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How many doctors actually stand to gain by mistreating patients, though? I don't know about the USA, but in my country, most medical care is provided by salarie

by Cass 13y ago

How many doctors actually stand to gain by mistreating patients, though? I don't know about the USA, but in my country, most medical care is provided by salaried doctors who are paid the same regardless of the hospital's profit margin. Now, obviously we do want the hospital to be profitable enough that they don't start firing us, but there's certainly no immediate benefit along the lines of "Well, I don't this guy to get an infection, but I'd make an extra $ 1000 if he did," which I agree would certainly provide skewed incentives. The only thing that happens when my patients get complications is I get to pull more unpaid overtime.

dkarl 13y ago
Complication rates are affected by hospital procedures and policies, staffing levels, training, and presumably the pressures that are or aren't put on doctors. All of those are under the control of the administrators who look out for the bottom line. Whether complications make money or cost money surely affects administrators' eagerness to revamp and/or enforce handwashing policies, update training for nurses, keep staffing levels high enough that inexperienced nurses are properly supervised, and put pressure on doctors with high complication rates. To make it more concrete, there was an article on HN a few years ago suggesting that post-surgical complication rates could be reduced by creating surgery checklists where very basic surgical steps would be checked off as the surgery proceeded: patient identity verified, everything properly sanitized, materials accounted for afterwards, things like that. You would expect a hospital administrator to make a cost-benefit analysis taking into account the cost of researching this idea, creating a trial program, and monitoring compliance and effectiveness. The cost-benefit analysis looks like this: If the program is ineffective, we lose money. If it's effective, we lose even more money. If it's really, really effective, it could screw up the bottom line so much that I lose my bonus or even my job.
ippisl 13y ago
We know from studies done around 2003 done by peter provonost that if doctors follow certain checklists while doing an IV(if i recall correctly), reduce the complication rate from 12% to 0%. Using checklists is still not a common practice among doctors. What do doctors gain by not using checklists ? freedom, less boredom, maybe feeling of status. Is that the reason ? dunno.

by Cass 13y ago

dkarl 13y ago

Complication rates are affected by hospital procedures and policies, staffing levels, training, and presumably the pressures that are or aren't put on doctors. All of those are under the control of the administrators who look out for the bottom line. Whether complications make money or cost money surely affects administrators' eagerness to revamp and/or enforce handwashing policies, update training for nurses, keep staffing levels high enough that inexperienced nurses are properly supervised, and put pressure on doctors with high complication rates. To make it more concrete, there was an article on HN a few years ago suggesting that post-surgical complication rates could be reduced by creating surgery checklists where very basic surgical steps would be checked off as the surgery proceeded: patient identity verified, everything properly sanitized, materials accounted for afterwards, things like that. You would expect a hospital administrator to make a cost-benefit analysis taking into account the cost of researching this idea, creating a trial program, and monitoring compliance and effectiveness. The cost-benefit analysis looks like this: If the program is ineffective, we lose money. If it's effective, we lose even more money. If it's really, really effective, it could screw up the bottom line so much that I lose my bonus or even my job.

ippisl 13y ago

We know from studies done around 2003 done by peter provonost that if doctors follow certain checklists while doing an IV(if i recall correctly), reduce the complication rate from 12% to 0%. Using checklists is still not a common practice among doctors. What do doctors gain by not using checklists ? freedom, less boredom, maybe feeling of status. Is that the reason ? dunno.