tomo,
I'm less optimistic about avoiding leaden bureaucracy. The destination is conceivable, but what path from here to there?

At a micro-level, a surgical team is comparable with a flight crew and that has been acknowledged and improvements made in the last couple of decades (at least). Not asking for that to stop. No way. But the wider health system doesn't match the flight crew so well. We shouldn't bend over backwards to make reality fit a metaphor.

I'll forgive you if you didn't read through that transcript yesterday, but one part stood out for me (still from 20 years ago — I didn't read the transcript either). The hospitals' doctors *weren't* required to have medical insurance; the hospital indemnified all doctors working for them. There was one proviso: any time a doctor realised he'd made a mistake, he had to report it to the hospital.

It's an elegant idea. Paired with patient outcomes it will tend to expose, not only the incompetents, but also the over-confident and the evil. Something along those lines, carefully thought through, could make our health systems a lot safer.

As you say, there's no panacea. A big gap in the flight-crew metaphor is that every "flight" ends with a "crash". Doctors involved in end-of-life care are bound to have a lot of "bad outcomes" and there's a huge amount subjectivity between those who want to maximise duration and those who want to minimise suffering.

I'm not a religious watcher of Air Crash Investigation, but a couple of nights ago I caught the tail end of one I hadn't seen before. A plane lost one of its generators shortly after take-off. Stuff-up by the crew meant they isolated the working generator and then, when they realised their mistake, couldn't get it back on line. Bigger mistake: thinking they could complete their half-hour flight with just batteries for the electrics. As the disaster closed in, they were reading their instruments by torchlight, apparently ignorant that the artificial horizon needed power. They banked into a steep turn chasing the slumping gyro.

Ignoring one item on their "checklist" (generator fail: land ASAP) put them in no-man's land. Strongly doubt get out your torch was on any checklist.

Relevance to the case in point is pretty marginal — I suppose it's the usual thing of you have to expect humans to have human failings — just found it an interesting change. So many of the crashes you're saying "Look at your instruments, dummy!", and this one it's "Look out the windscreen, your instruments are lying, dummy!".

From the Toby Young interview mentioned yesterday, I liked this part about woke enforcers:

Why do they constantly engage in these ways of avoiding having meaningful, philosophical debates about fundamental conflicts of values in the public square? It must be because they're not terribly confident of their own position; they don't want to be forced to defend it because they don't *really* know how to go about it.

I agree, but I doubt the tone of I've thought my views through and you aren't thinking at all is going to win many across.

tomo,
As we've discussed before, I think doctors' "CRM" procedures would be, at best, a misguided move.
On the tweet in question, what *exactly* is the worry if a physician is unable to identify the tail of the pancreas (in a pot of formalin, presumably). That's nothing to do with his day-to-day work. Obviously it is more important if the fellow's a surgeon but, even then, hardly critical for a neurosurgeon or orthopod. In reality, for most medicos, it amounts to a trivia question.

I'm pretty firmly against bureaucrats overseeing medicos, but all in favour of experienced medicos overseeing junior medicos, and there would be a place for bureaucrats to make sure, not of the medical expertise, but that the supervision isn't turning into a cosy club (though bureaucracies tend to do that too, so quis custodiet is still there).

I think I've linked to this 2001 Health Report on how a Utah hospital network went about improving patient outcomes here before. Only a transcript is available, but it was a very good broadcast at the time, and it does have some of the flavour of a cockpit checklist about it. At heart though, the story is that the "big mistakes" are a tiny part of the problem: wrong kidney extractions are vanishingly rare compared to bedsores as far as causing deaths in hospitals.

Another problem, just in my opinion, is that expectations of what medicos can do for us have risen to crazy heights. They aren't miracle workers, and we'll all go out feet-first sooner or later. It might be a good thing if more people adopted Ambrose Bierce's quip that a physician is:

one upon whom we set our hopes when ill and our dogs when well.

I see Jo Nova has taken up DaveS's recent point that the COPs have come up very short on their supposed objectives. Possible presence of elephants in the room.

Rapid-fire with Brendan O'Neill podcasts; today's was with Toby Young and the benefits and threats to free speech. No great surprises.

Dec 9, 2023 at 7:50 AM | tomo

Have a tad belatedly followed your link. I wasn't surprised to see my MP didn't attend, he's off to draw his generous MP's pension come the next election so is probably already demob happy.

I did like the Just Stop Oil reference two comments down - a reminder of just how stupid these clowns are. At least this prank would not have cost us much - the cost just for the Met Police (and thus to us taxpayers) for 'policing' this mob is already high enough, the powers that be really ought to go after the people known to fund them to recover the expense to the public purse of their antics.

tomo,
Briggs article seemed appropriately measured. His graphical explanations were very good and the bumps on the graphs did look suspicious. Some of the commenters wanted more damning conclusions, but there's only so much you can do without a control group and likely non-uniform populations per batch.

It seems that we might be seeing the COVID tyranny going out, not with a bang, but a whimper. In a year's time, will there be anyone *not* saying they were against lockdowns all along, doubted the vaccines, were anti-mandate, etc.? But then who knows? In a year's time, maybe there'll be a new hobgoblin troubling us.

DaveS,

Do you think the world will end?

I see Russ Roberts (EconTalk host) has started a Substack on the Israel/Gaza war. I liked this article which gives fair coverage to the complexities without excusing Hamas in any way. He uses Arnold Kling's Three Languages of Politics metaphor to good effect. He has a pretty big stake in it since he's living in Israel.

Also enjoyed Brendan O'Neill's interview with Batya Ungar-Sargon, an American Jew, on the current rash of Jew-hatred in the West. Had to laugh at her pointing out the double standards of the social justice warriors: #metoo(unless you're a Jew). Also liked her pugnacious air: don't fight this on the woke field of "victimhood"; wrong is wrong.

Interestingly, like that John Anderson interview a few weeks ago, she put nearly all Hamas sympathy in the US down to universities and the media. Cheering to hear another optimist.

Looks like previous COPs haven't achieved much.

https://www.bbc.co.uk/weather/av/67659384

Do you think the world will end?