5 ms·

>my dad is dead, because his family members were too naive to know that the thing they were instructed to do by the state was a false thing. We're told a lot o

by ugh123 11mo ago

>my dad is dead, because his family members were too naive to know that the thing they were instructed to do by the state was a false thing. We're told a lot of things by "officials" not because it's correct, but because it holds the least legal liability for official parties involved, especially anything involving healthcare. These officials also sometimes include doctors, who work to protect themselves and the system first, and then patients.

vkou 11mo ago
We're also told to do a lot of things by officials because it's correct most of the time, but with the benefit of 20/20 hindsight, generally correct advice can turn out to be dead wrong for you. Sometimes doing what you're told is the right thing. Sometimes, not doing what you're told is the right thing. Sometimes, you're told to do the intuitive thing, and it's wrong. Sometimes, you're told to do the unintuitive thing, and it's wrong. It's hard to tell the difference between those situations, even when you're not stressed.
- userbinator 11mo ago
  Perhaps 2020 hindsight, even.
  - vkou 11mo ago
    The 2020, in hindsight was largely correct. COVID was a highly infectious disease, it put a lot of people in the hospital, and a lot of people in the morgue. Social distancing and wearing masks slowed its spread, until an effective, safe vaccine was developed. Horse paste was not a cure for it, and after further investigation it turns out that it only had a positive effect on patients who, in addition to having COVID, also had worms. (To the surprise of absolutely everyone, it turned out that giving de-wormer to people with worms improved their health.) For some reason, chronic contrarians always to point at a few details that were gotten wrong during the fog of war, and shout from the rooftops that if only they were in charge, we'd all be living in castles made of candy and shitting rainbows. Joke's on us, though, those contrarians have since made a moron who doesn't believe in germs... The Secretary of Health.
    - raw_anon_1111 11mo ago
      Every time I give this opinion I’m labeled as an a to science/anti vaxxer. Hopefully this context will help: I have virus induced asthma where even a simple cold can have me gasping for breath. I took every precaution imaginable before the vaccines were available, stayed home, got groceries delivered, masked up when I did have to go somewhere, asked my wife to retire from working in the school system as a special needs bus driver, etc. I got in early when the J and J vaccine was available and I got an mRNA booster before it was recommended in the US when I saw other countries health departments recommended. But let’s not pretend that many of the precautions and policies weren’t performative. Mask mandates were always dumb. Most people didn’t wear effective masks and many didn’t cover their noses. You had to wear a mask on airlines long after the vaccines were available and everyone took them off at the same time to eat or drink. The US government down played that immunity wore off within six months and that the vaccine was much less effective than they publicized at first even when there were credible studies and evidence from other countries health departments and domestically. Again, I have every recommended vaccine imaginable. I get a flu shot every year and Covid shots at the recommended times
      - bsder 11mo ago
        > But let’s not pretend that many of the precautions and policies weren’t performative. Mask mandates were always dumb. Most people didn’t wear effective masks and many didn’t cover their noses. We have specific evidence that not masking and not distancing caused superspreader events. Before there were too many cases, contact tracing backwards showed that specific parties, weddings, etc. were responsible for accelerating the early spread above baseline. Thus, the burden of proof is on the "anti-mask, anti-distancing" people to prove that they aren't worse than the alternative--doubly so given the post hoc analyses available due to Norway and Sweden.
        raw_anon_1111 11mo ago
        I didn’t say that properly worn N95 masks don’t work. I said it was stupid to have a mask mandate when most people wore ineffective cloth masks and even then didn’t cover their nose. I said it was equally dumb to require masks on airplanes and then everyone take them off at the same time while eating.
zahlman 11mo ago
Okay, but we're also specifically told to wait for ambulances because they can administer certain forms of care within the vehicle, right?
- grogenaut 11mo ago
  Like most things, it gets pretty complicated. I went through 200 hours of training (EMT) which essentially helps me sort into what makes me go safe, go fast to a medic en route or a hospital, and go fast to a hospital (where a paramedic can't help much or at all). The goal of all Emergency medical personnel is to get people to definitive care (not EMS). Asking a lay person to know what a BLS (non-EMT fire & police), EMT (Ambulance), Parmedic, or MSO can take care of, or even what the differences are, is, I don't think, super useful. The red vehicle shows up and takes you to care. In the case of MCI, EMTs can a) give aspirin or nitro (rx), b) have an AED and lots of CPR training but have to stop the vehicle to give effective compressions, c) a radio and the ability to meet up with Paramedics. Paramedics have more complex treatments (drugs) and EKGs, but it's still 2 folks in a truck, not a hospital. They can do amazing things. But as the joke goes, sometimes the best treatment is High Volume Diesel Therapy (burn rubber).
  - FabHK 11mo ago
    > Like most things, it gets pretty complicated. As far as I know, there are also different paradigms for ambulances: "scoop and run" (ie stabilise the patient and take them to a hospital ASAP) vs "stay and play" (try the first line of treatment there before taking the patient to the hospital). Different countries (with different urban environments, distances, etc.) use different approaches.
- kelnos 11mo ago
  It kind of depends. EMTs are able to do some things, paramedics are able to do more things, and the hospital itself can do even more things. I live about 6 minutes from the closest ER. If an ambulance can get to me in, say, 3 minutes, it's still not clear if it's better for me to get myself to the ER on my own. Maybe I get an ambulance with EMTs who aren't trained/authorized to do what needs to be done for me. Maybe I really need to be at the hospital within 8 minutes or I'm going to die, and waiting for an ambulance just isn't going to cut it. But I think, statistically, people should usually prefer to wait for the ambulance. It's just that specific circumstances can make that the wrong move, but most people won't know when that's the case.
2muchcoffeeman 11mo ago
This is very conspiratorial thinking. Do you really think that in a high stress situation you’re going to make the best decisions? Do you really think health workers are all concerned about legalities first? Not moving a patient unless you explicitly know how is probably right the vast majority of the time. Sometimes that’s wrong, but how are you going to get the entire public to understand what the right situation is? It’s so easy looking at a single case in hindsight. May we all have the ability to make the right choices all the time.
- _drimzy 11mo ago
  > Do you really think that in a high stress situation you’re going to make the best decisions? I mean that statement could be used to excuse any mistake in any project/system ever made, and is mostly a cop out. Yes, the system is definitely designed to minimize legal risk for the health-workers/hospitals. A system is only as good as what it's' design objectives are, and if "save a life at all cost" was the objective the system might as well look entirely different.
- wk_end 11mo ago
  It's not that health workers are always thinking about legality; it's that they're following policies either written by people thinking about legality or re-written by people in response to legality, i.e. they got sued and changed the policy in light of that.
- somenameforme 11mo ago
  > Do you really think health workers are all concerned about legalities first? 100%. Legal issues are a huge deal in healthcare. This is a snippet from a study [1] on the topic, just to get an idea of the scale (which I think most do not realize at all): --- Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants). The proportion of physicians facing a claim each year ranged from 19.1% in neurosurgery, 18.9% in thoracic–cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry. The mean indemnity payment was $274,887, and the median was $111,749. Mean payments ranged from $117,832 for dermatology to $520,923 for pediatrics. It was estimated that by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties. --- I can give a very specific example of how legal issues play directly into behavior, and how it leads to antibiotic over-prescription. Antibiotics are obviously useless against viral infections but many, if not most, doctors will habitually describe them for viral infections anyhow. Why? Because a viral infection tends to leave your body more susceptible to bacterial infections. For instance a flu (viral) can very rarely lead to pneumonia (bacterial). And that person who then gets very sick from pneumonia can sue for malpractice. It's not malpractice because in the average case antibiotic prescription is not, at all, justified by the cost:benefit, but doctors do it anyhow to try to protect themselves from lawsuits. There have been studies demonstratively showing this as well, in that doctors who live in areas with less rampant malpractice lawsuits are less likely to prescribe antibiotics unless deemed necessary. Or if you have a friend/family in medicine you can simply ask them about this - it's not some fringe thing. [1] - https://web.archive.org/web/20250628065433/https://www.nejm.org/doi/full/10.1056/NEJMsa1012370 https://web.archive.org/web/20250628065433/https://www.nejm....
energy123 11mo ago
Incompetence and laziness among doctors is a big cause. As a professional you've probably worked with many colleagues you thought were bad. Well there are doctors like that too. Many of them. And unlike in tech, they don't get let go if they're bad. They stay around and keep "treating" patients.
- nrhrjrjrjtntbt 11mo ago
  I was thinking this the other day about GP. If I work in tech I work in a team and we pair. Why doesnt this happen with doctors. Why is everything all on one mind to get wrong or right. Yes there is a team of doctors sometimes but they communicate via emails async and you visit one then the next and so on. I guess I know the answer. Money.
  - mgh2 11mo ago
    Short supply, high demand
    - mckn1ght 11mo ago
      And imagine if we had the same requirements to write software as we do to perform surgery! Things would be very different.
      - wk_end 11mo ago
        On the flip side, if/when I ever go for surgery I'm pretty damn glad we don't have the same requirements to perform surgery as we do to write software.
  - deleted 11mo ago
    [deleted]
  - nradov 11mo ago
    Medicine is a team activity. There is no amount of money which could ever make it feasible to have multiple physicians working simultaneously on routine cases, but they do delegate some tasks to lower licensed providers such as nurses and technicians. For really complex cases there is the Mayo Clinic model (also used in a few other health systems). A patient can come for a day and be seen by an integrated team of specialists to get a diagnosis and treatment plan. But this isn't really scalable. https://www.mayoclinic.org/patient-centered-care/what-makes-mayo-clinic-different https://www.mayoclinic.org/patient-centered-care/what-makes-...
godelski 11mo ago
> We're told a lot of things by "officials" not because it's correct Often these rules are in place because they are statistically correct. What needs to be understood is that no rule can be so well written that there are no exceptions. Rules are guides. Understanding this we can understand why certain guidelines are created, because they are likely the right response 9/10 times. This is especially important when dealing with high stress and low information settings. BUT being statistically correct does not mean correct. For example, if the operator had information about the ETA of the ambulance (we don't know this!) then the correct answer would have been to tell them to not wait. But if the operator had no information, then the correct decision is to say to wait. The world is full of edge cases. This is a major contributor to Moravec's paradox and why bureaucracies often feel like they are doing idiotic things. Because you are likely working in a much more information rich environment than the robot was designed for or the bureaucratic rules were. The lesson here is to learn that our great advantage as humans is to be flexible. To trust in people. To train them properly but also empower them to make judgement calls. It won't work out all the time, but doing this tends to beat the statistical rate. The reason simply comes down to "boots on the ground" knowledge. You can't predict every situation and there's too many edge cases. So trust in the people you're already putting trust into and recognize that in the real world there's more information to formulate decisions. You can't rule from a spreadsheet no more than you can hike up a mountain with only a map. The map is important, but it isn't enough.
- kelnos 11mo ago
  This was exactly what I was thinking (though less eruditely) when I was reading the blog post. In this particular case, waiting for the ambulance led to a worse outcome, but I would not be surprised that, statistically, a you're better off waiting for the ambulance than trying to get to the hospital via other means. But unfortunately: > if the operator had information about the ETA of the ambulance (we don't know this!) then the correct answer would have been to tell them to not wait. But if the operator had no information, then the correct decision is to say to wait. I expect the operator just is not allowed to give advice like that, even if they did have information on ambulance ETA. There could be liability if someone is advised to drive to the hospital, and something bad happens. Even if that bad thing would have happened regardless. I think that's a bad reason to do the situation-dependent incorrect thing, but that's unfortunately how the world works sometimes.
deleted 11mo ago
[deleted]

by ugh123 11mo ago

vkou 11mo ago

We're also told to do a lot of things by officials because it's correct most of the time, but with the benefit of 20/20 hindsight, generally correct advice can turn out to be dead wrong for you. Sometimes doing what you're told is the right thing. Sometimes, not doing what you're told is the right thing. Sometimes, you're told to do the intuitive thing, and it's wrong. Sometimes, you're told to do the unintuitive thing, and it's wrong. It's hard to tell the difference between those situations, even when you're not stressed.

userbinator 11mo ago
Perhaps 2020 hindsight, even.
- vkou 11mo ago
  The 2020, in hindsight was largely correct. COVID was a highly infectious disease, it put a lot of people in the hospital, and a lot of people in the morgue. Social distancing and wearing masks slowed its spread, until an effective, safe vaccine was developed. Horse paste was not a cure for it, and after further investigation it turns out that it only had a positive effect on patients who, in addition to having COVID, also had worms. (To the surprise of absolutely everyone, it turned out that giving de-wormer to people with worms improved their health.) For some reason, chronic contrarians always to point at a few details that were gotten wrong during the fog of war, and shout from the rooftops that if only they were in charge, we'd all be living in castles made of candy and shitting rainbows. Joke's on us, though, those contrarians have since made a moron who doesn't believe in germs... The Secretary of Health.
  - raw_anon_1111 11mo ago
    Every time I give this opinion I’m labeled as an a to science/anti vaxxer. Hopefully this context will help: I have virus induced asthma where even a simple cold can have me gasping for breath. I took every precaution imaginable before the vaccines were available, stayed home, got groceries delivered, masked up when I did have to go somewhere, asked my wife to retire from working in the school system as a special needs bus driver, etc. I got in early when the J and J vaccine was available and I got an mRNA booster before it was recommended in the US when I saw other countries health departments recommended. But let’s not pretend that many of the precautions and policies weren’t performative. Mask mandates were always dumb. Most people didn’t wear effective masks and many didn’t cover their noses. You had to wear a mask on airlines long after the vaccines were available and everyone took them off at the same time to eat or drink. The US government down played that immunity wore off within six months and that the vaccine was much less effective than they publicized at first even when there were credible studies and evidence from other countries health departments and domestically. Again, I have every recommended vaccine imaginable. I get a flu shot every year and Covid shots at the recommended times
    - bsder 11mo ago
      > But let’s not pretend that many of the precautions and policies weren’t performative. Mask mandates were always dumb. Most people didn’t wear effective masks and many didn’t cover their noses. We have specific evidence that not masking and not distancing caused superspreader events. Before there were too many cases, contact tracing backwards showed that specific parties, weddings, etc. were responsible for accelerating the early spread above baseline. Thus, the burden of proof is on the "anti-mask, anti-distancing" people to prove that they aren't worse than the alternative--doubly so given the post hoc analyses available due to Norway and Sweden.
      - raw_anon_1111 11mo ago
        I didn’t say that properly worn N95 masks don’t work. I said it was stupid to have a mask mandate when most people wore ineffective cloth masks and even then didn’t cover their nose. I said it was equally dumb to require masks on airplanes and then everyone take them off at the same time while eating.

zahlman 11mo ago

Okay, but we're also specifically told to wait for ambulances because they can administer certain forms of care within the vehicle, right?

grogenaut 11mo ago
Like most things, it gets pretty complicated. I went through 200 hours of training (EMT) which essentially helps me sort into what makes me go safe, go fast to a medic en route or a hospital, and go fast to a hospital (where a paramedic can't help much or at all). The goal of all Emergency medical personnel is to get people to definitive care (not EMS). Asking a lay person to know what a BLS (non-EMT fire & police), EMT (Ambulance), Parmedic, or MSO can take care of, or even what the differences are, is, I don't think, super useful. The red vehicle shows up and takes you to care. In the case of MCI, EMTs can a) give aspirin or nitro (rx), b) have an AED and lots of CPR training but have to stop the vehicle to give effective compressions, c) a radio and the ability to meet up with Paramedics. Paramedics have more complex treatments (drugs) and EKGs, but it's still 2 folks in a truck, not a hospital. They can do amazing things. But as the joke goes, sometimes the best treatment is High Volume Diesel Therapy (burn rubber).
- FabHK 11mo ago
  > Like most things, it gets pretty complicated. As far as I know, there are also different paradigms for ambulances: "scoop and run" (ie stabilise the patient and take them to a hospital ASAP) vs "stay and play" (try the first line of treatment there before taking the patient to the hospital). Different countries (with different urban environments, distances, etc.) use different approaches.
kelnos 11mo ago
It kind of depends. EMTs are able to do some things, paramedics are able to do more things, and the hospital itself can do even more things. I live about 6 minutes from the closest ER. If an ambulance can get to me in, say, 3 minutes, it's still not clear if it's better for me to get myself to the ER on my own. Maybe I get an ambulance with EMTs who aren't trained/authorized to do what needs to be done for me. Maybe I really need to be at the hospital within 8 minutes or I'm going to die, and waiting for an ambulance just isn't going to cut it. But I think, statistically, people should usually prefer to wait for the ambulance. It's just that specific circumstances can make that the wrong move, but most people won't know when that's the case.

2muchcoffeeman 11mo ago

This is very conspiratorial thinking. Do you really think that in a high stress situation you’re going to make the best decisions? Do you really think health workers are all concerned about legalities first? Not moving a patient unless you explicitly know how is probably right the vast majority of the time. Sometimes that’s wrong, but how are you going to get the entire public to understand what the right situation is? It’s so easy looking at a single case in hindsight. May we all have the ability to make the right choices all the time.

_drimzy 11mo ago
> Do you really think that in a high stress situation you’re going to make the best decisions? I mean that statement could be used to excuse any mistake in any project/system ever made, and is mostly a cop out. Yes, the system is definitely designed to minimize legal risk for the health-workers/hospitals. A system is only as good as what it's' design objectives are, and if "save a life at all cost" was the objective the system might as well look entirely different.
wk_end 11mo ago
It's not that health workers are always thinking about legality; it's that they're following policies either written by people thinking about legality or re-written by people in response to legality, i.e. they got sued and changed the policy in light of that.
somenameforme 11mo ago
> Do you really think health workers are all concerned about legalities first? 100%. Legal issues are a huge deal in healthcare. This is a snippet from a study [1] on the topic, just to get an idea of the scale (which I think most do not realize at all): --- Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants). The proportion of physicians facing a claim each year ranged from 19.1% in neurosurgery, 18.9% in thoracic–cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry. The mean indemnity payment was $274,887, and the median was $111,749. Mean payments ranged from $117,832 for dermatology to $520,923 for pediatrics. It was estimated that by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties. --- I can give a very specific example of how legal issues play directly into behavior, and how it leads to antibiotic over-prescription. Antibiotics are obviously useless against viral infections but many, if not most, doctors will habitually describe them for viral infections anyhow. Why? Because a viral infection tends to leave your body more susceptible to bacterial infections. For instance a flu (viral) can very rarely lead to pneumonia (bacterial). And that person who then gets very sick from pneumonia can sue for malpractice. It's not malpractice because in the average case antibiotic prescription is not, at all, justified by the cost:benefit, but doctors do it anyhow to try to protect themselves from lawsuits. There have been studies demonstratively showing this as well, in that doctors who live in areas with less rampant malpractice lawsuits are less likely to prescribe antibiotics unless deemed necessary. Or if you have a friend/family in medicine you can simply ask them about this - it's not some fringe thing. [1] - https://web.archive.org/web/20250628065433/https://www.nejm.org/doi/full/10.1056/NEJMsa1012370 https://web.archive.org/web/20250628065433/https://www.nejm....

energy123 11mo ago

Incompetence and laziness among doctors is a big cause. As a professional you've probably worked with many colleagues you thought were bad. Well there are doctors like that too. Many of them. And unlike in tech, they don't get let go if they're bad. They stay around and keep "treating" patients.

nrhrjrjrjtntbt 11mo ago
I was thinking this the other day about GP. If I work in tech I work in a team and we pair. Why doesnt this happen with doctors. Why is everything all on one mind to get wrong or right. Yes there is a team of doctors sometimes but they communicate via emails async and you visit one then the next and so on. I guess I know the answer. Money.
- mgh2 11mo ago
  Short supply, high demand
  - mckn1ght 11mo ago
    And imagine if we had the same requirements to write software as we do to perform surgery! Things would be very different.
    - wk_end 11mo ago
      On the flip side, if/when I ever go for surgery I'm pretty damn glad we don't have the same requirements to perform surgery as we do to write software.
- deleted 11mo ago
  [deleted]
- nradov 11mo ago
  Medicine is a team activity. There is no amount of money which could ever make it feasible to have multiple physicians working simultaneously on routine cases, but they do delegate some tasks to lower licensed providers such as nurses and technicians. For really complex cases there is the Mayo Clinic model (also used in a few other health systems). A patient can come for a day and be seen by an integrated team of specialists to get a diagnosis and treatment plan. But this isn't really scalable. https://www.mayoclinic.org/patient-centered-care/what-makes-mayo-clinic-different https://www.mayoclinic.org/patient-centered-care/what-makes-...

godelski 11mo ago

> We're told a lot of things by "officials" not because it's correct Often these rules are in place because they are statistically correct. What needs to be understood is that no rule can be so well written that there are no exceptions. Rules are guides. Understanding this we can understand why certain guidelines are created, because they are likely the right response 9/10 times. This is especially important when dealing with high stress and low information settings. BUT being statistically correct does not mean correct. For example, if the operator had information about the ETA of the ambulance (we don't know this!) then the correct answer would have been to tell them to not wait. But if the operator had no information, then the correct decision is to say to wait. The world is full of edge cases. This is a major contributor to Moravec's paradox and why bureaucracies often feel like they are doing idiotic things. Because you are likely working in a much more information rich environment than the robot was designed for or the bureaucratic rules were. The lesson here is to learn that our great advantage as humans is to be flexible. To trust in people. To train them properly but also empower them to make judgement calls. It won't work out all the time, but doing this tends to beat the statistical rate. The reason simply comes down to "boots on the ground" knowledge. You can't predict every situation and there's too many edge cases. So trust in the people you're already putting trust into and recognize that in the real world there's more information to formulate decisions. You can't rule from a spreadsheet no more than you can hike up a mountain with only a map. The map is important, but it isn't enough.

kelnos 11mo ago
This was exactly what I was thinking (though less eruditely) when I was reading the blog post. In this particular case, waiting for the ambulance led to a worse outcome, but I would not be surprised that, statistically, a you're better off waiting for the ambulance than trying to get to the hospital via other means. But unfortunately: > if the operator had information about the ETA of the ambulance (we don't know this!) then the correct answer would have been to tell them to not wait. But if the operator had no information, then the correct decision is to say to wait. I expect the operator just is not allowed to give advice like that, even if they did have information on ambulance ETA. There could be liability if someone is advised to drive to the hospital, and something bad happens. Even if that bad thing would have happened regardless. I think that's a bad reason to do the situation-dependent incorrect thing, but that's unfortunately how the world works sometimes.

deleted 11mo ago

[deleted]