. A better surgeon should handle those cases. Already happens all the time, although it's at the discretion of the first surgeon. Again, it's difficult to formulate objective criteria for when a surgeon should forward a case on to someone else. I don't believe that surgeons obviously over operate. In my career I've seen - A case where the surgical team declined to operate for endocarditis with congestive heart failure, despite the fact that the society guidelines recommend surgery in that scenario - A case where the surgical team declined to operate for a spinal cord injury that left a patient paralyzed from the neck down (and dependent on machines to breathe due to the paralysis affecting their diaphragm) - A case where the surgical team declined to operate on an abscess even after a patient's blood stream infection failed to clear after two weeks of the strongest IV antibiotics In all the first and third cases, the disease turned terminal after our surgical team declined to operate. In the second example the patient opted to die rather than live the rest of their life on a ventilator and I was left with the responsibility of arranging hospice for the patient. I'll admit that these are extreme cases, but my point is the patients and family members in those cases likely had a very different view about whether surgeons should decline high risk surgeries as often as they do, let alone more often.
  - moi2388 2y ago
    I don’t. I want the surgeon to clearly state their concerns and the risks, but the patient to decide if it’s worth the risk. After all, it’s his/her life.
mlyle 2y ago
The problem is we don't exactly have a surplus of surgeons. The choice could be between a below average surgeon and no surgeon. Part of this is the AMA cartel artificially limiting the supply of residencies.

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
  > I want surgeons to decline any case that looks technically difficult. A better surgeon should handle those cases. Already happens all the time, although it's at the discretion of the first surgeon. Again, it's difficult to formulate objective criteria for when a surgeon should forward a case on to someone else. I don't believe that surgeons obviously over operate. In my career I've seen - A case where the surgical team declined to operate for endocarditis with congestive heart failure, despite the fact that the society guidelines recommend surgery in that scenario - A case where the surgical team declined to operate for a spinal cord injury that left a patient paralyzed from the neck down (and dependent on machines to breathe due to the paralysis affecting their diaphragm) - A case where the surgical team declined to operate on an abscess even after a patient's blood stream infection failed to clear after two weeks of the strongest IV antibiotics In all the first and third cases, the disease turned terminal after our surgical team declined to operate. In the second example the patient opted to die rather than live the rest of their life on a ventilator and I was left with the responsibility of arranging hospice for the patient. I'll admit that these are extreme cases, but my point is the patients and family members in those cases likely had a very different view about whether surgeons should decline high risk surgeries as often as they do, let alone more often.
- moi2388 2y ago
  I don’t. I want the surgeon to clearly state their concerns and the risks, but the patient to decide if it’s worth the risk. After all, it’s his/her life.

mlyle 2y ago

The problem is we don't exactly have a surplus of surgeons. The choice could be between a below average surgeon and no surgeon. Part of this is the AMA cartel artificially limiting the supply of residencies.