Comment by claudiusd | Hacker News Reader

Comment by claudiusd | Hacker News Reader

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I love your analogy, but I think you drew the wrong conclusion. Doctors don't have an incentive to prevent you from getting sicker any more than your mechanic has an incentive for keeping your car out of the shop. Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease?

Now this isn't to say that doctors are bad people who want to make you sick... on the contrary, most of the doctors I know are more passionate about helping people than making money. They are, however, subject to whims of the hospital they work for, which I can almost guarantee is more interested in making a buck than keeping you healthy. This is true of all large companies though, and as Clayton Christensen has taught us, this sort of marginal thinking usually leads to disruptive innovation by a start-up.

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I once mentioned that to a family friend who was a doctor. He said that if he wanted to make money off of people's suffering, he'd have become a lawyer. Its way easier.

Do realize that doctors are required to do continuing medical education (CME [1]) to maintain their license? Not to say that the system is perfect, but it is false that doctors do not do some sort of continued study in their field (mandated or not.)

Doctors most certainly have an incentive to keep their patients from getting sicker. One of the ways we evaluate quality of care is incidence of morbidity. How often does this patient continue to return to the hospital? This is a huge risk to physicians, in the form of a lawsuit.

It isn't like there is any shortage of patients who require care. There are so many ways that hospitals encourage doctors to do bad things to make a buck, but preventing preventative care would not be the first thing I'd target.

[1] http://en.wikipedia.org/wiki/Continuing_medical_education

I think another big problem is the generic advice (eat better, exercise more, don't smoke, etc.) is incredibly effective, but doctors routinely see huge numbers of their patients not doing it at all, so why would they bother researching for more specialized advice?

> Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease?

Woah woah woah there. Are you really saying doctors don't read the latest research so that they can make a greater profit? Really?

You could have at least picked a more realistic example of misaligned incentives in medicine... e.g. using a more expensive drill bit during a surgery because you know that the surgical rep will take you out to a nice dinner every time he's in town.

There's a huge population of doctors. Some ethical. Some unethical. But I believe the profession does a pretty admirable job of stamping out immoral behavior when it finds it.

The OP phrased it badly, but the point is sound. Suppose a doctor has a choice of two activities:

1. Read research, unpaid 2. Treat patient, paid

The doctor clearly has an incentive to focus on treating disease. They do read research, but they would surely read even more if they were paid directly to do so.

There's nothing nefarious in this, it happens in any industry. We do more of the things we're paid to do, and less of the things we're not.

It's sound if you assume both aren't part of the job description. Change the occupation in the poorly constructed analogy and we have...

Suppose a pilot has a choice of two activities:

1. Read FAA safety report, unpaid 2. Fly plane, paid

Doctors, especially at academic institutions, are required not only to be up to date in the latest research, but contribute to it. If a doctor treats a patient in a way not up to par with current practices in research, he will be sued and lose his licensure.

See mention of CME upthread. The choice is really:

1. Attend CME meeting, often at nice resort locale, usually unpaid, but deductible. Acquire at least 25 hours of such attendance per year.

2. Lose medical license. Pump gas, if you can find a full-service station.

Holy false dilemma.

The education tries to ingrain "do no harm" but then again, human nature is human nature.

The folks who go into primary care - i.e. GP's, pediatricians, etc, tend to be more altruistic, and think along the lines of preventative medicine. (They certainly aren't in it for the money...). It's really the subspecialties you hear about some random doc who is pushing tests or surgeries somewhere.

There is a push behind the new "Accountable Care Model" that tries to incentivize better performance on overall health metrics that tries to address this, but too soon to tell how well it works.

I don't think there will be a shortage of sick people anytime soon.

Also, the problem is that such papers don't exist, or at least not in the accuracy or certainty you'd like to have.

It's much easier to gather data from sick people and which treatments worked for them, than gathering decades worth of data from healthy people and correlate causes to which diseases they eventually may have developed.

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