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Yvain comments on [Link] An argument for Low-hanging fruit in Medicine - Less Wrong
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An obvious low-hanging fruit, hiding in plain sight is medical errors. Due to poor recognition and under-reporting, what we notice and read about is only the tail of the bell curve of severity.
Interesting timing; I spent this morning in a risk management simulation: a mock hospital, with actors playing patients, surrounded by a bunch of doctors criticizing me when anything I did looked like it left potential open for a medical error. This was part of about fifty hours or so of training specifically in avoiding medical errors I've gone through in the past four years. Also, my record for "number of different doctors who have mentioned Atul Gawande to me in a single day" currently stands at three, and I'm expecting it to be broken before finishing school in May. It's safe to say any trend that's reached medical schools in southwestern Ireland is well established in the States, Britain, and the rest of the world.
There are dozens of journals, textbooks, and three-letter-acronym organizations dedicated solely to healthcare risk management, and most good hospitals will have their own on-site risk management team. Newer paper hospital charts have been specifically designed around risk management (for example, on the charts I used today, there are two spaces to sign for giving any drug: the signature of the person who gave it, and that of the person they checked it with to make sure it was safe), and those hospitals that have electronic charts have their built-in measures to prevent errors (for example, they'll automatically pop up an alert if you prescribe an unusual dose of any drug, or two drugs that interact with each other, or a drug a patient is known to be allergic to; sometimes only certain authoritative staff at the hospital have the password to override these alerts.)
Now, none of this means that risk management is any good. You're still making a bunch of chronically sleep-deprived and very busy people play a game of Chinese whispers with complicated biochemical data. And I sort of worry that some hospital manager has done the math and decided that the amount of money saved in malpractice suits is less than what it would cost to hire lots of extra doctors so each one is individually less busy and more awake.
But I do think that once there are thousands of people and tens of millions of dollars in a field, you don't get to call it "hiding in plain sight" or "low hanging fruit" anymore.
This is at least a subset of the kind of software my dad works on. I remember him talking once about how someone was trying to get him to force doctors to dismiss every alert individually instead of just being able to select-all-dismiss, and my dad said that all that would do is waste time because the doctor would wind up mechanically dismissing 50 alerts without looking at them instead of doing it all at once, and trying to force the doctor to be conscientious with software was not the right way to go about making doctors be appropriately meticulous.
(Disclaimer: I probably misremember some substantial part of this.)
If you want more detail about how much care should go into designing a safety system, try The Checklist Manifesto.
Yeah, the problem with introducing any safety procedure is that if you have to do it a thousand times a day, it eventually becomes mentally automated. It's like clicking "I agree" to EULAs, or "let this program access to the Internet" on one of those versions of Windows that would incessantly ask you whether you wanted to let a program access the Internet (never had one, but heard awful things from people who did).
I've never used a program like that, so I don't know whether the bar for alerts is set high enough that most alerts will be real errors, or whether it gets into so many nitpicky things (you're using an antihypertensive with another antihypertensive! What if that causes hypotension?!) that you eventually develop a reflex of clicking through them. I'd hope the former.
This could be true, but I don't think it can be taken for granted.
Do you know if every hospital has implemented the Surgical Safety Checklist and mandates and ensures its use?
How about the Heimlich method? There were millions of dollars and thousands of doctors in the field when he invented what he invented. Not a very high hanging fruit.
Probably not a good example
Another relatively low hanging fruit. What is really the best response for chocking? Heimlich method OR "back slap" or something else?
Can you think of a way to test this that would get past an ethics committee, though?
I would go for statistics. How many have died/survived after this or another approach.