When my mom need her second urgent brain surgery, one of the nurses, a friend of a friend, warned us that one of the surgeons on staff that night had dreadful results with basically any procedure. and that if we were stuck with him, that refusing the surgery until another one was able to come in. If the floor nurses know, the head on neurology knows, and yet, they were still OK letting them operate.
Any functioning system just has to eject surgeons that get bad outcomes. It's not as if they have to stop practicing medicine, but move to something a little less dangerous.
When it comes to bad doctors, I think a lot of people in the medical field would agree "you know one when you see one." But when you're talking about putting professional restrictions on someone, you need objective criteria.
The naive way, counting up bad outcomes, leads to a system where surgeons are incentivized to decline any case that looks technically difficult or where the patient has lots of preexisting conditions that put them at risk for complications after the surgery. We already see this to a degree in transplant surgery, where outcomes are followed closely to avoid wasting organs.
That said, I think true incompetence is pretty rare. I can't think of a single doctor I 've worked with professionally where I'd be concerned if I found out they were taking care of one of my immediate family.
Already happens all the time, although it's at the discretion of the first surgeon. Again, it's difficult to formulate objective criteria for when a surgeon should forward a case on to someone else.
I don't believe that surgeons obviously over operate.
In my career I've seen
- A case where the surgical team declined to operate for endocarditis with congestive heart failure, despite the fact that the society guidelines recommend surgery in that scenario
- A case where the surgical team declined to operate for a spinal cord injury that left a patient paralyzed from the neck down (and dependent on machines to breathe due to the paralysis affecting their diaphragm)
- A case where the surgical team declined to operate on an abscess even after a patient's blood stream infection failed to clear after two weeks of the strongest IV antibiotics
In all the first and third cases, the disease turned terminal after our surgical team declined to operate. In the second example the patient opted to die rather than live the rest of their life on a ventilator and I was left with the responsibility of arranging hospice for the patient.
I'll admit that these are extreme cases, but my point is the patients and family members in those cases likely had a very different view about whether surgeons should decline high risk surgeries as often as they do, let alone more often.
Part of this is the AMA cartel artificially limiting the supply of residencies.
Ultimately it boils down to what a given surgeon practiced in their career.
Is this a concept that exists? I thought "thin tailed" and "fat tailed" were defined by contrast to a normal distribution.
> Excess kurtosis, typically compared to a value of 0, characterizes the “tailedness” of a distribution. A univariate normal distribution has an excess kurtosis of 0. Negative excess kurtosis indicates a platykurtic distribution, which doesn’t necessarily have a flat top but produces fewer or less extreme outliers than the normal distribution. For instance, the uniform distribution (ie one that is uniformly finite over some bound and zero elsewhere) is platykurtic. On the other hand, positive excess kurtosis signifies a leptokurtic distribution. The Laplace distribution, for example, has tails that decay more slowly than a Gaussian, resulting in more outliers.
(Emphasis added.)
You can't have a bell curve with thin tails, because a bell curve has standard tails by definition.
even if hand skills is orthogonal to test scores, test scores could still be highly correlated with outcomes