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The issue with that is that no hospital is willing to be the first. Hospital: We're going to lower costs by not letting doctors choose their equipment. Talent

by epmatsw 13y ago

The issue with that is that no hospital is willing to be the first. Hospital: We're going to lower costs by not letting doctors choose their equipment. Talented surgeons: Welp, don't want to work there. Patients: Why would I go to the hospital that doesn't have any of the good surgeons?

angersock 13y ago
So, have a deal that says "Hey, if you want to be able to receive Medicare/Medicaid payments, you have to standardize tools." All the hospitals will say "Wow, holy shit, alright", and the surgeons will have to play ball--because a surgeon without a proper OR is basically just a butcher or barber. EDIT: Please explain why this is a bad idea instead of just downvoting.
- drdoc 13y ago
  As an anesthesiologist, this is a bad idea for various different reasons. There are a numerous reasons why a physician needs the tools that he needs. The type of procedure, the type of patient and the familiarity of the equipment. I routinely intubate patients with a particular type of tool because that is what I feel most comfortable with and I have trained with. Yes, I can intubate with the myriad of other devices but there is that 1 out of a 1000 chance (slim but not unrealistically slim because I do >1000 intubations a year) that I cannot intubate you and you need to have a tracheostomy or worse, you die. Some may argue that we should all train with the same equipment, but even then, what about inherent differences in the physician or the patients. Maybe where I trained, all my patients had large tongues and I need a particular blade more often so I became better skilled with that or maybe my hands are just better with a particular blade.
  - angersock 13y ago
    If I dropped a Linux admin off at a shop which didn't have emacs on their boxen and he refused to work because he might accidentally screw up a config file, he'd be laughed out of the joint. If I dropped a plumber off at a job site and she didn't have a particular type of ergonomic monkey wrench she'd grown accustomed to and said she couldn't do the job, she'd be mocked endlessly. If I dropped a line chef off at a kitchen and they didn't have their favorite knife available and they held up orders for a whole night, their boss would fire them. ~ This custom bespoke medicine nonsense is increasingly seeming to be just that: nonsense. Sure, there's this .1% chance that you might screw up an intubation, but that seems to be more of an issue of bad training than bad equipment. As far as your point about differences in patients or physicians: that's a cop-out. Part of being good at what you do (as a dev, as a maker, as a person) is being flexible enough to make do and succeed. In a system which costs as much as ours does to people who simply can't afford it, we (as a society) cannot afford to cater to the whims of overspecialized professionals.
    - milesskorpen 13y ago
      In all your examples, you aren't dealing with a person's health or (potentially) life. The risk-benefit calculation changes (and people become, understandably, somewhat irrational) when the stakes get that high.
      - graylights 13y ago
        And if a soldier gets to a new unit and they assign him a weapon he's not familiar with? The military definitely deals with life and death stakes. Their solution: Frequent and continuous training. What kind of ongoing training do hospitals offer their doctors? Who trains doctors on new equipment in hospitals? (honest questions)
        angersock 13y ago
        " Who trains doctors on new equipment in hospitals?" Dirty secret. Equipment vendors. Ditto for pharmaceuticals.
    - dragonwriter 13y ago
      > If I dropped a Linux admin off at a shop which didn't have emacs on their boxen and he refused to work because he might accidentally screw up a config file, he'd be laughed out of the joint. The kind of errors made by a Linux admin who is more familiar with emacs using vi don't have as much likelihood of ending up with dead customers and massive liability for the Linux admin and/or his employer as the kind of errors that could be expected from a surgeon being forced to use non-preferred equipment. So the situations aren't exactly parallel. > In a system which costs as much as ours does to people who simply can't afford it, we (as a society) cannot afford to cater to the whims of overspecialized professionals. In a system which costs as much as ours does compared to every other advanced country, while providing worse access and not producing better outcomes, we certainly can't afford to not do some research to figure out what everyone else is doing right and we aren't. But somehow I don't think letting surgeons choose the tools used for a particular surgery based on their own expertise and understanding of the needs of the particular surgery, rather than having one standard kit used for all surgeries regardless of the specific details of surgeon and patient, is the difference.
- milesskorpen 13y ago
  This kind of thing leads to ridiculousness like the "death panel" meme. The American healthcare system prizes choice and expansive options at the cost of, well, almost everything else. This means that wealthy people can receive a higher standard of care, but does make things very very very expensive.

by epmatsw 13y ago

angersock 13y ago

So, have a deal that says "Hey, if you want to be able to receive Medicare/Medicaid payments, you have to standardize tools." All the hospitals will say "Wow, holy shit, alright", and the surgeons will have to play ball--because a surgeon without a proper OR is basically just a butcher or barber. EDIT: Please explain why this is a bad idea instead of just downvoting.

drdoc 13y ago
As an anesthesiologist, this is a bad idea for various different reasons. There are a numerous reasons why a physician needs the tools that he needs. The type of procedure, the type of patient and the familiarity of the equipment. I routinely intubate patients with a particular type of tool because that is what I feel most comfortable with and I have trained with. Yes, I can intubate with the myriad of other devices but there is that 1 out of a 1000 chance (slim but not unrealistically slim because I do >1000 intubations a year) that I cannot intubate you and you need to have a tracheostomy or worse, you die. Some may argue that we should all train with the same equipment, but even then, what about inherent differences in the physician or the patients. Maybe where I trained, all my patients had large tongues and I need a particular blade more often so I became better skilled with that or maybe my hands are just better with a particular blade.
- angersock 13y ago
  If I dropped a Linux admin off at a shop which didn't have emacs on their boxen and he refused to work because he might accidentally screw up a config file, he'd be laughed out of the joint. If I dropped a plumber off at a job site and she didn't have a particular type of ergonomic monkey wrench she'd grown accustomed to and said she couldn't do the job, she'd be mocked endlessly. If I dropped a line chef off at a kitchen and they didn't have their favorite knife available and they held up orders for a whole night, their boss would fire them. ~ This custom bespoke medicine nonsense is increasingly seeming to be just that: nonsense. Sure, there's this .1% chance that you might screw up an intubation, but that seems to be more of an issue of bad training than bad equipment. As far as your point about differences in patients or physicians: that's a cop-out. Part of being good at what you do (as a dev, as a maker, as a person) is being flexible enough to make do and succeed. In a system which costs as much as ours does to people who simply can't afford it, we (as a society) cannot afford to cater to the whims of overspecialized professionals.
  - milesskorpen 13y ago
    In all your examples, you aren't dealing with a person's health or (potentially) life. The risk-benefit calculation changes (and people become, understandably, somewhat irrational) when the stakes get that high.
    - graylights 13y ago
      And if a soldier gets to a new unit and they assign him a weapon he's not familiar with? The military definitely deals with life and death stakes. Their solution: Frequent and continuous training. What kind of ongoing training do hospitals offer their doctors? Who trains doctors on new equipment in hospitals? (honest questions)
      - angersock 13y ago
        " Who trains doctors on new equipment in hospitals?" Dirty secret. Equipment vendors. Ditto for pharmaceuticals.
  - dragonwriter 13y ago
    > If I dropped a Linux admin off at a shop which didn't have emacs on their boxen and he refused to work because he might accidentally screw up a config file, he'd be laughed out of the joint. The kind of errors made by a Linux admin who is more familiar with emacs using vi don't have as much likelihood of ending up with dead customers and massive liability for the Linux admin and/or his employer as the kind of errors that could be expected from a surgeon being forced to use non-preferred equipment. So the situations aren't exactly parallel. > In a system which costs as much as ours does to people who simply can't afford it, we (as a society) cannot afford to cater to the whims of overspecialized professionals. In a system which costs as much as ours does compared to every other advanced country, while providing worse access and not producing better outcomes, we certainly can't afford to not do some research to figure out what everyone else is doing right and we aren't. But somehow I don't think letting surgeons choose the tools used for a particular surgery based on their own expertise and understanding of the needs of the particular surgery, rather than having one standard kit used for all surgeries regardless of the specific details of surgeon and patient, is the difference.
milesskorpen 13y ago
This kind of thing leads to ridiculousness like the "death panel" meme. The American healthcare system prizes choice and expansive options at the cost of, well, almost everything else. This means that wealthy people can receive a higher standard of care, but does make things very very very expensive.