Nurses Launch Campaign to Alert Public to Dangers of Medical Technology | Hacker News Reader

Nurses Launch Campaign to Alert Public to Dangers of Medical Technology

nationalnursesunited.org

37 pointsnrjones825 comments

I don't think RNs need to feel threatened. If anything, medical technology will enhance their status and make doctors more dispensable. Nurses are the ultimate interface between the medical system and the patient.

Right now, there is a trend to allow NP (Nurse Practitioners) a greater autonomy in what they can do. While they still work under the authority of a physician, that's becoming more and more of a rubber-stamp.

More and more doctor activities can be replaced with an algorithm. Diagnoses are made before even seeing the patient and only rely on data from nurses and EMRs. That's the territory of software right there. (Of course this is not to say docs are obsolete, but their work can shift to research. And (at least for now) surgery remains more cost-effective if done by docs than by robots.)

> but their work can shift to research.

Can we use that much researchers ? what are the other barriers assuming doctors are willing ?

I think you're being far, far too gung-ho about the demise of doctors. Their presence might be at risk over 50-100 years, but for the foreseeable future technology will act primarily as an aid, not as an independent decision maker, and time saved for medical staff will just be reallocated to other clinical tasks.

Many times professionals do have valid self interest to fight innovation in their field.

Great teachers (and even good ones) shouldn't fear organizational innovations like charter schools, or technological innovation like blended learning. Many times they do fear these, especially when they (teachers) organize.

Medical professionals have used FUD(fear,uncertainty,doubt) and requiring very high burden of proof(trying the technology for a very long term, even though preliminary results show favor ability) for ages as a tactic to scare the public and politicians from accepting innovation and change.

I wonder, what are good tactics to fight such efforts ?

Counter tactics? The bill from doing it their way.

Umm... here's a passage from a year old Forbes op/ed: "... about half of real health expenditure growth is attributable to medical technology. The Robert Wood Johnson Foundation goes on to say that advancing technology may have a particularly large impact on spending in the U.S. because of “few requirements that effectiveness be demonstrated before technologies are used broadly and concern that their application tends to go beyond those patients likely to benefit the most from them.”"

http://www.forbes.com/sites/realspin/2013/04/03/whos-to-blam...

The things that medical providers block are often things that would reduce costs, for example enabling mid-level workers supported by tech do some of the doctor's jobs at lower costs, and low cost eye exam kiosks.

And sure, there's a problem with medical tech increasing expenses. That's another problem that needs solution.

I'd start by highlighting the truth at every opportunity, which is this:

Medical mistakes kill an estimated 200,000 to 400,000 Americans every year[1], making it the third leading cause of death after heart disease and cancer[2].

"Frank from IT" isn't killing those patients - doctors and nurses are, largely through really stupid stuff like failing to wash their hands adequately, leading to hospital acquired infections.

[1] Journal of Patient Safety https://www.documentcloud.org/documents/781687-john-james-a-...

[2] CDC http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

That's where you're wrong. The user interfaces to so many medical devices are tacked on, almost as an afterthought. The devices are made by hardware people, and the software people never get a look-in (as usual). They're messy to use and make it easy to do Bad Things, and the testing (though generally better than a web-app) is still frequently lacking. The canonical example is the Therac-25, which killed a number of people after a software bug blasted them with massive amounts of radiation. These problems still happen now - the modern radiotherapy machines are still capable of delivering horrendous doses, but the biggest killers now are infusion pumps - which have many different, confusing interfaces which make it easy to make big mistakes really quickly (55,000 adverse events, 710 deaths over the course of just five years).

The regulators are incompetent or captured, and the nurses get blamed for the fatalities.

http://cs.swan.ac.uk/~csharold/cv/files/IHCIkeynote2013.pdf

Yes, medical mistakes are problematic, but to say it's generally the staffs fault is a gross oversimplification. If it's because staff aren't washing hands, it's because the operational procedures of the industry are bad.

Just to be clear, those 200,000-400,000s aren't all things like washing hands. They occur when there are misdiagnoses or when an inappropriate form of care is chosen, as well. Which is probably the vast majority. Doctors and nurses aren't going to get better - medical training is already some of the most rigorous around, and the bad ones usually don't make it.

What does make a difference is making things easier for them - simpler devices, better analysis, better operations procedures. Trying to place some kind of blame on doctors and nurses for killing their patients (in the abstract statistically-large-number-of-people-died case) is stupid - if it happens everywhere, it's the system's fault and not the individual's.

There is no criticism of algorithms in this article at all except saying "they are unproven".

I want to be treated by FRANK. A computer might very well be inferior at first, but there's no reason it would suck as bad as portrayed in that substanceless ad. And it could easily be better on some things where statistics matter (and doctors are horrible at them.)

Sad to see them lose their jobs, but I would care more if I could afford them in the first place.

The article addresses you concern about the affordability of health care:

"Cutting costs is now seen as the prime directive in health care. Unwilling to reduce their profits or limit excessive pricing practices, the means to limiting expenses in the healthcare industry is by restricting or rationing care."

Very light on substance on how algorithms really destroy medical care, but heavy on how it destroys jobs in the field. Not that this doesn't suck for those affected, but let's be clear about the intentions here.

Edit: original title was "Algorithms Destroying Medical Care"

Also, the hospital "market" has seen massive consolidation / mergers, so the smarmy finance character might be his own separate problem.

While it doesn't invalidate the concerns in this article, I was reminded of an article by the New Yorker I read a while ago on the importance of using checklists (and, by extension, technology) in health care. It's been submitted before:

https://news.ycombinator.com/item?id=3360098

Perspective: http://www.tuxradar.com/content/karen-sandler-full-interview

As the HN guidelines ask, please do not editorialize titles. (The submitted title was "Algorithms Destroying Medical Care".)

This guideline has been ruining HN discussions for a very long time. There should be a way for a submitter to explain why the submission is relevant and what is offered as a discussion topic. The only place to do that is in the title. And the solution has been suggested a million times - keep both the original and moderated titles and let people choose which one to see - any plans to implement something along these lines, preferably soon?

PS. Just look at this very submission. "Algorithms ..." version would've made me read through the linked page, because it clearly identifies the relevant part of it. But seeing the "Nurses ..." title and skimming through the opener makes me think that this is some sort of US-specific content that just happens to be of a great local importance.

You say "ruining"; I say it's one of the best design decisions PG ever made and that it plays a critical role in establishing the character of this site, which is to focus relentlessly on content, keep distortions and spin to a minimum, and ask readers to engage with articles for themselves.

> The only place to do that is in the title.

That's obviously untrue. You can post a comment to the thread.

> the solution has been suggested a million times

There are countless suggestions, but rarely for the same thing, let alone "the solution".

> any plans to implement something along these lines, preferably soon?

I doubt it, because the guideline is exactly in line with the values of this site, as I described above. Any proposed change needs to take that into account. Very few do. For example, you seem not to consider it.

I spend a lot of time thinking about the quality of the front page and, in my opinion, few things would make it worse than opening titles to editorial spin. It would certainly change HN dramatically, and almost certainly disastrously.

> Just look at this very submission

Indeed. The rewritten title was a severe distortion. The story is a campaign by a trade association to protect its interests. "Algorithms destroying medical care" hits the trifecta of a bad title rewrite: it's editorial spin, it's linkbait, and it's misleading [1]. It's a sensational claim that requires evidence to establish, which the existence of a political campaign falls far short of. (I'm personally sympathetic with the campaign, if that matters.)

As long as we're talking about this, it should really be pointed out that I posted a comment saying that we'd reverted the title and what the submitted title was. It's reasonable for people to want to see a trail of what was changed; for now, we've been posting those at the bottom of the threads.

1. https://news.ycombinator.com/item?id=7797166.

Jeez, Daniel. You obviously has a strong opinion on this subject and you are simply not listening. What I mentioned is a simple solution to a major (if not the) moderation issue that HN has that will work for everyone. What you are defending is an approach that works for some cases, but fail in many.

  <edit>

For one, by editing a submission title you are effectively putting words in submitter's mouth. That in itself is already an ethically questionable practice. I had a title on my Tell HN post changed and I was absolutely totally pissed by that. If you change a title, then do everyone a favor and put your own name next to it.

For two, I happen to actually care for what particular angle the submitter had in mind when posting a link. This is not a Reuters, this is a discussion place and every discussion has a starting point. You change "Algorithms" to "Nurses", you change the point. You do it halfway through the discussion - congratulations, you just f#cked up the whole discussion. This is what I meant by "ruining". Who the hell cares about eventual consistency of HN archives if one can't readily understand the context of what's actually people are talking about now.

  </edit>

Try this - say, HN adds an option of keeping the original title. Let's further assume this is not a default. Can you please explain how did you arrive at "It would change HN dramatically, and almost certainly disastrously"?

> For one, by editing a submission title you are effectively putting words in submitter's mouth.

If that's the case, isn't editorializing the title putting words in the mouth of the article writer?

No, of course not.

Second best design decision: active, involved and highly visible moderator.

I think dang's efforts have made things a lot better around here. The two biggest visible changes are the title change notices and the reminders that acting like a decent human being is a prerequisite for commenting. I cheer every time I see one of the "we changed the title from X to Y" posts. I wish the reminders were not neccessary but I think they are a lot better for the community in the long run than anonymous downvotes with no explanation. I like to think of the reminders as "sit down and shut up you little twit messages" but of course dang keeps it a lot classier and also finds a way to educate the rest of the community:

  > Comments like this are not allowed on Hacker News. We ban people
  > for this, especially when they don't have a history as a positive
  > contributor here. Please don't do it again.
  >
  > All: When you see a comment that is truly egregious, you can flag
  > it by clicking "link" to go to the item page and then "flag" at the
  > top. We monitor those flags and take action based on them.

I completely agree but in this case the title was sensationalist. There is only one sentence mentioning algorithms and it doesn't have any substance.

I submitted the title with reference to an audio recording that is linked to on the page, having originally heard it played on the radio:

http://nationalnursesunited.org/page/-/files/audilo/iorn-rad...

Rather than linking directly to the mp3 file, I figured posting the whole article would give more context.

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