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Yet another weird SF fan
 

Thursday, August 28, 2008

An Engineering Proverb and Top Doctors

There's a well-known engineering proverb: A brilliant engineer is someone who can do for one dollar what any fool can do for two. There's evidence the same principle applies to medicine. According to a recent study (seen via Overcoming Bias):

Patient sorting can confound estimates of the returns to physician human capital. This paper compares nearly 30,000 patients who were randomly assigned to clinical teams from one of two academic institutions. One institution is among the top medical schools in the country, while the other institution is ranked lower in the quality distribution. Patients treated by the two teams have identical observable characteristics and have access to a single set of facilities and ancillary staff. Those treated by physicians from the higher-ranked institution have 10-25% shorter and less expensive stays than patients assigned to the lower-ranked institution. Health outcomes are not related to the physician team assignment, and the estimates are precise. Procedure differences across the teams are consistent with the ability of physicians in the lower-ranked institution to substitute time and diagnostic tests for the faster judgments of physicians from the top-ranked institution.
In other words, Dr. Charles Emerson Winchester III might seem pricy, but he can save you money.

This might seem odd. It's similar to a claim that top-ranked financial advisors cannot beat the market but can perform better first aid.

On the other hand, it's common for X to be recommended on the grounds that it does the important task Y, but Y is done to the same extent anyway, and X instead enables Z. In this case, X is prestigious medical education, Y is healing patients, and Z is saving money. In another example, time-saving houshold appliances don't save time but provide cleaner houses, dishes, and clothes. Similarly, artificial sweeteners don't help people lose weight, but at least they can eat better-tasting food. In yet another example, faster transportation doesn't shorten commutation times but it does enable transportation to neighborhoods with larger backyards.

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