[internaut]

I've always liked the Dutch for this reason.

If it isn't possible to work with somebody while disagreeing with them, then you're the problem. If you spend long enough talking to anybody you'll eventually come across disagreements.

Many people take disagreements too personally.

I was just yesterday talking to a paramedic. I mentioned to him the article I saw on HN about medical error being the 3rd highest cause of death next to cancer and heart disease.

He immediately started to attack me, exclaiming how I was not an authority in this area so how would I know what I was talking about and therefore had no right to talk about something like this.

I explained I was not the source of the information, and that large numbers of people inside and outside the medical profession are concerned that a great deal of medical research isn't reproducible and in any case if car accidents don't even touch the number of medical fatalities occurring then it's a problem since car accidents are so problematical it's one of the leading reasons we're trying to automate them.

He blew his top. Ad homs everywhere.

Later I took to the Net to see if I was correct in my impression. Turns out my 'Master of Paramedics who read lots of journals' can't have been paying much attention because the British Medical Journal and Lancet are in lockstep with everything I had been saying. In fact I was probably far too kind judging from what the leading lights of the medical profession are saying themselves.

I expect he would accuse me of being arrogant.

I've said it before but tribalism is very powerful. It is far more dangerous to Science than Religion and it definitely gets in the way of technological change.

[sukilot]

I don't know what your friend said, but the "errors are #3 killer" is a twisted fact. It comes from assigning "error" at the cause of death of every injury or illness that might have been non-fatal if every perfect test, advance in practice, technology, and mode of care were applied. It isn't a measure of how many otherwise healthy people were killed by errors that introduced new complications.

One of highlighted examples from an abstract of a major study was an "error" where a doctor didn't tell a kid with diagnosed heart disease that strenuous exercise would be dangerous, and the kid died after collapsing during a run.

[ScottBurson]

There's an interesting summary of the debate about this study on Medscape [0].

Failing to tell a patient that strenuous exercise might be fatal sounds like an error to me!

As it happens, my maternal grandmother was killed by a medical error (before I was born). She went in for some kind of routine surgery and didn't make it. Decades later, when the doctor involved died, among his effects were found a letter he had written to another doctor, explaining that he had made a stupid mistake that killed her. (I don't know any more details.)

Does that mean I believe the "#3 killer" claim? Not necessarily. But I'd bet that the problem is worse than most medical professionals would expect, and that there remains considerable room for improvement.

[0] http://www.medscape.com/viewarticle/863788

[eruditely]

tell us more about your grandmother's story.

[ScottBurson]

I don't know anything else about it, except I can add that it would have been about 1952, in Alabama.

[internaut]

Ack, I thought you were talking to me. Sorry!

[internaut]

It happened with my father's birth I think. He was the oldest of seven children like typical Catholic families of the time. As a child I knew she walked kind of funny but I put it down to her being an old lady (she wasn't but to a child's eyes it's different). As with something you're familiar with you don't question it. Later my father joined a cult and developed an acrimonious relationship with my grandfather who believed the cult was trying to steal his property and so he disinherited my father. We moved away while I was still very young and so I didn't see my grandmother for a time. In my late teens my father and grandfather became more friendly and we visited occasionally.

My grandmother was becoming ill, first diabetes, then Alzheimers. Around this time I learned from my mother than the doctors in the Bons (as we called the Cork Hospital) had performed a Symphysiotomy. My mother described it as a butcher shop involving hacking and sawing. I think a radio show prompted her outburst on the topic, although she and my grandmother didn't get along she obviously felt deep revulsion about the affair. As with most of the women I don't think they asked for permission, they just wheeled them into surgery. I think what galled my grandparents the most is that they perceived the Bons to be a much superior hospital to all the others. It was private. It had reputable doctors. It was Catholic. They were farmers so this would have been a considered expense for them. I'm confident they didn't want to talk about it, it was probably too much.

In this diagram on the wiki you can see what happened: https://en.wikipedia.org/wiki/Symphysiotomy#/media/File:Skel...

The part marked '5' was severed using something like a wood saw or circular saw. Saying they broke the pelvis isn't an exaggeration.

The accounts from the wiki are grotesque. Catherine McKeever, a private patient at the Lourdes Hospital, Drogheda in 1969, told the Committee that she did not realise what had happened: 'I saw him [the doctor] with an instrument which I thought was a bit brace because my father was a wood turner. I felt a crack … Nobody answered me or said anything'. Margaret Conlan, who was operated upon in 1962 in St Finbarr's Hospital, Cork, testified that she had never been told anything about it: 'My baby’s head was perforated and the baby died… I did not find out [about the symphysiotomy] until I read it in the newspaper'.

It seems the practice was done to encourage more children. I'm not familiar with Catholic dogma so I don't understand why doctors would foist on their patients. Today I wonder today how the Muslim and African doctors are getting away with FGM in Irish and English hospitals, so in a way the barbarism continues. Don't trust religious fanatics or doctors and especially not both.

The problem is that they both tend to come well dressed and respected by their communities. Taking them down makes you the bad guy, not them.

[internaut]

> Does that mean I believe the "#3 killer" claim? Not necessarily. But I'd bet that the problem is worse than most medical professionals would expect, and that there remains considerable room for improvement.

Yes exactly, that's my position.

I feel that doctors are overworked generally, don't sleep very much so it's not surprising they don't have the time for introspection on this subject. The error rate is probably largely caused by economic factors like the perpetual labour shortage (in Ireland/UK at least).

On a personal level my grandmother had her pelvis snapped by doctors.

http://www.irishcentral.com/news/irish-woman-awarded-600000-...

In my own experience with a (not life threatening) medical procedure I went to three different doctors asking for help. None was given. They ignored my requests for analysis and a solution. I didn't even know what was wrong.

Finally I went online, found out what the problem was about, found out what the solution could be for it, and then I literally took a flight to England to get an experienced medical practitioner to sort it out which he did very professionally for a reasonable fee.

After this I complained to the medical ombudsman. Only then did they get into a flutter after literally years of waiting for them to solve the problem. A solution was provided that I no longer needed and I told them so. In fact I had already told them so but they weren't paying much attention. Pretty sure I could have sued them into the ground for malpractice.

I work with a coworker who broke his ankle falling down from a ladder. A horrible injury that shattered. That didn't even turn out to be the real problem though because after going into the hospital a doctor didn't wash his hands, and put them into the wound, infecting it with MRSA. My coworker who was awake, literally asked him to wash his hands right there and the doctor said "No, it's Ok".

I'm just one guy in his twenties and I can think of 3 cases like this. That is not good!

Lastly on an optimistic note my uncle fell off a roof he was working on with roof tiling. He fell two stories and behind him a trolley containing roof tiles slipped down and onto his back, almost snapping his spine in two.

The doctors fixed him up with steel plates, taking them out years later. Now he walks around like nothing happened (still on roofs!) but it's an amazing feat of medical attention to detail that this is true given his spinal column was almost severed.

[internaut]

Yes I realize that. The BMJ paper is using hyperbole to prove a point (just like Dijkstra's GOTO considered harmful). It's not really the #3 killer but to be honest it should not be in the top ten of things likely to kill you or even close to it.

The medical profession, much like the teaching profession has a nasty habit of victim blaming if things go wrong when it can get away with it. They need humbling because they are too confident. They are highly resistant to this because it diminishes their status and few people enjoy a loss of confidence even if introspection is required for improvement. Computer people tend to take this for granted because we're in a feedback loop with the compiler that tells us constantly when we're in the wrong. That we're fucking idiots all the time isn't news to us. It is news to some other professions that don't have such a tight feedback loop between success and failure.

It is true for example that people don't take their medicine on a timely basis but frustration of dealing with people has bled into other areas and that is unhealthy.

[nonbel]

>"That we're fucking idiots all the time isn't news to us. It is news to some other professions that don't have such a tight feedback loop between success and failure."

This is great, there is nothing like thinking "wtf is wrong, someone changed some library last update and that is the cause", then hours later realizing you are a moron.

How exactly can this happen in medicine without severe social consequences?

[internaut]

Instead of library updates imagine half the doctors and nurses don't speak English with a high degree of fluency and don't come from the native culture. That is so obviously a problem for communicating subtleties that it's infuriating that it has to be explicitly pointed out.

Speaking of reform. I think the only answer is closing the gap between action and success/failure i.e. a tighter feedback loop.

Some futuristic thinking is required.

For surgery I would propose a VR sim in which they performed the same surgery again and again, with the details/features changing all the time. Then at a high level of proficiency I would copy the real movements to a machine copying the surgeons actions on a real patient with the feedback visual presenting itself to the surgeon as part of the sim.

- This helps homogenize surgeons movements.

- Increases confidence of a successful operation.

- Allows for high level practiced skill rapidly.

- Removes them from the theater directly to prevent disease.

- Calms the nerves so the surgeon is able to work without fear.

- System gets better over time with more data.

For diagnostics I would record the patient's voice describing her symptoms with a visual of the person. I would then pattern match for related conditions in my database that appear to resemble the symptoms. The system has some degree of common sense as it is a traditional expert system. Audio/Video inputs would be used to make requests e.g. can I see your arm that is paining you for more detailed visual analysis using machine learning. Vocal analysis for other detectable disease. Finally a list of options would be offered up to the doctor as plausible possibilities. In the beginning these would be offered up after the doctor made an independent diagnosis and a second opinion would also be made. This is to give feedback accuracy to the diagnosis system. Later on the 'obvious cases' would be presented to a doctor in real time as the patient began describing his or her symptoms. This would be presented either as a list or perhaps more appropriately as a mind map.

- Acts as a medical record.

- Logic behind choices can be retroactively justified.

- General practitioners can see patients faster because they won't need as many notes.

- Patients will be more confident in their diagnosis with a digital second opinion.

- Prescriptions can be autofilled to prevent error.

- System gets better over time with more data.

Now it is important to note I have no idea what I'm talking about. This took literally 30 seconds to come up with. So why hasn't something radically better already been done? I say it is very simple. It is not allowed. It is defacto illegal to do any of the above. You can't even digitize medical records properly. That is frightening.

The only way this is going to work is if we

- Provide services where they are impossible e.g. third world.

- Only provide this technology to private healthcare. Possibly even on Seasteads to avoid anti-tech litigation.

- The government creates a SMZ (Special Medical Zone) outside of the medical establishment's reach.

In addition to this you'd have to make the general public aware of how bad their healthcare really is. That's the only way to get "Tech companies screw 3rd world with experimental medicine" stories from whoever will be the next Gawker off your backs because the established order is going to do everything it can to blacken your name.

[nonbel]

>"Now it is important to note I have no idea what I'm talking about. This took literally 30 seconds to come up with."

I think you have some great ideas.

>"So why hasn't something radically better already been done?...In addition to this you'd have to make the general public aware of how bad their healthcare really is."

Maybe at this point the consequences would be worse than the current problem, at least in the short term.

[frank_jaeger]

A doctor failed to tell a CHILD about an appropriate level of activity for his condition, and you honestly have the gall to put quotes around that error?

[kazinator]

That child could have easily died running involuntarily from bullies or dogs. Or from having his heart race due to anything else: being startled, nervous, or excited on a first date or whatever.

He didn't die while undergoing a medical procedure; he died of a bad ticker.

The medical establishment didn't cause his heart ailment, it just neglected to inform him. That is unfortunate, but it is somehow not the in the same category as, say, being treated for a broken leg, and given a fatal overdose of some painkiller.

Honest accounting for deaths due to medical error must only count situations when someone dies of something irrelevant, not directly connected to the condition for which they are treated. (Certainly not of the condition for which they are treated, especially if that kind of condition itself carries a reasonable probability of causing death!) That cause of death which occurs must not be a recognized risk factor in that kind of treatment (when that treatment is correct).

The key reasoning is that without any medical intervention at all, the child would also have likely died, and of the same thing.

If we count as a "death due to medical error" a situation in which medicine merely failed to prevent a death, that has to be very well justified. This means that it was very probable that if the mistake had not been made, the patient would have made a full recovery: their condition would have cleared away to the point of that condition no longer being a death risk, and that this positive outcome is virtually guaranteed in such cases when the correct treatment is applied.

The advice not to ever strain yourself physically for the rest of your life or get excited is not a treatment which results in the condition being cured. The condition remains in place, along with the risk of dying.

[kazinator]

The dude is a paramedic. His job is to drive like a madman through red lights to emergency situations to frantically try to save someone, not to weigh the merits of research.