I don’t disagree with you exactly, but I think the focus on rational decision making misses the context the decisions are being made in. Isn’t this just an unaligned incentives problem? When a patient complains of an issue, doctors face exposure to liability if they do not recommend tests to clarify the issue. If the tests indicate something, doctors face liability for not recommending corrective procedures. They generally face less liability for positively recommending tests and procedures because the risk is quantifiable beforehand and the patient makes the decision. If they decline a recommended test, the doctor can’t be blamed.
The push to do less testing makes sense in that context. It has to emerge at the level of a movement so that the doctors have safety in numbers.
I am not in healthcare, perhaps this is cynical?
Edit, I see that Gwern already mentioned lawsuits briefly in a comment. But I think it deserves a lot more focus and obviates “you’re not dealing with fully rational agents.” I mean, maybe not, but that’s not necessary to get this result.
I don’t disagree with you exactly, but I think the focus on rational decision making misses the context the decisions are being made in. Isn’t this just an unaligned incentives problem?
I would agree that, in some sense, it is ‘just’ an “unaligned incentives problem”. But those are thorny problems!
The insight I found valuable from the post was ‘just’ the idea that ‘going along with unaligned incentives’ wasn’t inevitable. That, in fact, if we know or expect that the ‘incentive system’ is ‘unaligned’, we could try to find a way to ‘just not do that’.
I now think that ‘just not making this mistake’ is something that’s worth trying.
Doctor: “Let’s do Diagnostic.”
Me: “Okay”
[Diagnostic is done.]
Doctor: “Bad news. Diagnostic returned X. The standard treatment is Y.”
Me: “Y given X is stupid because of, e.g. base rates.”
And then either:
Doctor: “But Y is the standard treatment!”
Me: “No; goodbye.”
or:
Doctor: “Oh yeah; good point. Let’s not do Y then.”
Hmm, yeah, I guess that’s a good point. I was thinking myopically at a systems level. The post is useful advice for a patient who is willing to do their own research, confident they can do it thoroughly, and is not afraid to “stare into the abyss” i.e risk getting freaked out or overwhelmed.
Although, I also wonder if insurance companies might try to exploit a patient’s prior decision to decline recommended treatment/tests as a reason to not cover future costs...
I don’t disagree with you exactly, but I think the focus on rational decision making misses the context the decisions are being made in. Isn’t this just an unaligned incentives problem? When a patient complains of an issue, doctors face exposure to liability if they do not recommend tests to clarify the issue. If the tests indicate something, doctors face liability for not recommending corrective procedures. They generally face less liability for positively recommending tests and procedures because the risk is quantifiable beforehand and the patient makes the decision. If they decline a recommended test, the doctor can’t be blamed.
The push to do less testing makes sense in that context. It has to emerge at the level of a movement so that the doctors have safety in numbers.
I am not in healthcare, perhaps this is cynical?
Edit, I see that Gwern already mentioned lawsuits briefly in a comment. But I think it deserves a lot more focus and obviates “you’re not dealing with fully rational agents.” I mean, maybe not, but that’s not necessary to get this result.
I would agree that, in some sense, it is ‘just’ an “unaligned incentives problem”. But those are thorny problems!
The insight I found valuable from the post was ‘just’ the idea that ‘going along with unaligned incentives’ wasn’t inevitable. That, in fact, if we know or expect that the ‘incentive system’ is ‘unaligned’, we could try to find a way to ‘just not do that’.
I now think that ‘just not making this mistake’ is something that’s worth trying.
Doctor: “Let’s do Diagnostic.”
Me: “Okay”
[Diagnostic is done.]
Doctor: “Bad news. Diagnostic returned X. The standard treatment is Y.”
Me: “Y given X is stupid because of, e.g. base rates.”
And then either:
Doctor: “But Y is the standard treatment!”
Me: “No; goodbye.”
or:
Doctor: “Oh yeah; good point. Let’s not do Y then.”
Me: “Hurray!”
Hmm, yeah, I guess that’s a good point. I was thinking myopically at a systems level. The post is useful advice for a patient who is willing to do their own research, confident they can do it thoroughly, and is not afraid to “stare into the abyss” i.e risk getting freaked out or overwhelmed.
Although, I also wonder if insurance companies might try to exploit a patient’s prior decision to decline recommended treatment/tests as a reason to not cover future costs...
.
Yes, it’s a thorny problem, along many dimensions :)
But this is the kind of ‘impossible’ task I like to throw myself at (at times)!