In a Florida operating room … there’s an anesthesiologist alternating with a nurse anesthetist, an X-ray technician and a circulating nurse; … there’s the surgeon, a middle-aged orthopedist who has never performed this type of operation before. And, at the foot of the operating table, there’s Chuck Bates, a guy who studied biology in college. … Come up one centimeter and make your incision there, Bates tells the surgeon. …
I wondered about the feasibility of small hospital-subsidized "experimental divisions" - like some sort of medical Q branch, where seasoned docs try out different devices and techniques related to their specialty only.
My vision: The patients would pay less money - due to the experimental nature of the care, the doctors would get a salary on the lower end with bonuses for upticks in patient survival and health that can be attributed to their recommendations, and the sales reps would have a known set of contacts for the hospital at large.
I know the military has unofficial experimenters for just about every kind of gear possible and that process seems to suss out the better ones (with a pretty high failure rate for the unfit products).
I would imagine that patients dying would lead to bad sales for their products.Got any evidence of that? That’s not how things usually work in medicine.It may not hurt as much as we'd like it to, but certainly doesn't help sell their product.
Professionals in the medical device industry can easily know more about how to use their product than doctors, and may know more about how to perform certain kinds of surgery. Of course this doesn't mean they are as good at it (as they've probably never done it), but they can be a very good source of knowledge.
The article is not painting the worst-case scenario, by far. Many doctors call tech support lines for help, sometimes needing assistance with general techniques (an example that comes to mind is how to correctly use a torque wrench to screw an abutment into a dental implant). The people answering these lines definitely don't have MBAs (not that I see that as a problem; lower skilled people assisting in or performing medical procedures can easily be a good thing).
Much more basic than the questions about the sales reps motivation, I am alarmed by the apparent acceptance of the idea that the sales rep actually understands the technology he's pushing. While my experience is admittedly all outside the medical field, rule number one, don't believe anything the sales rep says about what the product can do or how it works, make sure to read and understand all technical documentation yourself or you will be sorry. They never understand it as well as they think they do.
First, if a salesman has incentives to sell medical products even if they are bad for you, wouldn't they also have the same incentives to sell medical porducts even if they're good for you? I'm sure most (or all) medical supply companies strive to get a good reputation, even more so than they strive to get dead stock off their shelves (at least at the margins).
Second, standards for Med students may be high, but they are not infinite. If a Med student spends 10 years learning hundreds of thousands of intricacies about treating humans, why wouldn't you trust someone who had six months training on one specific treatment? By my calculations, that would make the sales rep more capable. And the rep wasn't even doing the procedure. He was probably just repeating what higher paid doctors that work at his R&D department told him.
“They’re not in any way motivated to recommend what might be the best thing for the patient,” Matthews said. “They’re there to sell their product.”
I would imagine that patients dying would lead to bad sales for their products.
Sure, I can understand the worry in cases like Bill Gardner's, where the sales rep influences the decision of which pacemaker to choose. But if they're in the operating room, simply telling the doctors how to use their equipment?
Dentists are in fact lower status (see The Hangover), we are more comfortable with folks paying out of pocket for dentistry, we allow dental assistants to do more of dental work than we allow doc assistants to do doc work, and there is clearer evidence that dentistry is useful on the margin.
Dentists should face a lower demand for status than doctors, since dentists deal with non-life-threatening problems where the demand for magical reassurance is lower. Aside from that, though, dentistry is a problem of medicine and biology that shouldn't be different in principle from dealing with other organs.
To the extent that you've attributed various real-world aspects of health care to the demand for magical reassurance / showing that you care, can you show that these aspects are different in dentistry?
If ya want objectivity. Buy an opinion from some expert who wont benefit from you getting the surgery (or wont get a commission on the sale of your house, etc).
The article implies that Bates was in the operating room as a technical field rep for the firm, not as a salesman. Yes, he also sold the device, and his sales job required an MBA. But this seems irrelevant.
Well, there's a difference between an MBA with a masters in biomedical engineering and a quantitatively semi-literate MBA who specializes in office politics success and expressions of social dominance regardless of subject matter expertise.
In my opinion administration and management professionals should be much higher status, or at least there should be a high status variant with rigor equivalent to an MD or a quantitative Ph.D.
Perhaps a series of certification levels equivalent to the CFA or medical boards, and a standard, professional, 4 year program.
Also, stronger quantitative analysis underpinnings (the same should go for medical credentialing, IMO).
I think maybe things like sigma six and project management certifications are playing this role, but it doesn't seem to me to be as formalized as would be useful, yet.
The bullshitty aspects of Six Sigma are interesting.
Yes, and there are right many. . .
I wondered about the feasibility of small hospital-subsidized "experimental divisions" - like some sort of medical Q branch, where seasoned docs try out different devices and techniques related to their specialty only.
My vision: The patients would pay less money - due to the experimental nature of the care, the doctors would get a salary on the lower end with bonuses for upticks in patient survival and health that can be attributed to their recommendations, and the sales reps would have a known set of contacts for the hospital at large.
I know the military has unofficial experimenters for just about every kind of gear possible and that process seems to suss out the better ones (with a pretty high failure rate for the unfit products).
I would imagine that patients dying would lead to bad sales for their products.Got any evidence of that? That’s not how things usually work in medicine.It may not hurt as much as we'd like it to, but certainly doesn't help sell their product.
Professionals in the medical device industry can easily know more about how to use their product than doctors, and may know more about how to perform certain kinds of surgery. Of course this doesn't mean they are as good at it (as they've probably never done it), but they can be a very good source of knowledge.
The article is not painting the worst-case scenario, by far. Many doctors call tech support lines for help, sometimes needing assistance with general techniques (an example that comes to mind is how to correctly use a torque wrench to screw an abutment into a dental implant). The people answering these lines definitely don't have MBAs (not that I see that as a problem; lower skilled people assisting in or performing medical procedures can easily be a good thing).
Much more basic than the questions about the sales reps motivation, I am alarmed by the apparent acceptance of the idea that the sales rep actually understands the technology he's pushing. While my experience is admittedly all outside the medical field, rule number one, don't believe anything the sales rep says about what the product can do or how it works, make sure to read and understand all technical documentation yourself or you will be sorry. They never understand it as well as they think they do.
Good wikipedia page. The bullshitty aspects of Six Sigma are interesting.
First, if a salesman has incentives to sell medical products even if they are bad for you, wouldn't they also have the same incentives to sell medical porducts even if they're good for you? I'm sure most (or all) medical supply companies strive to get a good reputation, even more so than they strive to get dead stock off their shelves (at least at the margins).
Second, standards for Med students may be high, but they are not infinite. If a Med student spends 10 years learning hundreds of thousands of intricacies about treating humans, why wouldn't you trust someone who had six months training on one specific treatment? By my calculations, that would make the sales rep more capable. And the rep wasn't even doing the procedure. He was probably just repeating what higher paid doctors that work at his R&D department told him.
I would imagine that patients dying would lead to bad sales for their products.
Got any evidence of that? That's not how things usually work in medicine.
In related news, last year Overcoming Bias reported on a study that showed that physicians from top schools could lower medical costs.
It looks like business schools are giving medical training and medical schools are giving business training.
Hahaha :-D
The best articles on here are the ones where Robin allows himself to get a little bit arsey and sarcastic.
When a post is delivered in that hyper-rational tone he sometimes uses I am always tempted to comment "once more, with emotion".
Heh. You mean Six Sigma, not Sigma Six. I've done the first, and my son has purchased the second.
“They’re not in any way motivated to recommend what might be the best thing for the patient,” Matthews said. “They’re there to sell their product.”
I would imagine that patients dying would lead to bad sales for their products.
Sure, I can understand the worry in cases like Bill Gardner's, where the sales rep influences the decision of which pacemaker to choose. But if they're in the operating room, simply telling the doctors how to use their equipment?
Dentists are in fact lower status (see The Hangover), we are more comfortable with folks paying out of pocket for dentistry, we allow dental assistants to do more of dental work than we allow doc assistants to do doc work, and there is clearer evidence that dentistry is useful on the margin.
Dentists should face a lower demand for status than doctors, since dentists deal with non-life-threatening problems where the demand for magical reassurance is lower. Aside from that, though, dentistry is a problem of medicine and biology that shouldn't be different in principle from dealing with other organs.
To the extent that you've attributed various real-world aspects of health care to the demand for magical reassurance / showing that you care, can you show that these aspects are different in dentistry?
If ya want objectivity. Buy an opinion from some expert who wont benefit from you getting the surgery (or wont get a commission on the sale of your house, etc).
The article implies that Bates was in the operating room as a technical field rep for the firm, not as a salesman. Yes, he also sold the device, and his sales job required an MBA. But this seems irrelevant.
Well, there's a difference between an MBA with a masters in biomedical engineering and a quantitatively semi-literate MBA who specializes in office politics success and expressions of social dominance regardless of subject matter expertise.
In my opinion administration and management professionals should be much higher status, or at least there should be a high status variant with rigor equivalent to an MD or a quantitative Ph.D.
Perhaps a series of certification levels equivalent to the CFA or medical boards, and a standard, professional, 4 year program.
Also, stronger quantitative analysis underpinnings (the same should go for medical credentialing, IMO).
I think maybe things like sigma six and project management certifications are playing this role, but it doesn't seem to me to be as formalized as would be useful, yet.