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Many years ago I was attending pre-surgery for a hip replacement surgery for my sister, who had known severe reactions to anesthesia (actually required a trache

• api 3mo ago
  US healthcare is very strange in that on one hand it pinches pennies and is incentivized to not fund treatment, but on the other hand there seems to be some kind of internal incentivize to spend liberally and do everything. The whole system is a mess of perverse incentives. I've often described it as "everything bad about socialized medicine combined with everything bad about privatized medicine."
  • alightsoul 3mo ago
    This is what happens when healthcare is for profit.
    • deleted 3mo ago
      [deleted]
    • m0llusk 3mo ago
      It is more complicated than that. Markets have the structure and regulations we give them. Health care gets set up and delivered with very different concepts and guidance in various places regardless of whether it is for profit.
      • alightsoul 3mo ago
        How is not weighing risk not for profit, when not weighing it is crucial for profit?
      • laughing_man 3mo ago
        We don't have a true free-market in health care, so regulations and various programs are meant to create an environment where we get the benefits of a free market while still having universal availability and a universal "standard of care". Of course it doesn't work very well. That's asking too much of any system.
        • iso1631 3mo ago
          the only problem with communism is nobody's actually tried #TrueCommumismTM
    • iso1631 3mo ago
      The UK has healthcare for profit, and not just the private healthcare options like BUPA -- GP surgeries are privately owned. Does it happen there?
      • alightsoul 3mo ago
        I live in Panama and yes it happens in for profit healthcare.
  • modeless 3mo ago
    Some people thought it was a good idea to cap [administration cost + profit] of health insurance companies as a percentage of premiums. As a result, health insurance administrators have two ways to increase their compensation: they can compete to acquire more customers, or they can artificially inflate costs per customer. Guess which one is easier! Now you don't have to wonder why medication is half the cost when you buy it without insurance... Love to hear all the time how the "free market" is ruining healthcare. Of course everyone knows a "free market" is when you have profit caps, supply restrictions (residency cap), government-run marketplaces, byzantine tax subsidies tying insurance to employment for no reason, etc etc
    • Avicebron 3mo ago
      If anyone is curious, this the USA, it came from the ACA in 2010 championed by Democrats. It's almost like it doesn't matter which jersey is being worn.
    • Eisenstein 3mo ago
      > Love to hear all the time how the "free market" is ruining healthcare. Of course everyone knows a "free market" is when you have profit caps, supply restrictions (residency cap), government-run marketplaces, byzantine tax subsidies tying insurance to employment for no reason, etc etc What people are talking about with regard to health insurance being ruined by being market based is that the profit motive should not be applied to it. The basic fact is that it should be some form public service and not reliant on a system which has as its incentive maximizing profits, and attempting to regulate it into being patient first and not profit first will always have side-effects like you pointed out.
      • modeless 3mo ago
        Removing the "evil" profit motive has always been an argument for socialism. If it would work for healthcare, why not everything?
        • api 3mo ago
          Steel man counter-argument: health care is weird and different and special in lots of ways. The people who need it most are often the least profitable to treat and the least able to pay for it. That's because being sick negatively impacts your earning potential. The sicker you are the less you can afford a way to pay for treatment to not be sick. It's analogous to the problem with debtors' prison. Obscure or low-survival-rate conditions are almost by definition unprofitable to treat. Rare condition? Stage four cancer? It's most profitable to let you suffer or die. There's not enough of a market for the former and the latter has a low probability of leaving someone behind to pay the bill. Old age care can't be profitably offered on insurance or credit. Old? Pay cash or die. Demand is not infinite because (excluding certain neuroses) people generally do not want health care. They only get it when they need it. Demand does not skyrocket with reduced price or free availability, so the system doesn't automatically just drown in demand when you take the cost away. Competition is sparse because talent is scarce and the cost means there tend to be only one or a few hospitals covering an area. Specialty services and general practitioners are different, but for advanced and expensive care it tends to be not quite a natural monopoly but almost one. It's like how there's not very many space launch companies. Because it's so f'ing hard the supply of competitors is small. Lastly, because customers are ignorant (very few people are qualified to evaluate health care tech or treatments), quackery is structurally more profitable than medicine that works. It's hard to have a healthy market when fraud is massively easier and more profitable and the customer finds it hard to tell the difference. Add to that the fact that try before you buy and comparison shopping are almost impossible, especially for serious medical care. You can't exactly toss out or return a surgery.
• Loughla 3mo ago
  The problem is, how do you know when to advocate for yourself? I have zero idea if what the doctor is telling me is accurate or not. I'm not a doctor. This is why people are moving away from main stream medicine, in my opinion.
  • ipaddr 3mo ago
    Always advocate and avoid delegation to experts who have little stake in the outcome.
    • iambateman 3mo ago
      Parent had a good question and this is restating what’s already been said. _how_ do you advocate? If I could avoid delegating to experts, I wouldn’t be in the situation in the first place.
      • preg_match 3mo ago
        Ripped from another comment, I’ve gotten good at advocating for myself: Do extensive research before hand. AI can aide research, but you have to prompt it right. Tell it to do web searches, and tell it to only use trusted vetted sources and papers. And the approach here isn’t to take the research at face value. It’s to take the research and derive questions, and then ask your doctor. You can be aggressive. I had a rare and very complicated surgery for my cancer. I researched it heavily, and going into the appointment I already knew how the surgery should be performed. I asked the surgeon many questions, including how often he performs this surgery, for how many years, and how many complications he has. He was a bit offended. I also asked him how he would do the surgery, and he told me a rarer, more complicated method that is typically reserved for pre-chemo patients (chemo melts your insides, makes some surgery more complicated). I told him this was unusual, not standard of care, and that I was skeptical. And he methodically laid out why I was a good candidate even though I’ve had chemotherapy. The surgery was very successful, and he was a fantastic surgeon. But you still have to push. And if you don’t get the answers you need, you go somewhere else.
  • snaking0776 3mo ago
• caraffle 3mo ago
  This is fear mongering at best and unbelievable. Why would a surgeon know anything about anesthesia risk? Anesthesia regurarly cancels cases due to safety concerns - there's no "protocol" or "getting in trouble" (what does that even mean), that's standard of care. "Anesthesia" is a doctor too and ultimately holds the call on if they will put a patient under or not.
  • Georgelemental 3mo ago
    "Anesthesia" could also be a nurse anesthesist, nurses generally aren't supposed to contradict doctors in front of patients
  • amatecha 3mo ago
    > Why would a surgeon know anything about anesthesia risk? Idunno, maybe because their entire career is performing surgeries which include anaesthesia and they have worked for potentially decades alongside anaesthesiologists? For instance, I've worked in the same type of role (programmer) for my entire career and I somehow know a ton about the disciplines adjacent or closely related to mine, especially because I work with them every day.
    • Supermancho 3mo ago
      Graciously, I think this was the point they were trying to make, with an inappropriately sarcastic intro.
    • solenoid0937 3mo ago
      Medicine is not programming.
  • Supermancho 3mo ago
    This is matches my experience, having been under at least 30 times. The phrase: "Why would a surgeon know anything about anesthesia risk?" could be misleading to someone who has never undergone (or just didn't understand) what a pre-surgery anesthesiologist consult is for. Surgeries are performed by teams. Anesthesia is one aspect of the procedure and most of the doctors know some, while surgeons know a great deal. The anesthesiologist's job, as a physician, is to monitor, adjust, and assess risk during the procedure. This disclosure, if it happened, was during the consultation.
• HedonicEscal8r 3mo ago
  Malignant hyperthermia?
• diskzero 3mo ago
  That is terrible and I am glad someone broke ranks to inform you of the risk. My wife had a very agressive triple-hit lymphoma and CAR-T was eventually suggested. Fortunately, the medical team was very honest about how hard it impacts your body, with very likely chance of death. My wife decided to do it, and it almost killed her. The team actually had to "shut down" the process, so she didn't benefit completely from the treatment. The suffering was pretty immense as well. She died a few months later regardless. We are (were) both engineers and we did wonder how many might get streamrolled by the whole medical process, where you do get this odd combination of extreme indifference and optimistic exuberance.
  • esotericrunner 3mo ago
    Sorry for your loss, I feel your pain. Your wife was very brave to give it a shot and take the fight to the limit, and you should remember her courage and honor her memory and keep fighting till the end regardless of what hardships you encounter in life. The treatment actually killed my dad. I may be wrong but it appears with the treatment there was a 30% chance of some recovery, 40% chance that it would at least stop the cancer growth, 30% chance that it had no impact. I guess you have to take that chance when you have no other option. I don't blame the hospital (which was terrible) or the treatment, it was the last card left. And our loved ones end up in the 30% statistic and maybe as another anecdote for the risks section, but we know what we they went through and we won't forget. It was tough because my dad was suffering, but he still was active and had at least a few months left without the treatment and I know that at that point in his battle he did this treatment to keep fighting for us rather than for him, even though it was he who had to suffer through it. So I am going to honor his memory and keep fighting until the end as well.
    • NoLinkToMe 3mo ago
      Thank you both for sharing.
• esikich 3mo ago
  I don't believe this for a second. The anesthesiologist is obligated to tell them this, they meet and discuss this kind of thing with the family/patient. It isn't a breach of protocol, the doctor and surgeon would also have been informed and would have relayed as well. Fear mongering bullshit.
  • HedonicEscal8r 3mo ago
    I agree, sounds suspicious and likely misremembered.
  • senderista 3mo ago
    I can confirm it with my mother, but this is what happened to the best of my recollection. You can fuck right off with your accusation that I am fabricating this story. For reference, this happened about 20 years ago.
• itishappy 3mo ago
  > The lesson for me is that you must advocate for yourself and your loved ones in the medical system, because doctors will not do it for you; they may not even perform the most basic risk assessments. And you have to try to quantify risk yourself, because doctors will refuse to give you the slightest hint of any number attached to risk (I know, I've tried many times). Doctors vary wildly, and that's part of the issue. For instance, my oncologist had zero problem rattling off mortality statistics. I've personally had doctors try to sell me surgery before identifying the issue, but I've also had doctors successfully talk me out of what would have been useful procedures by offering their risk/benefit assessment unprompted. It's like any other field. If there are 10x and 0.1x engineers, you bet there are 10x and 0.1x doctors. A 1hr intake appointment isn't anywhere near enough time to judge even for folks in the field.
  • thruway515 3mo ago
    No it's not like any other field. There's no such thing as a 10x doctor. A '10x' doctor is just as likely to kill you as any other especially when it comes to experimental never before done procedure. In fact a 10x doctor like Qiu is more likely to take risks. This is medicine not a software shop where we measure productivity by number of commits or number of surgeries per hour except by 10x you mean 10times more likely to be careful and ethical
    • nickff 3mo ago
      What exactly do you mean by "10x doctor"? Some surgeons have a 10x higher 'revision rate' than others, and from what I understand, that may be an understatement. Many of the statistics which would indicate the ones to avoid are not tracked, precisely because the doctors do not want them tracked.
      • thruway515 3mo ago
        You'll have to ask the OP what they meant by 10x. I assume they meant it in the programmer/hacker sense of producing more work in the same amount of time than their peers or being a 'rockstar'
• ekianjo 3mo ago
  Most doctors are very bad at data as well. Few understand statistics. That does not help.
• genericresponse 3mo ago
  This seems very unusual on many, many levels. I hate to ask, but were you a child when this happened? If so, are you sure you were in all the conversations. First- There are less than 600 total hip replacements conducted each year on children in the United States. Second- It would be unusual for this surgery to be even recommended without something serious being addressed. Third- Failure to discuss risks and tradeoffs would be regarded as malpractice if something went wrong.
  • deleted 3mo ago
    [deleted]
  • senderista 3mo ago
    I was just out of college and I believe I was involved in all conversations with the care team. My sister suffered from a rare congenital condition (MPS, Morquio syndrome) which among myriad other complications involved arthritis in the hips. (Something I didn't mention is that she was expected to live less than a decade after the surgery, which proved roughly accurate.) The surgeon was willing to discuss risk vs. benefit (although absolutely not quantitatively), but only after we brought it up after the anesthesiologist approached us. It was never discussed beforehand, to the best of my recollection.
• nkrisc 3mo ago
  You’re absolutely correct, but I think your story about the anesthesiologist shows that there are some doctors who do care.
• al_borland 3mo ago
  I think this is how they avoid liability. They lay out some options and leave it up to the patients, with no medial training, to decide how they want to move forward.
• tomcam 3mo ago
  > Keep in mind that nobody on the care team had previously discussed any risk or indeed any tradeoffs whatsoever. This was at one of the best-regarded children's hospitals in the USA. I bet you live in the Seattle area. Similar experience with my daughter.
  • senderista 3mo ago
    You are correct.
• kazinator 3mo ago
  1/3rd chance of not surviving is like suddenly dashing across a busy freeway without looking, from a crouched position behind a bush. That's what it means to send the person into that. Yikes!
• kazinator 3mo ago
  Is that even legal? Can a bunch of people decide to go ahead with performing some procedure that has a 1/3 chance of killing the person, whose life is not in danger if it is not performed? If that person dies, that's seems like murder.
  • Danox 3mo ago
    Nonsense easy to say if you’re not in that position, there are many procedures that are done today that we take for granted, and almost every one of us if we live long enough, will face the doctor telling us that there is nothing to do, the only chance you have is a Hail Mary and even that will only prolong your life a short while but it won’t fix the problem. Penicillin, antibiotics, and many vaccines have only come into general use within the last 80 years which is what one or two lifetimes. Many/every medical procedure starts somewhere everyone just hopes they don’t start with them.
    • kazinator 3mo ago
      It seems clear from the grandparent comment that this was not a life-saving procedure. Operating on someone for a non-life-threatening reason where they have a 1 in 3 chance of dying according to a documented prior reaction to anaesthetic, is akin to attempted murder. You might as well tie them to a post and shoot an apple off their head with a rifle from 50 yards.
  • pvaldes 3mo ago
    All that we know is that the doctor carefully guided the patient out of the intervention, flashing a value that nobody had introduced before in the conversation. Is unclear WHY without more information. The fair possibility is that it would be not the best choice for the patient, But other possibility could be a schedule problem with the doctor holidays for example. Or that it would be too expensive for the hospital Or that they didn't have the materials or the experience To go forward with this operations the interests of the patient, the doctor and the hospital must match. Sometimes only two parts benefit from it.
• LoveMortuus 3mo ago
  Off topic, but: >will refuse to give you the slightest hint of any number attached to risk (I know, I've tried many times). reminds me of my lawyer... (I lost)