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Small-Scale Question Sunday for January 1, 2023

Happy New Year!

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

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If you accepted upfront that 10% of people are going to have an unnecessarily bad outcome and 1% of people are going to die unnecessarily you'd be able to do as you say, but nobody is signing up for that. We (rightly so) value human life too much for that.

Really? What are the numbers under the status quo?

The unnecessarily is doing work for me but I can't construct any real numbers without a lot more clarification and information, for instance you could do OP's flowchart suggestion if you were cautious and dumped people to a real level of care at a drop of a hat (this is basically how urgent care works, anything that shouldn't actually be managed by a primary care gets sent to the ED and billed by the ED and the urgent care).

The idea that medicine is somehow not complicated is a common one but is indicative of near absent epistemic humility. I'm a doctor and probably in greater than 90th percentile knowledge of other specialties and I can't use the other disciplines algorithms at a standard of care level. The field is big, technical, but also fuzzy (thus the "Art and Science of Healthcare").

We can see this in revealed preferences in innumerable ways (ex: calling consults even when we are 95% sure what is going on because we don't want to make a mistake or get sued).

I sympathize but this struck me as the argument against self-driving cars: it's a difficult problem, there are fuzzy situations, as such it's basically impossible for the cars to drive perfectly, and therefore it's not a viable technology. But this is of course ridiculous: self-driving cars don't need to drive perfectly to be viable, they only need to drive better than the current humans on the road, who are as a group atrocious.

So the real question is, what number of people are dying "unnecessarily" or having "unnecessarily bad outcomes" under the status quo where care may be high quality but expensive and illegible to the end user, as compared to a scenario where care might be less cautious but more accessible. First, you seem to be implying that the base rate of unnecessary bad outcomes or death under current practices is much less than 10%/1%, but we know that medical errors are not uncommon. Is it less than those figures? How much less? Recent figures put the annual number of deaths in the U.S. due to medical error at about 250,000 annually. Is your position that this is substantially less than 1%, or that these are necessary errors?

Second, how many people don't go to the doctor because they are afraid of predatory billing or just because it's too much hassle? How many people experience complications from tests and procedures that had a low probability of being useful? How many people consume ER resources just because it's easier to ignore the bill than with a normal office visit? It's not fair to compare a potentially reformed system as a whole against a subset of outcomes under the status quo.