Anecdotally, my father-in-law was chief of staff for a small city hospital and they had a rule about not scheduling afternoon surgeries on important days like anniversaries, birthdays, etc. Basically, if the surgery started going long, you didn't want the surgeon worrying about missing their spouses birthday, birthday with their kids or an anniversary.
It actually wasn't that many surgeries delayed, as the surgeon just juggled surgeries and consults/paperwork/insurance to fit.
If this is fairly standard practice, then an afternoon birthday surgery would be an emergency situation and, hence, more deadly. Given the paper said some surgeons take the day off entirely, any surgeon with that habit would be performing an emergency surgery.
The problem is amusingly circular. Even if you reject the conjure in parent comment, you will be tempted to reduce the number of birthday surgeries due to the increased mortality. This will mean that birthday surgeries are only done in even more desperate circumstances which of course will increase the risk.
So mitigation of this problem will lead to the percentage increasing even more! Actually, it turns out that it is possibly better if the percentage is high!
> If this is fairly standard practice, then an afternoon birthday surgery would be an emergency situation and, hence, more deadly
This is spot on. The causality can be both ways.
Note that it would be interesting to dig into what is really computed here, because the whole wording seem intentionally sensationalistic.
1) "23% more likely to die" seems _huge_, but it applies to an already very small chance. The mortality rate just goes from 5.6% to 7%. Using this logic, moving from 0.1% mortality rate to 0.3% would mean "you are 3 times more likely to die".
2) Comparing mortality rates only make sense if the distribution of operation complexity are identical for these days. As the parent post suggest, it seems very likely that low complexity operations are postponed after a surgeons birthday.
3) Where are the confidence intervals? I refuse to even consider looking at a statistics if error boundaries and significance metrics are not provided.
That may very well all be provided in the underlying paper, but the article itself does not really discuss these points.
> If this is fairly standard practice, then an afternoon birthday surgery would be an emergency situation and, hence, more deadly.
As pointed out by jlebar, this is controlled for by comparing similar emergency surgeries.
"The patients were all Medicare beneficiaries aged 65 to 99. They had all undergone one of 17 common emergency surgical procedures between 2011 and 2014."
My father is a surgeon at a small hospital and my mother just got her hip replaced a few weeks ago (at a different, larger city hospital) and the first thing he insisted on was she was scheduled as the first patient of the day.
My father is a physician. He always recommends that if you are getting a test done, try to schedule it for the middle of the week and not near a holiday. It seems the lab techs make more mistakes on Fridays, weekends, etc. Just his anecdotal experience.
Getting surgeons to adopt the kind of "It's obvious but point and speak or you're fired"-style checklists a la operating an aircraft has reduced complications (from the minor to deaths) by several percent in the NHS. It's perhaps worrying given how low-hanging some of these fruit are - i.e. "Do we have the right patient?".
Back when I was still practicing as an anesthesiologist (1977-2015) I had a pack of 3x5 cards I carried in my scrubs pocket on each of which was an exhaustively detailed list I'd made of EVERYTHING I needed at hand to perform specialized procedures such as inserting an arterial line (putting a #20g plastic catheter through the skin on the inside of the wrist into the radial artery for direct beat-to-beat monitoring of arterial blood pressure, a measurement employed for seriously ill or unstable patients). I would assemble a tray with the following items in the OR before going to ICUs or the ER because invariably one or more of the items I would need would not be present and would take time to procure.
For example:
ARTERIAL LINE
• several sterile alcohol skin wipes
• 3cc syringe with 25g needle [for skin infiltration of local
anesthetic at puncture site]
• bottle of 2% lidocaine with epinephrine 1/1000
• 2x2 cotton gauze pads to use for pressure on failed
puncture sites
• 3 #20 gauge plastic catheters (22 gauge for small children)
• 2 surgical towels to drape over hand and lower arm to
absorb blood that accompanied successful arterial puncture
• size 7.5 sterile surgical gloves for me to wear while
performing procedure
• specialized 1" waterproof plastic skin tape to secure and
protect catheter in situ
I was constantly amazed by how my colleagues would have to stop and wait for something not present in the unit they were called to.
Conversely, when I was called because of an inability to insert an A-line, as they were referred to, and wasn't in a place where I could assemble my desired materials, I'd proceed with the materials at hand, all the while thinking "this could have been done a lot better...."
> It's perhaps worrying given how low-hanging some of these fruit are - i.e. "Do we have the right patient?"
It turns out that while it's a good idea to check things this "low-hanging", the value is far larger than catching wrong patients, so don't worry too much!
Much of the value comes from essentially disrupting routine with an opportunity to stop, and from creating a culture of speaking up. I think the NHS was the organisation to trial having the nurse run the checklist, which had the effect of empowering the "lowest level" person in the operating theatre. Studies showed that even just having everyone in the room speak once increased the chance of subsequent communication, and ultimately improved patient outcomes.
Atul Gawande was one of the key people in designing and rolling out these checklists and wrote a book about it that I'd recommend – The Checklist Manifesto.
I'm probably going to sound silly now but I do this when doing any technical work I deem important or critical enough, point and say outloud what it's for or what state it should be in or in the imperative what to do to it... it does work, it somehow catches silly mistakes compared to keeping everything in your mind, and also gives you confidence because it works like a checklist.
Reminds me of a scene in House, where the cynical veteran doctor about to receive surgery on his right leg uses a sharpie to write "NOT THIS LEG" on his left leg.
> It's perhaps worrying given how low-hanging some of these fruit are...
You don't realise how "bad" normal operational discipline is until you've seen it done right. The risk isn't so much that people skip a step, but that phantom steps start creeping in because people aren't quite sure of the standard, that saps a surprising amount of resources away which could be used for checking mistakes. And then people get disorganised and potential holes appear.
A big part of excellence isn't doing the right steps, it is trimming out the steps that don't need to be there, to focus attention on the stuff that works.
If you want to read more on the background of this The Checklist Manifesto is a great book and has lots of applications when it comes to IT operations. Stupid checklists in markdown that you can check off as you go through have certainly improved our performance in ad hoc tasks that we don't automate.
sad anecdote: a friend of mine got surgery to remove a problematic mole on his back, and not only the surgeon got the wrong one, but even got upset with him when my friend mentioned something like "I thought it was further up my back".
I just got surgery in California and noticed I was asked to state my name and birthday anytime I moved rooms or saw a new person. Seems like this is now part of protocol in a lot of places.
Procedures in hospitals are interesting. I recently visited a hospital and there was a red sign above the table where nurses dose medicines for patients: "No room numbers on trays, no bed numbers on trays". Seems like a low hanging fruit but a very non-obvious one (well at least non-obvious to me).
As an advocate of checklists for specific tasks, yes that stuff is good. Oftentimes there are a lot of checks that one would go "yeah no duh." But most good checklist exist with a checkbox because that was an issue before.
I’m going to guess (article won’t load for me) it is because the title should be “proportion of elderly deaths is 23% higher for surgery done on surgeons birthday” which might be a different thing if working on your birthday confounds with a certain type of surgery E.g. emergency surgery and being on call vs. elective surgery
That is not correct, the article talks about methodology:
> The patients were all Medicare beneficiaries aged 65 to 99. They had all undergone one of 17 common emergency surgical procedures between 2011 and 2014. Examples of those 17 procedures included cardiovascular surgeries, hip and femur fracture, appendectomy, and small bowel resection. The study focused on emergency surgery, so as to minimize the potential selection bias. For example, surgeons might otherwise choose patients based on their illness severity, or patients might choose their surgeon.
I recently had a complex facial surgery. Before doing so, I tracked all informations I could about my surgeon.
Everyone had good comments, good healing, very impressive track record, etc.
Everyone but one patient. She complained on how her surgery was rushed, how quick she was out of the operating theater, how she is scarred from it, etc.
At first, I thought she was lying. Why was she such an outlier?
I asked her for more details. It turns out her surgery was in the afternoon of the last friday before the Christmas holidays.
After knowing this, I made sure to schedule in during the middle of the week aways from holidays. My surgery went well.
I am glad to finally have statistics on this gut feeling I had. 23% is a LOT, and the 30% for the holidays is even worst. I had made a mental note to avoid those days, now it's become a rule.
Just a note, this (and many) titles report _releative_ change as the percentage. E.g. 1% -> 1.5% report as "50% increase". It is IMHO very misleading. At one point I developed a gut reaction to any statistic "Relative or absolute".
> The study, which appears today in the British Medical Journal (BMJ), looked at 980,876 procedures performed in US hospitals by 47,489 surgeons. Of those procedures, 2,064 (0.2%) took place on a surgeon’s birthday.
So, only a fraction of the surgeons performed operation on their birthdays. Would be interesting to compare the outcomes using the same surgeon group: surgeries on birthday vs same-surgeon surgeries on other dates.
I never took the day off on my birthday, but a lot of people do. So it might also make sense to ask why these surgeons are operating on their birthdays. Did they take the day off and went back to perform surgery on a critical patient? Are they overworked? Etc.
You make a good point, though I'd like to add that one would expect 1/365 = .274% of procedures to be on a random day (like a birthday). .21% is not so far off that it can't be random chance.
They included fixed effects for hospitals and surgeons: "To test whether our findings were affected by including both hospital and surgeon fixed effects in the same regression models." [1]
Perhaps the link could be changed to the paper itself?
> They also found that some surgeons did not work on their birthdays
Is this partially that better/more experienced/senior/more affluent doctors are taking their birthday off, hence people getting more junior doctors?
It would be interesting to see how many more people die on a particular surgeons birthday compared with the rest of their year, rather than the birthday of the surgeon a patient gets.
I remember a previous study showing that junior doctors were actually associated with better results since they were more recently trained and had less ingrained habits/biases.
> Research on judges has yielded similar results. It has found, for example, that external factors as diverse as outdoor temperatures and sports results can influence judges’ decisions.
When I hear of these funky effects I always wonder how they relate to AI. Presumably this is somehow related to some kind of lossy compression of the state of the world, maybe similar to principal components[0]? Where the "I feel grumpy" component is a mix of defendant-is-guilty, temperature-is-low and my-team-lost.
It might also be related to the binding problem[1]?
Also interesting is "Impossibly Hungry Judges". Many of these correlation effects are paradoxically so strong that they they _cannot_ be the true explanation.
I don't have a reference handy, but I seem to recall that that study on judges' verdicts being influenced by temperature, how close they were to lunchtime and so on, failed to replicate. I wouldn't be surprised if the OP study fails to replicate as well. They have a relatively high number of data points (to get an idea of order of magnitude: mortality of 145 across 2064 operations on birthdays) but only reach a P-value of 0.03 on their main conclusion.
For human beings: How about simple plain distraction as the problem?
If you refer to AI there are many examples where the training data is biased. One funny example was enemy tank recognition that saw enemies whenever there was gloomy weather, because the sample images of enemy tanks all where shot at such weather conditions to make them appear sinister to human eyes.
If you refer to a mental model, I guess it might simply be a resource management problem. Just because we do not experience the distraction actively it does not mean it is not there. How exactly distraction is compensated is irrelevant to this explanation. Explaining this with mathematical terms is probably pretty arbitrary and leads to framing (in a psychological sense). But I also like speculating on AI ;)
“ The study, which appears today in the British Medical Journal (BMJ), looked at 980,876 procedures performed in US hospitals by 47,489 surgeons. Of those procedures, 2,064 (0.2%) took place on a surgeon’s birthday”
Actual data:
2064/980876 operation on bday 6.9% die, rate = 142 death
Expected: (if we use non bday death rate)
1/365=0.0027
2687 operation
With better 5.6% death rate
= 150 death
So deaths are only 6% more, so basically they are doing less and more emergency operations on birthday, so death rate is increasing it seems.
It means they are making 23% less operations on birthday then any normal day.
More than a decade ago we had to digitize some org’s patient cards into a database. After running few “test” queries against that dataset out of curiosity we found out that you’re less likely to be alcoholic-y if you live on 4-5 floor. The explanation I thought was that they hang out outside, but those who live higher have harder time to go home and prefer to not go. Building with 6+ stories usually have an elevator and “the problem” disappears.
This might be different elsewhere, but here, the apartments on lower floors are typically rented and they're cheaper than those on higher floors. It's the case at the building I currently live in, although it's because on the lower floors, there are more apartments (smaller ones) than on the higher ones. Roof apartments are all sold out, not rented.
So, I could imagine, that the higher floors are occupied by more wealthy people, who might be less prone to alcoholism. This theory, however, doesn't check out for high rise prefab houses. But it could perhaps cause the deviation?
"The effect size of surgeons’ birthday observed in our analysis (1.3 percentage point increase or a 23% increase in mortality), though substantial, is comparable to the impact of other events, including holidays (e.g., Christmas and New Year) and weekends. (...) But the authors say the “natural experiment” in the present study is more revealing than, for example, holiday-related mortality rates. That is because “those events not only affect physicians’ performance but also influence patients’ decision to seek care (i.e., patients seeking care on these special days might be sicker than those seeking care on other days), as well as hospital staffing.” Unless, of course, the patients know their surgeon’s birthday, which is unlikely (though that may change if this study becomes widely known)."
That doesn't take exclude the possibility that surgeons may be assigned different patients on their birthdays. Some studies on the 'weekend effect' [1] seem to also control for illness severity, not clear if that was done here.
[1] https://en.wikipedia.org/wiki/Weekend_effect
I feel like we need an opposite saying for sentiments like this to the age old "correlation does not equal causation", something like "correlation does not mean automatically dismiss"
Well, that's how you discover things. You go fish for correlations, and publish any interesting findings, so another group can get independent data and check them.
On the meanwhile, a news reporter gets your (probably spurious) correlations and announce them for the entire world as "the TRUTH! science says so, and you don't doubt science, do you?"
That's basically how science gets done on any complex field where we can't test things directly.
> The effect size of surgeons’ birthday observed in our analysis (1.3 percentage point increase or a 23% increase in mortality), though substantial, is comparable to the impact of other events, including holidays (e.g., Christmas and New Year) and weekends.
> But the authors say the “natural experiment” in the present study is more revealing than, for example, holiday-related mortality rates. That is because “those events not only affect physicians’ performance but also influence patients’ decision to seek care (i.e., patients seeking care on these special days might be sicker than those seeking care on other days), as well as hospital staffing.” Unless, of course, the patients know their surgeon’s birthday, which is unlikely (though that may change if this study becomes widely known).
That doesn't take exclude the possibility that surgeons may be assigned different patients on their birthdays. Some studies on the 'weekend effect' [1] seem to also control for illness severity, not clear if that was done here.
[1] https://en.wikipedia.org/wiki/Weekend_effect
For those wondering about that “elderly”: the researchers only looked at “100% fee-for-service Medicare beneficiaries aged 65 to 99 years who underwent one of 17 common emergency surgical procedures in 2011-14” (https://www.bmj.com/content/371/bmj.m4381), so they didn’t check whether this applies to non-elderly patients.
> The study focused on emergency surgery, so as to minimize the potential selection bias. For example, surgeons might otherwise choose patients based on their illness severity, or patients might choose their surgeon.
The results are a lot less interesting when you read that the risk increase they found is comparable to that present during regular weekends:
>The effect size of surgeons’ birthday observed in our analysis (1.3 percentage point increase or a 23% increase in mortality), though substantial, is comparable to the impact of other events, including holidays (eg, Christmas and New Year) and weekends, which have been argued to affect the quality of patient care.
I suspect a causation along those lines would be that surgeons are less likely to push back surgeries to the day after their birthday if they're worried that the patient may soon become too sick to operate on.
> The researchers emphasized that this study focused on common procedures, and on older Medicare patients. This means that the findings may not apply to other types of patients, or to other surgical procedures.
Is there any reason Medicare would play a role in the surgeon's performance?
Medicare (as in the method of payment) obviously wouldn't, but by only polling Medicare patients they bias the patients, as Medicare patients are predominately the elderly.
I read something similar based on how long the surgeon had been working that day. I always wondered how plausible it was to show up for surgery day and ask the surgeon how many hours of sleep they got the night before and how long they have been working that day.
In general I wonder there is some QA/QC process involved in surgery, may be have some sort of independent evaluators observe each surgery and ensure the work is being done upto the laid down guidelines.
I’ve worked with a lot of surgeons and have heard/seen a lot of unbelievable things. Human beings are human. And often poorly educated in principles and ethics.
OK and how is this observational fact of any scientific relevance? Well there could be a similar observation like Elderly people are X% more likely to die if the moon is in the fifth phase of jupiter. So by some hocus-pocus astrological deduction this is a Study worth considering?
So you have 365 days in the year when a surgery can take place but only one day when a surgeon can have birthday. You compare two samples of 364:1 ratio ... it wouldn't be suprising the tiny sample gets some crazy deviations. Yet you find nothing so you're forced to dig in deeper (well this kind of content does well on internet you better find something) and bam there's a deviation for elderly patients, now you've got something to get your work talked about ...
Funny the website that hosts the study* even displays an "altmetric" chart showing how many media talk about it, how many tweets etc. Well done science :)
Ensorceled|5 years ago
It actually wasn't that many surgeries delayed, as the surgeon just juggled surgeries and consults/paperwork/insurance to fit.
If this is fairly standard practice, then an afternoon birthday surgery would be an emergency situation and, hence, more deadly. Given the paper said some surgeons take the day off entirely, any surgeon with that habit would be performing an emergency surgery.
colonwqbang|5 years ago
The problem is amusingly circular. Even if you reject the conjure in parent comment, you will be tempted to reduce the number of birthday surgeries due to the increased mortality. This will mean that birthday surgeries are only done in even more desperate circumstances which of course will increase the risk.
So mitigation of this problem will lead to the percentage increasing even more! Actually, it turns out that it is possibly better if the percentage is high!
Galanwe|5 years ago
This is spot on. The causality can be both ways.
Note that it would be interesting to dig into what is really computed here, because the whole wording seem intentionally sensationalistic.
1) "23% more likely to die" seems _huge_, but it applies to an already very small chance. The mortality rate just goes from 5.6% to 7%. Using this logic, moving from 0.1% mortality rate to 0.3% would mean "you are 3 times more likely to die".
2) Comparing mortality rates only make sense if the distribution of operation complexity are identical for these days. As the parent post suggest, it seems very likely that low complexity operations are postponed after a surgeons birthday.
3) Where are the confidence intervals? I refuse to even consider looking at a statistics if error boundaries and significance metrics are not provided.
That may very well all be provided in the underlying paper, but the article itself does not really discuss these points.
WarOnPrivacy|5 years ago
As pointed out by jlebar, this is controlled for by comparing similar emergency surgeries.
"The patients were all Medicare beneficiaries aged 65 to 99. They had all undergone one of 17 common emergency surgical procedures between 2011 and 2014."
jlebar|5 years ago
TFA says they're only counting emergency surgeries, to avoid exactly this bias.
misiti3780|5 years ago
My father is a surgeon at a small hospital and my mother just got her hip replaced a few weeks ago (at a different, larger city hospital) and the first thing he insisted on was she was scheduled as the first patient of the day.
giantg2|5 years ago
ericpauley|5 years ago
mhh__|5 years ago
Getting surgeons to adopt the kind of "It's obvious but point and speak or you're fired"-style checklists a la operating an aircraft has reduced complications (from the minor to deaths) by several percent in the NHS. It's perhaps worrying given how low-hanging some of these fruit are - i.e. "Do we have the right patient?".
bookofjoe|5 years ago
For example:
ARTERIAL LINE
• several sterile alcohol skin wipes • 3cc syringe with 25g needle [for skin infiltration of local anesthetic at puncture site] • bottle of 2% lidocaine with epinephrine 1/1000 • 2x2 cotton gauze pads to use for pressure on failed puncture sites • 3 #20 gauge plastic catheters (22 gauge for small children) • 2 surgical towels to drape over hand and lower arm to absorb blood that accompanied successful arterial puncture • size 7.5 sterile surgical gloves for me to wear while performing procedure • specialized 1" waterproof plastic skin tape to secure and protect catheter in situ
I was constantly amazed by how my colleagues would have to stop and wait for something not present in the unit they were called to. Conversely, when I was called because of an inability to insert an A-line, as they were referred to, and wasn't in a place where I could assemble my desired materials, I'd proceed with the materials at hand, all the while thinking "this could have been done a lot better...."
danpalmer|5 years ago
It turns out that while it's a good idea to check things this "low-hanging", the value is far larger than catching wrong patients, so don't worry too much!
Much of the value comes from essentially disrupting routine with an opportunity to stop, and from creating a culture of speaking up. I think the NHS was the organisation to trial having the nurse run the checklist, which had the effect of empowering the "lowest level" person in the operating theatre. Studies showed that even just having everyone in the room speak once increased the chance of subsequent communication, and ultimately improved patient outcomes.
Atul Gawande was one of the key people in designing and rolling out these checklists and wrote a book about it that I'd recommend – The Checklist Manifesto.
tomxor|5 years ago
Known as pointing and calling in transport AFAIK.
michaelt|5 years ago
roenxi|5 years ago
You don't realise how "bad" normal operational discipline is until you've seen it done right. The risk isn't so much that people skip a step, but that phantom steps start creeping in because people aren't quite sure of the standard, that saps a surprising amount of resources away which could be used for checking mistakes. And then people get disorganised and potential holes appear.
A big part of excellence isn't doing the right steps, it is trimming out the steps that don't need to be there, to focus attention on the stuff that works.
oblio|5 years ago
Regarding your checklist, you should read about Semmelweiss: https://en.wikipedia.org/wiki/Ignaz_Semmelweis
It's crazy to think that entire generations of doctors retired and died arguing against washing your hands!
poooogles|5 years ago
riffraff|5 years ago
sad anecdote: a friend of mine got surgery to remove a problematic mole on his back, and not only the surgeon got the wrong one, but even got upset with him when my friend mentioned something like "I thought it was further up my back".
throwaway2245|5 years ago
e.g. https://www.bmj.com/content/366/bmj.l4700.full
someburner|5 years ago
praptak|5 years ago
MeinBlutIstBlau|5 years ago
quickthrower2|5 years ago
dj_mc_merlin|5 years ago
> The patients were all Medicare beneficiaries aged 65 to 99. They had all undergone one of 17 common emergency surgical procedures between 2011 and 2014. Examples of those 17 procedures included cardiovascular surgeries, hip and femur fracture, appendectomy, and small bowel resection. The study focused on emergency surgery, so as to minimize the potential selection bias. For example, surgeons might otherwise choose patients based on their illness severity, or patients might choose their surgeon.
unknown|5 years ago
[deleted]
moosinho|5 years ago
Raphmedia|5 years ago
Everyone had good comments, good healing, very impressive track record, etc.
Everyone but one patient. She complained on how her surgery was rushed, how quick she was out of the operating theater, how she is scarred from it, etc.
At first, I thought she was lying. Why was she such an outlier?
I asked her for more details. It turns out her surgery was in the afternoon of the last friday before the Christmas holidays.
After knowing this, I made sure to schedule in during the middle of the week aways from holidays. My surgery went well.
I am glad to finally have statistics on this gut feeling I had. 23% is a LOT, and the 30% for the holidays is even worst. I had made a mental note to avoid those days, now it's become a rule.
cloverich|5 years ago
kkoncevicius|5 years ago
So, only a fraction of the surgeons performed operation on their birthdays. Would be interesting to compare the outcomes using the same surgeon group: surgeries on birthday vs same-surgeon surgeries on other dates.
spiderfarmer|5 years ago
lmilcin|5 years ago
esquire_900|5 years ago
wjnc|5 years ago
Perhaps the link could be changed to the paper itself?
[1] https://www.bmj.com/content/371/bmj.m4381
phreeza|5 years ago
https://www.bmj.com/content/bmj/371/bmj.m4381.full.pdf
tinus_hn|5 years ago
Put another way, assuming a flat distribution, on any given day 980876/365 = 2687 surgeries happen. While apparently on their birthday it’s 2064.
Saying ‘only a fraction of the surgeons performed operation on their holidays’ is a strong exaggeration. It’s about 75% of surgeons.
unknown|5 years ago
[deleted]
randomsearch|5 years ago
helsinkiandrew|5 years ago
Is this partially that better/more experienced/senior/more affluent doctors are taking their birthday off, hence people getting more junior doctors?
It would be interesting to see how many more people die on a particular surgeons birthday compared with the rest of their year, rather than the birthday of the surgeon a patient gets.
bottled_poe|5 years ago
phreeza|5 years ago
unknown|5 years ago
[deleted]
habosa|5 years ago
Don't know if it applied to surgery though.
kleiba|5 years ago
im3w1l|5 years ago
When I hear of these funky effects I always wonder how they relate to AI. Presumably this is somehow related to some kind of lossy compression of the state of the world, maybe similar to principal components[0]? Where the "I feel grumpy" component is a mix of defendant-is-guilty, temperature-is-low and my-team-lost.
It might also be related to the binding problem[1]?
[0]https://en.wikipedia.org/wiki/Principal_component_analysis
[1]https://en.wikipedia.org/wiki/Binding_problem
sixhobbits|5 years ago
[0] http://nautil.us/blog/impossibly-hungry-judges
nefoo62|5 years ago
chromanoid|5 years ago
If you refer to AI there are many examples where the training data is biased. One funny example was enemy tank recognition that saw enemies whenever there was gloomy weather, because the sample images of enemy tanks all where shot at such weather conditions to make them appear sinister to human eyes.
If you refer to a mental model, I guess it might simply be a resource management problem. Just because we do not experience the distraction actively it does not mean it is not there. How exactly distraction is compensated is irrelevant to this explanation. Explaining this with mathematical terms is probably pretty arbitrary and leads to framing (in a psychological sense). But I also like speculating on AI ;)
unknown|5 years ago
[deleted]
bluesign|5 years ago
Actual data: 2064/980876 operation on bday 6.9% die, rate = 142 death
Expected: (if we use non bday death rate)
1/365=0.0027 2687 operation With better 5.6% death rate = 150 death
So deaths are only 6% more, so basically they are doing less and more emergency operations on birthday, so death rate is increasing it seems.
It means they are making 23% less operations on birthday then any normal day.
wruza|5 years ago
fart32|5 years ago
So, I could imagine, that the higher floors are occupied by more wealthy people, who might be less prone to alcoholism. This theory, however, doesn't check out for high rise prefab houses. But it could perhaps cause the deviation?
samplenoise|5 years ago
That doesn't take exclude the possibility that surgeons may be assigned different patients on their birthdays. Some studies on the 'weekend effect' [1] seem to also control for illness severity, not clear if that was done here. [1] https://en.wikipedia.org/wiki/Weekend_effect
ekianjo|5 years ago
voxl|5 years ago
marcosdumay|5 years ago
On the meanwhile, a news reporter gets your (probably spurious) correlations and announce them for the entire world as "the TRUTH! science says so, and you don't doubt science, do you?"
That's basically how science gets done on any complex field where we can't test things directly.
unknown|5 years ago
[deleted]
martin_a|5 years ago
samplenoise|5 years ago
paulintrognon|5 years ago
e_f_rodrigues|5 years ago
"While we welcome light-hearted fare and satire, we do not publish spoofs, hoaxes, or fabricated studies."
https://www.bmj.com/about-bmj/resources-authors/article-type...
Someone|5 years ago
It also is worth noting that this is published in the BMJ Christmas Issue (https://www.bmj.com/about-bmj/resources-authors/article-type...), so it should be taken with a grain of salt.
huntermeyer|5 years ago
mrfusion|5 years ago
(Sorry if that’s already been suggested)
pps|5 years ago
throwawaylolx|5 years ago
>The effect size of surgeons’ birthday observed in our analysis (1.3 percentage point increase or a 23% increase in mortality), though substantial, is comparable to the impact of other events, including holidays (eg, Christmas and New Year) and weekends, which have been argued to affect the quality of patient care.
aldo712|5 years ago
[1] https://web.archive.org/web/20201216100507/https://www.psych...
andreygrehov|5 years ago
[1] https://pubmed.ncbi.nlm.nih.gov/29251716/
[2] https://news.ycombinator.com/item?id=22020160
cryptica|5 years ago
KMag|5 years ago
imtringued|5 years ago
wjnc|5 years ago
[1] https://www.bmj.com/content/371/bmj.m4381
sebmellen|5 years ago
Is there any reason Medicare would play a role in the surgeon's performance?
echelon|5 years ago
It's less pay, more paperwork.
Sucks if you're on Medicare. You're stuck with the doctors that do accept it, which probably weeds out some of the better practices.
Healthcare and getting old suck in the US. Think about how this might affect, say, your parents. And eventually you.
cmeacham98|5 years ago
johncolanduoni|5 years ago
thaumasiotes|5 years ago
redis_mlc|5 years ago
[deleted]
dangus|5 years ago
If something is 23% more likely to happen, you have to look at the original probability to get a handle on whether that increase is serious.
For example, if something has a 5% chance of happening, and it’s now 23% more likely, that means it now has a 6.15% chance of happening.
AlwaysRock|5 years ago
MeteorMarc|5 years ago
buzzerbetrayed|5 years ago
rzz3|5 years ago
mrfusion|5 years ago
(Im most careers, do people even take their birthday off?)
TehShrike|5 years ago
Triv888|5 years ago
ConradKilroy|5 years ago
billfruit|5 years ago
parentheses|5 years ago
seebetter|5 years ago
nvrGiveUp|5 years ago
There's a reason physicians don't consider themselves scientists. If they make an error they can claim they knew from Tradition/Art/Authority.
It's politically impossible to outspend the US Physician Cartel (AMA), so I doubt we will have a Science based alternative or science based reform.
pankajdoharey|5 years ago
michalu|5 years ago
Funny the website that hosts the study* even displays an "altmetric" chart showing how many media talk about it, how many tweets etc. Well done science :)
*https://www.bmj.com/content/371/bmj.m4381