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Comment by luddaite | Hacker News Reader

It's easy to attribute this whole situation to greed and/or malice but I think that fails Hanlon's razor. I can easily see this whole situation occurring because of poor communication and the culture of paternalism in medicine. It is not hard to imagine a team of healthcare providers that know or think they know what is good for their patient and do a poor job explaining why they are making the decisions that they are making whether that is because of poor communication skills or because they are simply too busy. I think the article proposes a good solution in calling up the hospital's ethics council. This should be standard operating procedure when a patient disagrees with medical staff and the presence of this resource should be communicated to the patient early on and by a employee who isn't directly involved with the patient's care.

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While I agree this type of situation is likely most often due to miscommunication, that doesn't preclude certain instances from being malicious in intent (possibly including this one - we really don't have enough information to attribute motive and cause, but there are enough odd behaviors on the Mayo clinic's part that I hesitate to employ Hanlon's razor). The hospital's ethics council only works as a solution to greed and/or malice when the patient has prior knowledge of the council, as otherwise there is little reason to believe they would be informed - and even in the case of a knowledgeable patient, the integrity of the council may be compromised due to the same conflict of interest. An unaffiliated council might be effective in avoiding this, but that fails to solve the problem of dissemination of information. Perhaps the role could be foisted onto insurance providers, but they are not impartial (having financial incentives to reduce patient expenses, as well as strong relationships with hospitals). A potential solution is to use smaller, local clinics, rather than nationwide chains, as smaller companies are generally more pliable, both to non-contentious discussion and legal pressure, but such clinics are increasingly a rarity in many areas.

It's a thorny problem, that's made more so by its perceived rarity - if few are impacted by it and even less speak out over it, it's difficult to justify reform or review, especially if it increases the financial burden of the healthcare system.

Ethics councils are often hybrid in nature, including members of the local community that do not stand to benefit financially from patient care. I agree that informing patients about the presence of these governing bodies is a difficult problem. However, many bad situations would be avoided if the information was disseminated as standard procedure at the earliest possible convenience (before disagreement has a chance to arise).

I was unaware of this design for the ethics councils. In that case, I agree that this would go a long way towards alleviating the problem - even if it's not completely unbiased, even a few unaffiliated members can be a major moderating influence.

Thank you for the information, your suggestion seems like a very effective way of minimizing future incidents.

> I can easily see this whole situation occurring because of poor communication and the culture of paternalism in medicine.

I can see it starting that way, but there is an absolute line the hospital should have never crossed: People have the right to chose what medical treatment they want.

They crossed the line.

We don't know the full story and likely never will. What if the doctors were correct in their assessment that the patient was unfit to make medical decisions and that she was being coerced by parents to act against her own best interest? I would be interested in looking at her medical record to try and understand what was really going on but that is unlikely to ever happen. There is really bad information asymmetry here because the hospital is legally prohibited from releasing any medical information but the patient can choose to reveal as much or as little as they wish.

> What if the doctors were correct in their assessment that the patient was unfit to make medical decisions and that she was being coerced by parents to act against her own best interest?

The article asks that very question, and answers that she was making her own medical decisions on everything except being able to leave the hospital.

The hospital doesn't get to have it both ways.

Read here: https://www.cnn.com/2018/08/13/health/mayo-clinic-escape-2-e...

"That hadn't jibed with the captain of investigations for the Rochester police. Sherwin said it didn't make sense that Mayo staffers told police Alyssa had been making her own decisions, yet in the discharge note, they stated she wasn't capable of making her own decisions."

And the two Judges they went to both agreed, and refused to let the Mayo become her guardian. Not to mention the hospital could have tried to get a different family member to be her guardian - but that's not what they did, they wanted themself to be the guardian.

And on top of all of that when they went to a different hospital the Dr's there agreed with the parents!

> because the hospital is legally prohibited from releasing any medical information but the patient can choose to reveal as much or as little as they wish.

That's not correct: The hospital said they would talk if the patient signed a form consenting - so she did (which they were probably not expecting), and they still refused to talk. That's pretty damning.

> I would be interested in looking at her medical record to try and understand what was really going on but that is unlikely to ever happen.

The article makes it clear enough: The parents argued with a Dr. who got a hissy fit basically and decided to cut them out of all decisions as a form of revenge.

The Mayo is losing a TON of respect here, and they should publicly fire this Dr. before it gets worse.

The hospital is only legally forbidden from sharing the patient's medical records without the patient's consent. The patient legally granted permission for the hospital to release medical information to CNN and the hospital has continued to refuse to do so.

I don’t think being prohibited from seeking a second opinion could possibly be described as likely to just be the result of a miscommunication.

Is there a need to attribute to malice when all the incentives are stacked against the correct behavior ?

Poor communication partly occurs because at no point does the Clinic have to go against its interest, there is that much less friction in the decisions taken.

Ethics is an issue but it seems that wouldn’t be sufficient as a focus for a solution.

I agree that the monetary incentives are definitely incorrectly aligned in the current healthcare system as is. That said, I don't think that monetary incentives are the only incentives present here. Most physicians don't go into medicine only to make money. There are easier ways to make more money. From my experience, most healthcare providers genuinely care about the patients' well being. That is why I bristle whenever people rush to attribute a physician's actions to greed. I totally agree with you that a better incentive structure would improve the system.

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