Why Do Patients Stop Dying When Doctors Go on Strike? (2015) | Hacker News Reader

Why Do Patients Stop Dying When Doctors Go on Strike? (2015)

psychologytoday.com

20 pointsshubhamjain14 comments

> Doctors in the U.K. are considering whether to strike over proposed changes in their contracts, and they are marching in London as part of the protest.

> But when doctors strike, the scientific research shows that patients stop dying.

My wife is a junior doctor in London and she was part of the strike. As a matter of fact, I've launched juniordoctorsstrike.co.uk as part of that movement in 2015 to support the cause. In the specific case of the UK, a junior doctor is anyone who is not a consultant, so the contract changes were applicable to not just new doctors (which is what most people would think when they hear junior) but really any doctor who didn't bother to become a consultant, even very very experienced doctors with many years of practice.

In the UK senior doctors (consultants) were doing crazy overtime to cover for the (junior) doctors who were on strike, so effectively patients were being seen by the most senior staff for a period of time. In that regard I'm not surprised that if you throw an army of consultants for a very short and limited time at all your patients that patient outcomes might actually improve. It's needless to say that this crazy work amount for consultants is unsustainable though. Take every "statistic" which you haven't forged yourself with a grain of salt!

Risky surgery can potentially kill you now and but safe you down the road.

You'd have to look just at people with planned surgery and those that would have had surgery in normal times but didn't and than look at their mortality over a timespan of years.

Right now is a good time to look into this with a lot of hospitals around the world suspending non-essential surgery to free up resources deal with COVID-19, without having to wait for the next strike.

Still, what do they need to learn - which surgeries have unacceptable risk vs benefits and should potentially not be performed?

I think it's really worth noting the sort of stupid science behind this. Yes, deaths will decrease during a strike - because extra other staff will be made available to cover the strike whilst non-essential work will be delayed until after the strike. To make a real judgement you need to look at the statistics across both a lead and lag period - the extra patients who died in the lead up due to over-worked staff, the extra patients who died in the routine operations that were displaced etc.

The exact same issues are at the core of the source of the UK strikes mentioned in the article:

> He said: ‘…three times less medical cover at weekends as they (doctors) do in weeks and that means that there's a 15% greater chance of you dying if you are admitted on a Sunday, compared to being admitted on a Wednesday.’

Because no one gets admitted to hospital for routine reasons on Sunday, so if you're admitted to hospital on a Sunday it';s because your case is more serious. If you make doctors do routine work on weekends you achieve 3 things:

1. Doctors leave the UK to work for employees who aren't moronic psychopaths. Driving down the level of care in the UK causing extra deaths.

2. The exact same people who are routinely being admitted on wendesday are being admitted on weekends too - so the death rate on wednesday admissions go up whilst death rate of sunday admissions go down. With no net benefit.

3. The government pretends it has reformed the NHS whilst dramatically reducing its efficacy.

Note how, initially we talked about the total deaths going down during strikes? Becuase routine operations are cancelled? And then we talk about death rate in relation to the weekend shifts? They are literally just two sides of the same coin, want to complain about it being bad? Cite the rate! Want to claim it's good? Well quote the total number! Perfect!

> However, as soon as elective surgery resumed, there was a rise in deaths.

Well, duh? …

Very simple, because the doctors who record the number of fatalities also go on strike. :)

Studies looking at Cardio ward outcomes when all the senior doctors go away to conferences found a similar thing

https://www.npr.org/sections/health-shots/2014/12/22/3725083...

One theory there was that juniors are more likely to "wait and see" while senior (more confident) doctors pushed their skills too far but that's far from proven.

Aren't chief doctors (or how they are called) also responsible for money and biased that way?

That would make sense. "You can't bill for not doing something" is a big incentive to do things. I think it would be interesting to compare procedure rates before and after doctors are told their hospital is struggling financially or that pay might have to be frozen if revenue doesn't rise. We are all human afterall...

No senior doctors are not responsible for the money in the UK nor elsewhere in Europe. Not sure how things work in the US, but given that the US thinks automatic machine guns are normal to carry into a school I wouldn't look at them and rather look at Europe ;)

Great doctors can have worse mortality rates than average because they tackle the most marginal / difficult cases.

It would not be wise to compare mortality rates between dentists and heart surgeons and conclude that dentists are the better practitioners and should be doing the heart surgery.

With that said, the article is intriguing. They followed 30 day mortality, which might not quite be a long enough timeframe. This metric penalises surgery which might be trading a higher "up front" risk for many more years of better quality life and rewards treating a patient who is more likely to die without surgery in the next 30 days.

The conclusion of the article could still be true but it seems one of those findings that (as usual) warrants further investigation.

If you have ever been the victim of a metric that can lead to perverse outcomes like "LoC per day" or "tickets closed per week" then I think you can appreciate.

A doctor has to be present to pronounce someone dead.

Is this just another incorrect causation? Eg fewer surgeries == fewer deaths?

> For five weeks, approximately 50% of doctors in the county reduced their practice and withheld care for anything but emergencies.

The answer is right here. Anything but emergencies.

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