[m3047]

This is funny. I've had an unbelievable string of bad doctors / clinics... almost as though something is wrong with medical care around here.

Couple of years ago the latest doctor who I fired started talking colonoscopies. I asked some basic questions like how do they get paid? How much do they get paid? Who inspects their facilities?

He took great umbrage at the notion that the doctors were getting "bounties" for nipping pieces of tissue for lab review, refused to discuss that. (Tell me you know something without telling me you know something.) He also took umbrage at the notion that his clinic wasn't "clean" and that it was inspected regularly... didn't say by whom.

So here's the deal. Here in Washington State, USA his clinic gets a "wet work" inspection, just like a slaughterhouse or restaurant, as part of the occupancy / doing business license. But there is no ongoing inspection, and fuck no there is no "safe to eat here" poster in the window of his clinic.

It gets more interesting when you start looking at the datasets an inquiry like that turns up. Like: how many deaths / hospitalizations are there per 1K procedures? Actuarily we have a number. Now clinics, at least the ones doing things on a regular basis, have to report adverse events leading to hospitalization: the reporting rate is impossibly lower than the actuarial rate, complications leading to hospitalization are not being reported. But.. there's more! The State collects "foreign contamination" stats from pathologists; you can look at this by pathologist, if they do enough of them. The majority of pathologists scoring colonoscopy samples report ZERO foreign contamination; among the pathologists actually reporting, the rate for presence of foreign contamination is around 25%.

[boppo1]

What an interesting and obvious approach, wish I'd thought of it. Tell me more about your inquiry for the answers the doctor avoided.

[m3047]

I tend to let Feynman, Fermi, and Bayes guide my inquiries generally in that order. Part of the process is generating good questions; another part of the process is generating good actionable questions (tailored to the moment). Questions which are obvious, which are "horseshoes and hand grenades" type questions, based on what we know now. Follow things a little bit, test it, see where it's soft.

In this case I called public health and building inspection agencies and asked them what sort of ongoing inspections there were for clinics and other medical facilities. That turned up databases online, and keywords which turned up other databases.

What was the germ (pun intended) of this inquiry? Several years earlier, sitting in the waiting room of a different clinic, and the linen supply company pushes a cart through (gets buzzed through to the back) to collect the dirty linen, wearing gloves. Like they did this every day. Many years ago, the memo taped to the doors to a lab wing at a biotech: "gloves must be removed when greeting visitors". Various reports over the years concerning improperly sterilized dental instruments.

[kelvinjps10]

What is your point?