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Comment by kazinator | Hacker News Reader

Low mortality is a good damned measure.

I don't want to be operated on some yahoo surgeon who unconditionally operates regardless of risk and has a high mortality track record as a result.

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Then maybe mortality rate should be attributed to doctors not operating as well. Low mortality is a good metric on patients, not doctors.

But on the other hand, I don't want to be treated by a doctor who cares more about his sellable stats than saving lives.

Maybe it's a good metric for hospitals. There are other pressures discouraging hospitals from rejecting patients altogether, or such is my impression, anyway.

You say that as if you had a choice. The point of the article is that you don't. That yahoo doctor is the only one willing to operate on you. The rest -- presumably the smart ones -- are playing the game to win, so they'll sit out this turn, because you're a bad bet.

The point is that if you are already dying then you would prefer the surgery instead of doing nothing. The doctors seem to have no problem with actually doing the work but don't like their stats ruined, which is rather disconcerting given the consequences.

Your comment also shows that patients are just as much of an issue by focusing on the metric more than the cases involved.

If you need a high-risk operation or die, no-one wants to operate on you because of this rule.

You are committing a common fallacy - when evaluating risk, you are considering only one of the alternatives and forgetting the risk of the other. Yes, nobody wants to be operated on by a yahoo. But mortality is not a good measure of yahoo-ness, because in some cases not operating carries larger risk of death than operating. And if a surgeon decides to operate in this case, the decision is right even if resulting risk is high - because the alternative is even higher risk. Considering only mortality rate of operations ignores this. It is a variation of survivorship bias, only on the opposite side.

You presumably want the metric (operation, mortality rate); its useless to consider mortality across the board, because that assumes all activities are equally risky. Otherwise, you end up like this, just entirely removing the option of high-risk activities, regardless of the potential benefit.

Essentially, the doctor has decided that he doesn't want to take the risk of killing you, even if you're willing to accept it. Why should that be the doctor's choice to make, and why is he being given this additional risk, when the benefit/loss should clearly be yours?

A doctor might have a 5% mortality track record for a surgery that generally has a 20% mortality risk. I feel like you are pushing it to an extreme with this yahoo doctor example.

It becomes a bad measure because once it's a target people start to manipulate it in order to hit the target. In this case if a surgeon refuses to take anything but easy surgeries their stats will look amazing but it says very little about their actual abilities.

but he'll become good at accurately measuring risk, so if accepts to operate on you, you can be certain that your case is simple and your odds of dying on the table are slim.

Some doctors have high mortality records because they specialize in treating deadly diseases. And you'd rather be treated by a doctor who has only ever treated non-fatal ones? Well, that'll work if you never have anything worse than a common cold.

When the option is "or die" I think you'd change your tune.

I'm so happy that this system of 'likes' works for some people.

So if it's difficult we shouldn't try?

Finger ----------------> Moon

^ You're looking at this.

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