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Comment by maxerickson | Hacker News Reader

A large portion of the people undergoing heart surgeries still face a high risk of death if they don't have the surgery (with the surgery bringing the chance of a longer, more comfortable life).

Here's why your hot take isn't the best take:

“About 30 percent of them said they had turned patients down for surgery even when they knew full well that surgery was in their best interest.”

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One problem is that fee-for-service incentives strongly distort what people think they "know full well."

Correct me if I am wrong, but don't doctors in the UK get paid a salary instead of the fee-for-service model prevalent in the US and Canada?

For NHS hospital doctors (including heart surgeons) that's true. General practitioners may be salaried or equity partners (the system is largely by contract to doctors' offices rather than directly employed). There is also a small percentage of non-NHS private work, though this is mainly in routine elective work rather than high-risk heart surgery.

Here's the converse of that, though: why do we think it's okay to expect a team of doctors and nurses to be okay with almost assuredly killing someone during surgery? They're not robots, "it's their job" is not an acceptable answer.

Even if the surgery is in a patient's best interest, if the odds of killing them are all but guaranteed then it's most definitely not a matter of looking at the patient and rationalising it with "they will die otherwise anyway". It's not just about the patient.

People who make this argument seem to forget that there's also an entire team of medical professionals that your rationalisation says should be okay with going into a surgery knowing they are almost guaranteed to kill this patient. They have the stats, the stats say "this person will die under the knife", many more lives are affected in this decision than just the patient.

So expecting them to just do the surgery instead of going "No. This will kill the patient, I don't want that on me and my team" is very far from an okay attitude towards fellow human beings, and leads to terrible medical practices.

I don't see where the article says "the odds of killing them are all but guaranteed", so I don't really appreciate you stuffing that meaning into my comment. I highly doubt that surgeries at that level of risk are actually in the medical interests of the patient (the standard I used).

Are you speaking from further knowledge of the the statistics of the cases where surgery is refused? If so, why not drop that instead of the lecture?

But it does not have to be that extreme. Let us take a made up example where there are two categories of patients. One that are healthy enough that a positive outcome of surgery is almost guaranteed, almost all survive. If you operate on people like that you will have excellent stats.

However let us add someone that is really sick and will most likely die within 6 months if they don't get surgery. They are in bad shape so surgery has a 25% risk of killing them. Most patients would probably want to take that gamble but for the surgeon who operates on patients like that frequently that would mean that their stats would go from almost perfect to pretty bad. You don't want to surgery from a guy with where 10% of his patients die from heart surgery when you can get another guy where only 0.1% die.

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