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Medicine is like any other profession - it shouldn't be surprising that some doctors are better than others, like some lawyers/engineers/teachers are better tha

by graeham 12y ago

Medicine is like any other profession - it shouldn't be surprising that some doctors are better than others, like some lawyers/engineers/teachers are better than others. There are a lot of challenges with healthcare metrics. Medical problems are more complex, arising from more factors than practically any other problem. Most other sciences can be resolved by theory or relatively convergent empirical data. Medicine is empirical, but the scatter is huge. Data is not tracked well. When it does exist, it is in formats that are not well conducive to analysis and sharing. This seems to be slowly (and expensively) improving. Pressure for privacy adds to inertia for innovations that could use medical data for improved outcomes. With the title of the article, I was hoping there would be some more discussion about implications of some 'rating system' for doctors. It would probably superficially be a good idea, but such a system would obviously result in some level of gaming. Does a doctor in a rated system only take easy cases to keep a good track record? Are hard cases given more weighting? Who/ how is such a weighting decided? Such a system could offer a results-based compensation scheme for doctors, which is lacking from most publicly funded systems.

derekp7 12y ago
What about the equiv. of code reviews? For surgeons, take videos of each surgery, and have them rated by an impartial review panel. I can't find the link now, but I recently saw a segment posted on Youtube that compared a surgeon with good technique, to one with poor technique, and it correlated with the overall outcome of the patients.
- FLUX-YOU 12y ago
  I remember this, but I also can't find it. Part of it involved maintaining proper view of the field through laparoscopes, minimizing wasted movement, and avoiding unnecessary tissue damage. That last one has the most direct effect on outcomes, while the former two can lead to the third. The lower ranked surgeons would have the scope jostling around and the laparoscopic instruments would contact nearby tissues, while the higher ranked surgeons just seemed to have more elegance in his skill; a laser-precision focus to borrow from this thread and an intention and purpose for every movement. I had a similar impression watching that video on surgery technique to watching high level Starcraft player replays versus some afternoon ladder replays by mid-level players. When placed side-by-side, the differences were fairly obvious even if you've never done the act yourself.
yodsanklai 12y ago
"Medicine is like any other profession - it shouldn't be surprising that some doctors are better than others" Surely, some doctors are better than others, but (for the sake of discussion :)) I don't think every professions or activities are equivalent with respect to 'rating'. Take the extreme example of walking. All human beings walk equally well. This is unlike playing music or solving math problems for instance. I'm certainly not saying that medicine is as easy as walking, but maybe for a wide range of health problems, there are well known standard procedures or solutions that all doctors are competent enough to follow. And in doubt, they usually refer their patient to a specialist, who in turn can send them to a more competent doctor.
- robotresearcher 12y ago
  "All human beings walk equally well." This is obviously not true.
  - yodsanklai 12y ago
    I think you got my point. Usually, you don't stop looking at people in the street thinking how great is their walking. Walking is a simple enough task so that in normal conditions you don't see a wide range of abilities. Unlike swimming, playing music or cooking where even in normal condition you can see that some people are incredibly better han others. An other example that comes to mind are regular airline pilots: nobody wonders whether they are good or bad. We never have to worry that the pilot is unable to fly the plane.
    - robotresearcher 12y ago
      Sure, I get it. We call that idea "professional". http://en.wikipedia.org/wiki/Professional http://en.wikipedia.org/wiki/Professional I just didn't like the walking example since it's neither true nor analogous.
    - dmd 12y ago
      > nobody wonders whether they are good or bad Again, this is a terrible example. I'd say that a good third of passengers are wondering exactly that. (It's irrational to do so, but that's another story.)

by graeham 12y ago

derekp7 12y ago

What about the equiv. of code reviews? For surgeons, take videos of each surgery, and have them rated by an impartial review panel. I can't find the link now, but I recently saw a segment posted on Youtube that compared a surgeon with good technique, to one with poor technique, and it correlated with the overall outcome of the patients.

FLUX-YOU 12y ago
I remember this, but I also can't find it. Part of it involved maintaining proper view of the field through laparoscopes, minimizing wasted movement, and avoiding unnecessary tissue damage. That last one has the most direct effect on outcomes, while the former two can lead to the third. The lower ranked surgeons would have the scope jostling around and the laparoscopic instruments would contact nearby tissues, while the higher ranked surgeons just seemed to have more elegance in his skill; a laser-precision focus to borrow from this thread and an intention and purpose for every movement. I had a similar impression watching that video on surgery technique to watching high level Starcraft player replays versus some afternoon ladder replays by mid-level players. When placed side-by-side, the differences were fairly obvious even if you've never done the act yourself.

yodsanklai 12y ago

"Medicine is like any other profession - it shouldn't be surprising that some doctors are better than others" Surely, some doctors are better than others, but (for the sake of discussion :)) I don't think every professions or activities are equivalent with respect to 'rating'. Take the extreme example of walking. All human beings walk equally well. This is unlike playing music or solving math problems for instance. I'm certainly not saying that medicine is as easy as walking, but maybe for a wide range of health problems, there are well known standard procedures or solutions that all doctors are competent enough to follow. And in doubt, they usually refer their patient to a specialist, who in turn can send them to a more competent doctor.

robotresearcher 12y ago
"All human beings walk equally well." This is obviously not true.
- yodsanklai 12y ago
  I think you got my point. Usually, you don't stop looking at people in the street thinking how great is their walking. Walking is a simple enough task so that in normal conditions you don't see a wide range of abilities. Unlike swimming, playing music or cooking where even in normal condition you can see that some people are incredibly better han others. An other example that comes to mind are regular airline pilots: nobody wonders whether they are good or bad. We never have to worry that the pilot is unable to fly the plane.
  - robotresearcher 12y ago
    Sure, I get it. We call that idea "professional". http://en.wikipedia.org/wiki/Professional http://en.wikipedia.org/wiki/Professional I just didn't like the walking example since it's neither true nor analogous.
  - dmd 12y ago
    > nobody wonders whether they are good or bad Again, this is a terrible example. I'd say that a good third of passengers are wondering exactly that. (It's irrational to do so, but that's another story.)