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Comment by BoiledCabbage | Hacker News Reader

I agree. And what Tom didn't realize is that Doctors aren't financially incetivized to give better healthcare. There is no money in it for them. If anything, return visits because of a partial prior resolution make more money.

Now clearly I'm not saying that doctors try to give bad diagnoses for profit (because they don't). But beyond a certain minimum bar, and on a purely financial basis, improving diagnostics or prescription accuracy doesn't not make a medical practice more money. And the responses here illustrte that.

Now, whether that's the right/wrong incentive strucgture is a whole 'nother discussion. And I personally can't think of something better than what we currently have - but it is a truth of the current system.

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I see this take all the time but it’s kind of misleading. Realistically things like uptodate, clinical journals and conferences mint money. Doctors are one of the prime demographics of people who do things for non monetary gains. Yes if you want to be nihilist you’ll find a minority of docs where this isn’t true, but the point is there’sa huge market to doctors willing to improve care without direct monetary gain.

This startup product failed because it wasn’t shown to improve outcomes— it just compiled study results by a non expert. At the very least the founder should have at least attempted doing a study on the tool showing using it resulted in better outcomes. But it didn’t make that link and so people didn’t know what to do with it.

> Doctors aren't financially incetivized to give better healthcare.

I think that's an overly nihilistic and not entirely accurate viewpoint. Good doctors get more patients through referrals, and once they have enough patients they can be more selective about which patients they take on. And they make more money. Bad doctors will lose trust and patients.

What doctors aren't incentivized to do is provide marginally stronger drugs. If aleve works a little bit better but tylenol is easier on your stomach, then is Aleve really "better"? If you actually need a stronger painkiller you can just up the dose. Medicine is rarely a black and white "best" situation.

He actually received a clue from 'Susan', one of the doctors he demonstrated his application to: "in many cases I’ll just prescribe what I normally do, since I’m comfortable with it"

He should have sold his tool to sales and marketing at pharmaceutical companies who would use it to convince doctors to prescribe their product.

But if you're selling a drug, aren't you going to rely on just the studies that show the efficacy of your product? If your drug _isn't_ the best according to the meta-analyses, this tool is of no help to you. And even if your drug _is_ the best according to the meta-analyses, that's because there are already multiple studies that show how good your drug is, and you can overstate your product's value by throwing out the rest of the studies.

Agreed, at that point the value proposition is to some trying to close a sale to overcome the objection that the supplied studies are cherry picked.

Its... uh.... niche.

> If anything, return visits because of a partial prior resolution make more money.

I don't know what system you are referring to, but in the EU, for common physician services, this is (fortunately) not how it works. Physicians are by and large being paid per case, not per visit. In Germany a case is being defined as the same patient visiting the same physician in the same quarter of the year (https://www.kbv.de/tools/ebm/html/3.1_1623969609994938562151...)

I'm assuming the US as that is the case here. Each visit is billed for individually. By the case is certainly a much better model.

The financial incentives behind care differ greatly between states and health systems, so you can't just make blanket statements like that. Look up accountable care organizations and value-based care. We're still in our early stages, but our country is trying to figure out how to properly incentivize care, I hope.

your comment makes sense from a layman's perspective of logic and economics. but in the industry you'll find most doctors actually do not want to see patients for revisits and would rather a pill or injection solve the problem in one go. unfortunately due to biology this is rarely the case, and managers/pharma reps/business dev are keen to capitalize on it- not the overworked doctors.

> But beyond a certain minimum bar, and on a purely financial basis, improving diagnostics or prescription accuracy doesn't not make a medical practice more money.

But giving better diagnostics and better prescriptions can result in improved profits if it's marketed in an efficient way. Would you go to a clinic that will give you the best diagnostic and prescription possible or to one where you are unsure about the result?

Some mediocre restaurants in tourist areas are doing well because they are vouched for and have TripAdvisor stickers on their front door. What if clinics had GlacierMD stickers on their front door? To sell GlacierMD to doctors you have first to convince the patients that is something great about it.

Let me rewrite your comment:

Doctors are incentivised to provide better healthcare. The incentives are not directly financial.

This was the whole thing with bundled payments. https://www.cms.gov/newsroom/fact-sheets/bundled-payments-ca.... One lump sum for a condition, and the stakeholders involved want to treat it the fastest/cheapest way possible.

Barring that aside, at least the doctors I'm related to would love nothing better than to give better care. I always hear about how they need to stay up on the latest stuff.

That's sad.... that you think that.

It is like saying that software engineers write bad code, so that they can get paid to fix it. (Which is really not true at all)

> If anything, return visits because of a partial prior resolution make more money.

I don't think any doctor deliberately prolongs the illness of their patients to keep the money flow coming.

Do you have any evidence to back up what you said (other than a flawed game-theory hypothesis)?

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