4 ms·

I read about this clinic somewhere else, and there it was said this clinic actually outperforms western clinics in terms of complications, which seems to be ach

I read about this clinic somewhere else, and there it was said this clinic actually outperforms western clinics in terms of complications, which seems to be achieved through staggering case numbers per doctor.

seanmcdirmid 13y ago
That makes sense: experience increases performance, which is why we have intensive residencies; there is a reason why until recently residents were working 80+ hours a week. Perhaps we should ship all our resident-ready medical students off to third world countries where the needs are great so they can become proficient very quickly. Perhaps our system has become too soft.
- stephencanon 13y ago
  Our residents do work 80+ hour weeks. Until recently, it was 100+ hours.
  - aioprisan 13y ago
    It's still ~100 hours a week: 6 days at up to 16 hours = 96 hours/week.
    - stephencanon 13y ago
      There’s a cumulative “in-hospital” time cap of 80 hours/week (88 for neurosurgical residents). In practice, however, this means that (a) the cap is regularly broken or (b) residents end up doing preparatory study, reading papers, doing research, etc outside of the hospital to remain under the cap. They are still working more or less the same hours. Also, the 16 hour/day rule is only for interns, IIRC. Resident shifts can go up to 30(?) hours.
- stonemetal 13y ago
  Perhaps we should ship all our resident-ready medical students off to third world countries where the needs are great so they can become proficient very quickly. Perhaps our system has become too soft. The problem is they would become proficient at treating the wrong things. Medical conditions vary greatly by geography. Polio is still alive in the third world, Russia is fighting drug resistant TB, and up thread there is a mention of a surgery performed at a 1000x rate in India compared to the US(Once a decade vs once a day). All the while what affects Americans would be glossed over because it doesn't infect the rest of the world at the same rates.
Gatsky 13y ago
It's completely meaningless to compare mortality rates. It's also not clear that if a patient had a CABG in India, went home and dropped dead within 30 days, that this data would actually be captured rigorously. Anyway, you're drawing the wrong conclusion - it's astounding how close the US mortality rate is to the Indian, which attests to how good the US system is at operating successfully on more complex, elderly patients. Of course, you could argue that the US has optimised the wrong thing, at great expense...
- DanBC 13y ago
  > Anyway, you're drawing the wrong conclusion - it's astounding how close the US mortality rate is to the Indian, which attests to how good the US system is at operating successfully on more complex, elderly patients. Of course, you could argue that the US has optimised the wrong thing, at great expense... Is that connected to the extra funding that older people get? What happens if we compare mortality in people under 65?
  - Gatsky 13y ago
    It's still going to be problematic. There is a hidden selection bias that you can't get around. Eg in India there are still a lot of people that can't afford the CABG no matter how much it costs. Are those people less or more likely to die after surgery than the people that do get operated on? The answer invariably would be yes. Do centres that do more surgery have better outcomes? The answer to this is already a resounding yes. There isn't any doubt about that, it's been shown over and over again for multiple different surgeries within developed countries. Surgeons knows this, and so do health insurance companies. But of course this has to be asymptotic. Doing 1000000 CABGs doesn't make you 1000 times better than the surgeon that does 1000. So I doubt there is any real difference between the surgical skill in Shetty's centre and top institutions in the US. It's an untestable question in any case. The important point is that the care overall seems grossly non-inferior to the US, not that the US is inferior.

seanmcdirmid 13y ago

That makes sense: experience increases performance, which is why we have intensive residencies; there is a reason why until recently residents were working 80+ hours a week. Perhaps we should ship all our resident-ready medical students off to third world countries where the needs are great so they can become proficient very quickly. Perhaps our system has become too soft.

stephencanon 13y ago
Our residents do work 80+ hour weeks. Until recently, it was 100+ hours.
- aioprisan 13y ago
  It's still ~100 hours a week: 6 days at up to 16 hours = 96 hours/week.
  - stephencanon 13y ago
    There’s a cumulative “in-hospital” time cap of 80 hours/week (88 for neurosurgical residents). In practice, however, this means that (a) the cap is regularly broken or (b) residents end up doing preparatory study, reading papers, doing research, etc outside of the hospital to remain under the cap. They are still working more or less the same hours. Also, the 16 hour/day rule is only for interns, IIRC. Resident shifts can go up to 30(?) hours.
stonemetal 13y ago
Perhaps we should ship all our resident-ready medical students off to third world countries where the needs are great so they can become proficient very quickly. Perhaps our system has become too soft. The problem is they would become proficient at treating the wrong things. Medical conditions vary greatly by geography. Polio is still alive in the third world, Russia is fighting drug resistant TB, and up thread there is a mention of a surgery performed at a 1000x rate in India compared to the US(Once a decade vs once a day). All the while what affects Americans would be glossed over because it doesn't infect the rest of the world at the same rates.

Gatsky 13y ago

It's completely meaningless to compare mortality rates. It's also not clear that if a patient had a CABG in India, went home and dropped dead within 30 days, that this data would actually be captured rigorously. Anyway, you're drawing the wrong conclusion - it's astounding how close the US mortality rate is to the Indian, which attests to how good the US system is at operating successfully on more complex, elderly patients. Of course, you could argue that the US has optimised the wrong thing, at great expense...

DanBC 13y ago
> Anyway, you're drawing the wrong conclusion - it's astounding how close the US mortality rate is to the Indian, which attests to how good the US system is at operating successfully on more complex, elderly patients. Of course, you could argue that the US has optimised the wrong thing, at great expense... Is that connected to the extra funding that older people get? What happens if we compare mortality in people under 65?
- Gatsky 13y ago
  It's still going to be problematic. There is a hidden selection bias that you can't get around. Eg in India there are still a lot of people that can't afford the CABG no matter how much it costs. Are those people less or more likely to die after surgery than the people that do get operated on? The answer invariably would be yes. Do centres that do more surgery have better outcomes? The answer to this is already a resounding yes. There isn't any doubt about that, it's been shown over and over again for multiple different surgeries within developed countries. Surgeons knows this, and so do health insurance companies. But of course this has to be asymptotic. Doing 1000000 CABGs doesn't make you 1000 times better than the surgeon that does 1000. So I doubt there is any real difference between the surgical skill in Shetty's centre and top institutions in the US. It's an untestable question in any case. The important point is that the care overall seems grossly non-inferior to the US, not that the US is inferior.