The most telling detail in Robin Hanson’s lecture about doctors was about a nurse assigned to measure hand-washing rates among surgeons at her hospital. After she measured the hand-washing rates, she — as ordered — correlated them with death rates. It turned out that the surgeon who washed his hands the least had the highest death rate. For reporting this — as she was ordered to — the nurse was fired. Robin learned this story from his wife, who was a friend of the ex-nurse.
I was very impressed by Robin’s lecture, which was both accessible and profound, and it was one reason that during my next encounter with a doctor I was more skeptical than most patients. As I blogged earlier:
I have a tiny hernia that I cannot detect but one day my primary-care doctor did. He referred me to Dr. [Eileen] Consorti, a general surgeon [in Berkeley]. She said I should have surgery for it. Why? I asked. Because it could get worse, she said. Eventually I asked: Why do you think itâ€™s better to have surgery than not? Surgery is dangerous. (Not to mention expensive and time-consuming.) She said there were clinical trials that showed this. Just use google, youâ€™ll find them, she said. I tried to find them. I looked and looked but failed to find any relevant evidence. My mom, who does medical searching for a living, was unable to find any completed clinical trials. One was in progress (which implied the answer to my question wasnâ€™t known). I spoke to Dr. Consorti again. I canâ€™t find any studies, I said, nor can my mom. Okay, weâ€™ll find some and copy them for you, she said, you can come by the office and pick them up. She sounded completely sure the studies existed. I waited. Nothing from Dr. Consortiâ€™s office. After a few weeks, I phoned her office and left a message. No reply. I waited a month, phoned again, and left another message. No reply.
Yesterday Dr. Consorti finally got back to me, by posting a comment:
Seth, While I am in the process of finding papers in the literature to satisfy your scientific curiosity on why this hernia should or should not be fixed I am additionally trying to care for around 30 new patients referred to me for their new cancer diagnosis in the last 3 months. This may or may not explain why I have not been motivated to answer your call regarding your ambivalence about fixing your hernia. Yes, it is small and runs the risk of incarceration at some time. I will call you once I clear my desk and do my own literature search. Thanks for the update. Eileen Consorti
Fair enough. She’s busy. And I am glad to have her reply and her view of the situation. On the other hand, I am pretty sure the studies she was so sure existed — that justified the surgery — don’t exist. To call my curiosity about whether the proposed surgery would do more good than harm “scientific” has a bit of truth: No doubt scientists understand better than others that you can test claims such as “you need this surgery”. But it isn’t “scientific” in the least to worry that a medical procedure will do more harm than good. Everyone, not just scientists, worries about that. Surgery is scary. Let’s set aside the death rate, which is low but non-zero. How many brain cells are killed by general anesthesia? Dr. Consorti doesn’t know, nor do I. The number is plausibly more than zero. I suspect a power-law distribution: Most instances of general anesthesia kill a small number, a small fraction kill a large number.
I pointed Robin to Dr. Consorti’s response. He replied:
I wonder if she even realizes that she in fact doesn’t know why you should get surgery.
What I know and Dr. Consorti, very reasonably, doesn’t know, is that my mom was a librarian at the UCSF medical library and has done a vast amount of medical-literature searching. If she can’t find any relevant studies, it is very likely they don’t exist. And my mom did find a study in progress, which, to repeat myself, shows that my question about cost versus benefit is a good one. Others had the same question and launched a study to answer it. Robin’s lecture helped me ask it. Thanks, Robin.
More. Robin’s version of the fired-nurse story is here. Thanks to Charles Williams.