Thursday 3 February 2011

Medical and economic advice

I agree with Karl Smith:
The view I subscribe to currently is that most people don’t care that much about increasing their life expectancy, they care about being cared for and being cared about. They care about reassurance and they care about feeling like they are not alone.

We can see that people don’t care that much about maximizing their life expectancy because they place an enormous premium on their doctor’s bedside manner and a much smaller premium on his error rate. We can see that when objectively bad doctors who are nice rarely get sued for malpractice, while much better doctors who are assholes get sued all the time.
When we were shopping around for an obstetrician in 2007, we first asked for a measure of successful deliveries correcting for difficulty. That didn't exist. Then we asked for just rates of adverse outcomes. That doesn't exist either as the docs refuse to supply the data. Our midwife recommended which ones were nice. I said "I don't give a damn which one's nice, I want the one who can unwrap an umbilical cord from around a kid's neck if there's a problem." Finally, phrasing it as "If you only cared about the safest best possible delivery, who would you pick for your own delivery" provided me her assessment. She probably still thinks I'm a jerk, but two successful caesarean deliveries subsequent to unsuccessful trial of labour later, with the latter having involved an umbilical cord twice wrapped around the baby's neck [all turned out fine], I've no regrets.
We can see that when we offer potential surgical patients stats on the number of fatalities at prospective hospitals and they refuse them. We can see that when message boards about doctors are filled with comments like “He really understood me.” “She took the time to stop and listen. “ “I knew they cared about whether I got better” “I was more than just a number.”

These are not comments about the skill of the medical provider but about the caring of the medical provider.
Well, that explains why the midwife was surprised when I asked for stats. It probably had never come up before.

How different is economic advice?


  1. I also agree that people don't care much about life expectancy, but I'm not sure this is mostly about that:

    It seems more about the fact that people have a hard time thinking about the questions you're asking, or maybe (unconsciously?) associate niceness with good doctors.

    Why do I think this? Because it really seems like unsuccessful deliveries have a serious impact on quality of life, not just life expectancy.

  2. @David: Wouldn't you then expect the best docs to highlight their success rates, then the second best docs to list theirs so as not to be thought lumped with the worst, and so on down the line? It's hard to get an equilibrium where the docs compete with each other, the customers care about a good measure of success rates, and they don't wind up mentioning it.

    Cartels among doctors in small markets doesn't sound implausible though.

  3. Yeah, I dunno. Maybe highlighting success rates just reminds people that failure is possible? Maybe publishing rates to compare with is difficult (hard to get data, don't want to piss people off, etc.)?

    I dunno. But wouldn't you say that success in this delivery was not just a matter of "life expectancy", but also quality of life (e.g., for you, who isn't medically involved in the procedure at all)?

    I can see claiming people don't care about life expectancy. But this is also about quality of life, and maybe the quality of life benefit of a nice doctor is more important than the quality of life risk of a failed pregnancy. I don't really know, but I do know it's a very different claim.