If We Told You That, We Would Have to Shoot You | Hacker News Reader

If We Told You That, We Would Have to Shoot You

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74 pointsdpatru26 comments

You live in a country where medical people of any sort (doctors, medical suppliers, etc) can be sued without scientific evidence that they harmed anyone. They will face trial with a jury having no ability to evaluate scientific evidence and who will make a decision based on who is more sympathetic. The plaintiff's lawyer may pretend to be a psychic and still be awarded millions of dollars rather than being laughed out of court (http://www.nytimes.com/2004/01/31/politics/campaign/31EDWA.h...).

Is it any surprise that everyone involved goes out of their way to avoid any hint of possible legal liability?

A million times yes. I am convinced many of the issues with systems everywhere in America could be fixed by less frivolous litigation.

My best friend is in the middle of his residency and this is what I hear from him A LOT.

Well, it's not like he's going to say "I'm the problem". Check my link above about the size of tort costs in the USA compared to overall medical cost, and their respective inflations.

The worst thing about liability is not the first-order costs, but the second-order costs. I'd make up an example, but all you need to do is read the posted article. Even if we say for the sake of argument that every last penny of what he spent was because of lawsuits, just to simplify things, the lawsuit cost to him is still utterly dwarfed by the opportunity cost to him of jumping through all those hoops and having his life shredded by sleep apnea for several unnecessary weeks vs. the way it could have gone: "You know, it does sound like you have sleep apnea. Diagnosing it definitively is hard, but let's send you home with a test CPAP for a week and see how it goes. I'll get you one from the back and you can start tonight."

Your tort statistics won't include anything about making this guy suffer, or the fact that going with serious sleep apnea for an unnecessary month may well be taking months off his life, or the extra income lost and just general worsening of quality of life, yet they are by far the larger factor here.

People on HN are prone to treat every medical issue as if the doctor is choosing between two medicines where one will save you, one will kill you, no medicine will kill you, and only the amazing skill and training of the doctor can resolve the incredible conundrum of which to choose. But really, there's no need to treat every medical issue that way, only the ones that actually are that critical. Abstractly, there's very little reason that my scenario above shouldn't be the way it actually happens. CPAP machines won't kill you if it isn't sleep apnea. (A quick Google search on "cpap fatality" has a lot of links about dying because you didn't wear the mask, albeit hypotheticals.) You probably can't get into a sleep study this very night anyhow, so trying that out isn't that great a loss. Silly scenarios ending in death can be constructed but the probability of them is negligible, and that's a stupid base to build policy on... but here we are. Meanwhile, in the real world, he really is suffering.

Certainly we want to reduce/eliminate frivolous lawsuits. The (really hard) problem is finding a good way to do so.

I don't think that's quite accurate. They could be improved, certainly, but tort reform would still leave our healthcare system woefully overpriced and underperforming. The amount of money it costs is trivial compared to lifestyle choices like being overweight.

It seems crazy that modifying the machine doesn't invalidate any legal claim if it goes wrong (aka a warranty)

Medical tort costs in 2007 were 30 billion and have been increasing at about 5% a year for the last 10 years (http://www.towersperrin.com/tp/getwebcachedoc?webc=USA/2008/...)

Meanwhile, medical costs are more on the order of 2 trillion and have been increasing by over 15 % a year for the last 10 years.

I don't think liability is really the main cost driver here. I'd look at profits first. $2k to do a sleep study? How much work could that possibly be? And then they insist on another one? Not to mention the whole PCP -> specialist -> other specialist to get a frickin piece of plastic. Everyone got a piece there.

The question is how much unnecessary expense is incurred trying to avoid legal liability.

The laws haven't changed over the last few years, yet the cost of healthcare has increased way more than the total in tort settlements. Even though reimbursement of healthcare costs is a big part of those settlements.

Given those figures, I'd guess that "avoiding liability" is a convienent excuse for running up the bill in many cases. If the laws aren't changing, and the amount of settlements awarded is actually decreasing relative to the cost of care, why is care going up so fast? Why spend more money avoiding liability this year than last year, if the odds of being sued have actually gone down?

Of course, expenses incurred doing better medicine and not screwing up as opposed to reducing liability are probably a good idea.

I don't recall claiming torts were the cause of all medical inflation. I claimed torts were the cause of Daniel Markham being shuffled from sleep study to sleep study and of him not being allowed to hack his own medical device.

Also, your argument is specious since it completely ignores the cost of unnecessary medicine performed in order to ward off lawsuits. For example, a lawsuit fearing doctor might order unnecessary tests and procedures with little medical benefit but, but which the doctor can point to in court and say "look, I did the best I could".

You claimed torts were the cause -- I'm claiming they're the excuse, and the $2k bill is the cause. $2k in guaranteed cash is a stronger incentive than the very remote chance of a lawsuit over sleep apnea. Even if the latter does exist in some small number and can be blamed.

1) The pulmonary specialist who ordered the sleep study does not get $2k, the sleep study guy does. Why would the pulmonary specialist care about enriching the sleep study guys?

2) Humans respond disproportionately to low probability, high cost events. Witness the reaction to "XXX causes cancer", the DC sniper, 9/11, or similar rare events.

So yeah, I'd say fear of lawsuits is a better explanation than the desire to make somebody else $2000 richer.

Go read that Times magazine article about the most expensive town in America for health care.

Average health in the town, nothing special about it except the fact that they bill twice as much. They're sending each other referrals like crazy. It's in Texas, so I'm guessing their medical malpractice costs are not above average.

The pulmonary specialist who ordered the sleep study does not get $2k, the sleep study guy does. Why would the pulmonary specialist care about enriching the sleep study guys?

So, you're 100% certain that the pulmonary specialist is not an owner or an investor at the sleep study facility?

In reality, it is quite common for doctors to own or invest in facilities to which they refer their own patients.

I think the problem is systemic. If you look at any one part of the system, you wind up saying "that's out of whack but it's only a small percentage." The problem seems to be that those small percentages are compounded.

This is pretty problematic. The government and legal system don't seem to view taking responsibility for your own health as a legal right. I don't care that some people would do stupid things. A big "you shouldn't do this without a doctor's supervision" note is really all that should be required.

I wish people would think outside themselves for a bit. Is every person who has self-diagnosed with Dr Google right? I am sure doctors have seen a bunch of people that are waving some printout that says "I have X, I need Y! Stat!" and are totally wrong. I personally don't blame them for wanting to go through the tests.

I know a couple of doctors who have said that people come in saying "I have X, I need Y".. they called it "Googleitis". There are some times when they are right, but many times that they are wrong.

I agree that the tests should still be performed to take care of that problem. I also strongly agree that "requiring referrals" and having to go to 3 or 4 different doctors to get a test, diagnosis, prescription, and often times, another test just to make sure is terrible. Each time, I need to schedule appointments, wait, go to another doctor, wait, etc. It seems like what should take a week to do is stretched out in to 6-8 weeks, and I have to pay for it every time, even with Insurance.

It's actually an even deeper problem that people self-diagnosing through Google, as diagnostic tools increase in sophistication and decrease in cost you can potentially find "issues" that never existed before.

Take CT scans: if you took a random sampling of people, gave them a CT scan and then had an ortho doc look at the result 30% of the scans would show an "abnormality", but almost none of the patients would end up actually needing spine surgery.

Similarly with apnea, almost everyone has some sleep apnea, but not everyone needs a CPAP, etc.

This is simply innumeracy, in particular an inability/unwillingness to use Bayes rule.

My startup is working in exactly this field; building a small embedded tag which can be linked to the data port of a variety of clinical devices, allowing data to be offloaded into a electronic patient record or external database.

We've had a bit of trouble getting protocols out of the manufacturers, but generally the hospital department in change of device maintenance (here, Medical Physics) will have access or can request it for datasheets, protocol specifications, and almost everything you'd want.

Not sure they'd be too happy providing it to a random patient though, whereas we have a working relationship with a few local hospitals.

I also recently underwent a sleep study for sleep apnea, and after having waited around 4 months for the test, it will now be another 5-6 before the specialist can review my results and make a diagnosis. Chances are any sort of CPAP will require another test for calibration and the like as well :/

I'm highly tempted to do as described in this article, and take one of the office test devices, a Nonin XPod http://www.nonin.com/OEMSolutions/Xpod and do a bit of night-time data logging of my own. Having worked with those devices, I quite like their very simple serial packet format, which is standard RS232 serial, and fully documented on the public datasheet on their website.

This was posted a couple of days ago... can't find the link though.

Here it is: http://news.ycombinator.com/item?id=1471123

Recommended reading: Andy Kessler, The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor.

There are startup opportunities hidden here!

I dunno, these patient narratives have a way of driving me up the wall.

It seems like just about everybody who can't cope has "Obstructive Sleep Apnea" these days... Enough that I'm starting to wonder if it's not just fashionable, but contagious.

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