Comments on: Two Anecdotes

By: Noumenon

Noumenon — Wed, 20 Jan 2010 09:30:39 +0000

Seems to boil down to “I did it because I’m gullible. Here are some factors that make people gullible.” I would have hoped he had a real excuse like “I checked X, Y, and Z and they were all OK, so…” He does say he was lulled by the promise of moderate rather than spectacular returns, which seems valid to me.

By: Robin Hanson

Robin Hanson — Wed, 20 Jan 2010 03:58:51 +0000

No doubt this is also why car dealers try to sell you expensive cars, because they want the world to have more car innovation.

By: quanticle

quanticle — Wed, 20 Jan 2010 03:49:53 +0000

Its not just doctors. Its true of many fields. For example, I wouldn’t mind working on a AJAX/Ruby on Rails banking system. But, would I want my bank using such a system? Of course not! Given that it’d be one of the first rollouts of such a system there’d be a higher risk of security flaws that could lead to compromised financial data.

Its a “belling the cat” problem. The benefits of the advancement, whether its a new medical procedure, or a new online banking UI go to everyone. The risk, however, is concentrated on a single individual or a small group. Unless there’s a way to compensate the individuals at risk for the increased risk they’re taking (e.g. charge the others for the free benefit) there’s little incentive for anyone to try the latest method.

For some things, (e.g. computers, cars, etc.) having the latest and greatest is higher status. This increase in status serves as compensation for the risk that the new technology doesn’t work out. However, for medical procedures, there is no such reward – not many people would consider bragging about the technique used to fix their back.

By: richard

richard — Wed, 20 Jan 2010 00:43:48 +0000

andy mackenzie is absolutely correct. the real reason is not because of a financial incentive, it is probably because any surgeon would be more risk averse when dealing with his own wife. the conclusion of the author that the surgeons are motivated by avarice is most likely the product of his own bias against physicians.

By: Bryan

Bryan — Mon, 18 Jan 2010 18:58:02 +0000

Robin, did you read Greenspan's explanation for why he was fooled?

By: Jim S

Jim S — Mon, 18 Jan 2010 18:07:36 +0000

I disagree with your comment about doctors being over consumers of medicine, based on my 21 year marriage to a family practice doc. Based on her advice I didn’t get a “check-up” at all in my 20′s or early 30′s.

Based on her anecdotes, I happen to believe that most over consumption is consumer driven. She is constantly trying to talk people out of things like PSA tests, mammograms for young women, etc.

I’d love to see a study which compared the consumption rate for medical services between avid TV watchers and non-TV watchers. People are bombarded with messages about all the things they should do for their health, and all the tests they should get, as well as unrealistic cures on medical drama’s, when it mostly boils down to eat decently and get some exercise.

By: billswift

billswift — Mon, 18 Jan 2010 14:59:13 +0000

“Intelligence briefings are only useful to the intelligent.”

Likewise, “book learning” is only valuable to those alert and intelligent enough to apply it. Admittedly, that is only a tiny minority of the population.

By: uberVU - social comments

uberVU - social comments — Mon, 18 Jan 2010 11:05:12 +0000

Social comments and analytics for this post…

This post was mentioned on Twitter by a_b_debrie: http://bit.ly/53MzK4 Irony: Psychologist writes book on how to avoid being duped, then loses money to Madoff…

By: Flashman

Flashman — Mon, 18 Jan 2010 10:23:42 +0000

Of course, there is another possible explanation to the doctors’ reluctance to engage in costly experimental services involving their wives. It is a well known fact, that doctors a stingy. It is also possible that many HATE THEIR WIVES. Put these two things together et voila.

Perhaps a better question might have been: What if it were your daughter – the one with braces and a pony?

Anyway, thanks for the great blog….

By: Andy McKenzie

Andy McKenzie — Mon, 18 Jan 2010 05:49:31 +0000

One alternative explanation besides incentive structure:

Docs are in general willing to experiment with new techniques because they know that they will push the boundaries of the field and possibly eventually lead to better techniques. So, if they are performing surgery on the average patient they prefer to experiment on the technique that might eventually be better.

On the other hand, if they are performing surgery on their own wife they will be much more risk averse and will opt for the tried and true method.

Gawande talks about exactly this dilemma wrt training new docs in his book Complications.