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Comment by drdoc | Hacker News Reader

As an anesthesiologist, this is a bad idea for various different reasons. There are a numerous reasons why a physician needs the tools that he needs. The type of procedure, the type of patient and the familiarity of the equipment. I routinely intubate patients with a particular type of tool because that is what I feel most comfortable with and I have trained with. Yes, I can intubate with the myriad of other devices but there is that 1 out of a 1000 chance (slim but not unrealistically slim because I do >1000 intubations a year) that I cannot intubate you and you need to have a tracheostomy or worse, you die.

Some may argue that we should all train with the same equipment, but even then, what about inherent differences in the physician or the patients. Maybe where I trained, all my patients had large tongues and I need a particular blade more often so I became better skilled with that or maybe my hands are just better with a particular blade.

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If I dropped a Linux admin off at a shop which didn't have emacs on their boxen and he refused to work because he might accidentally screw up a config file, he'd be laughed out of the joint.

If I dropped a plumber off at a job site and she didn't have a particular type of ergonomic monkey wrench she'd grown accustomed to and said she couldn't do the job, she'd be mocked endlessly.

If I dropped a line chef off at a kitchen and they didn't have their favorite knife available and they held up orders for a whole night, their boss would fire them.

This custom bespoke medicine nonsense is increasingly seeming to be just that: nonsense.

Sure, there's this .1% chance that you might screw up an intubation, but that seems to be more of an issue of bad training than bad equipment.

As far as your point about differences in patients or physicians: that's a cop-out. Part of being good at what you do (as a dev, as a maker, as a person) is being flexible enough to make do and succeed.

In a system which costs as much as ours does to people who simply can't afford it, we (as a society) cannot afford to cater to the whims of overspecialized professionals.

In all your examples, you aren't dealing with a person's health or (potentially) life. The risk-benefit calculation changes (and people become, understandably, somewhat irrational) when the stakes get that high.

And if a soldier gets to a new unit and they assign him a weapon he's not familiar with? The military definitely deals with life and death stakes.

Their solution: Frequent and continuous training.

What kind of ongoing training do hospitals offer their doctors? Who trains doctors on new equipment in hospitals? (honest questions)

" Who trains doctors on new equipment in hospitals?"

Dirty secret. Equipment vendors. Ditto for pharmaceuticals.

> If I dropped a Linux admin off at a shop which didn't have emacs on their boxen and he refused to work because he might accidentally screw up a config file, he'd be laughed out of the joint.

The kind of errors made by a Linux admin who is more familiar with emacs using vi don't have as much likelihood of ending up with dead customers and massive liability for the Linux admin and/or his employer as the kind of errors that could be expected from a surgeon being forced to use non-preferred equipment.

So the situations aren't exactly parallel.

> In a system which costs as much as ours does to people who simply can't afford it, we (as a society) cannot afford to cater to the whims of overspecialized professionals.

In a system which costs as much as ours does compared to every other advanced country, while providing worse access and not producing better outcomes, we certainly can't afford to not do some research to figure out what everyone else is doing right and we aren't.

But somehow I don't think letting surgeons choose the tools used for a particular surgery based on their own expertise and understanding of the needs of the particular surgery, rather than having one standard kit used for all surgeries regardless of the specific details of surgeon and patient, is the difference.

"But somehow I don't think letting surgeons choose the tools used for a particular surgery based on their own expertise and understanding of the needs of the particular surgery, rather than having one standard kit used for all surgeries regardless of the specific details of surgeon and patient, is the difference."

In isolation, your intuition is correct. But, with thousands and thousands of surgeons performing hundreds of thousands of surgeries a year, we end up with a logistical nightmare. This doesn't scale.

It's perhaps not the main difference, but I'm willing to wager it is at the least a symptom of whatever the underlying problem is.

> It's perhaps not the main difference, but I'm willing to wager it is at the least a symptom of whatever the underlying problem is.

I doubt its even a symptom: because I don't think the other OECD countries that spend less for broader access and equal or better outcomes use one-size-fits-all-surgeries standardized equipment kits, either. But even if it was a symptom, it would be better to treat the underlying problems.

If an engineer or machinist used to working with SI tools goes to work somewhere using metric measurements, perhaps building equipment for space travel...

Oh wait.

Obviously, doctors can get things done under less than ideal circumstances. I'm sure every TV show has had an episode of someone doing an in-field tracheotomy with a swiss army knife and a biro cap.

A license is not necessary for a Linux admin to work (in general). Screwing up a service file isn't on average going to result in the CEO of his company having a meeting with the company's attorneys and practice review boards to determine how much to pay the victim of his edits.

Worst case based on negligence (maybe taking all the zones down for a DNS provider), the admin loses his or her job.

You're comparing something minor with something that has both a high risk of serious damage or death (throw the statistical average value of life in here) plus an environment (especially in the USA) where attorneys advertise on bloody public buses for people who were "harmed" by a doctor, and there's a lot of ass covering with best practice behavior.

The human body is not a car (there's the metric/SI thing again). Things are bigger, smaller, in a slightly different location, softer, harder, or any of a million other combinations of complications that make it safer to use appropriate customized equipment.

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