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Comment by bjornsing | Hacker News Reader

> The doctor misdiagnoses your illness whose symptoms are in the first paragraph of the trivially googleable wikipedia article. He does not care.

This one is the hardest for me to digest. But I’ve seen it first hand a couple of times (here in Sweden), so impossible for me to dismiss.

Personally I think it’s an incentives problem, but one consisting of a lack of negative consequences. Once incompetence (and sometimes what I’d even call malevolence) reaches a certain level feedback mechanisms are overwhelmed: those who do care can no-longer impose negative consequences on those who don’t. Their boss doesn’t care either, their careers progress just the same, they make the same money, their jobs are just as secure. It snowballs from there.

At least here in Sweden it’s taboo to say it, but I think we just need to get back to individual negative consequences for not caring.

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This is a great way to get all doctors who care out of the profession.

Healthcare is always going to have the most severe consequences when mistakes are made. Diagnosis are also hard and there are many risks with treatments. If you are going to demand punishment for mistakes consider punishing yourself next time you make a normal mistake at your job.

The thing is, I care a lot when I make a mistake. To me some kind of “punishment” wouldn’t make a dent. I already imagine I do get “punished” for my mistakes, in the form of reputation and missed opportunities down the line (even if that may not be strictly true).

But if you don’t care and you expect zero consequences, then yes: “punishment” would make a dent.

And to be clear, the kind of “punishment” I think is needed is e.g. that a regulatory authority keeps a score of severe misdiagnosis that is publicly accessible. Every doctor would probably have a few in their career, nothing to worry about. But if you routinely misdiagnose patients then it’s going to add up over the years.

A publicly accessible score would mean that being a doctor means giving up privacy.

I'm not sure how it works in other countries but here there is a medical board that will hear cases and you can lose your license. I would guess a similar system exists in most places in Europe. Being brought before the board is basically like fighting a court case. I don't imagine most professions have this hanging over them combined with the amount of opportunities to get into such a situation.

I’m a founder with a failed startup behind me. It’s not like I can hide that.

If I make a mistake filing my company’s taxes or similar and it’s caught by the authorities, that will be part of the public record.

For me it’s a bit hard to understand that I should be subjected to immensely much more public scrutiny than a doctor. Why? I thought they had so much responsibility, not me.

At least here in Sweden the problem with the medical board is that they are doctors and will only revoke a license for truly egregious violations of ethical standards / law. They also look at one case at a time, so a doctor can have tens of cases representing a staggering level of unprofessionalism in total, but still keep their license.

In the US your insurance is literally worthless. Doctors make more money referring doctors to bullshit specialists then doing their job. I think you’re right about Swedish cheese. It does taste better.

Not saying the US system is better. But the basic problem that people just don’t care is fairly ubiquitous in the West I think.

Maybe catholic countries are doing a bit better. I sometimes get that feeling.

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