Worthless warnings

Imagine in buying a bicycle you are forced to sign multiple sheets with statements like “use of this equipment could result in injury or death; use is entirely at your discretion and at your own risk.” Since you know how you are going to use the bike and have experience with its risks, you chuckle and sign the form. 

But now go somewhere for “minor” surgery and you are staring at the same kinds of vague phrases. This procedure can cause death, it says. Well shoot, I didn’t come here to die, you think, that isn’t the point and so you sign. 

Unlike bike and car accidents that you see reported on the paper and where statistics show up a lot–and bike and car riding experience we often have–medical problems are serious black boxes. How often does a nose job go bad?  How about joint repair? So we all guess that it can’t be that bad of this wouldn’t be done. 

But an accident happens and you do die. The doctors and hospital say you agreed to the risk. But did you really?

In GG’s opinion, no. Without some estimate of the level of risk, these statements provide almost no information. Sure you could die. The doctor in the middle of the procedure could too. Hell, the building could collapse and kill everybody participating. 

What would work? Maybe for a main form something like “odds of dying from this procedure are about the same as dying from a lightning strike this year” and then actual numbers on a separate page if desired. 

Frankly the more places where more quantitative statistics appear, the more likely people start to understand them. And the more we comprehend the statistics of risks, the better we as a society will be at managing and balancing risk. So next time your doctor shoves one of these bland sheets at you, ask just what fraction of his patients die from this.  Or are crippled. 

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4 responses to “Worthless warnings”

  1. geodoodler says :

    Very few people, even teachers really understand Risk, especially compound risk. Only expert gameplayers have a good feel for this.


    • cjonescu says :

      While I agree that understanding risk is an important but more complex mess many have worried about (it is far past time for every American to be able to make a simple expectation calculation, for instance), but the main point here is that we also fall on our collective faces in presenting quantitative risk estimates in many fields. Hard to worry about understanding if data isn’t presented to misunderstand.


  2. Paul Braterman says :

    Of course, the statistics may simply not be available. Procedures are not subject to the same kind of reporting, and requirements for initial approval, as medicines.

    At a deeper level, this may stem from the structure of the American medical industry. In every other advanced country, the cost of rehabilitation and after-care if a procedure goes wrong will fall on the State. In the US, it would fall initially on your own health insurance company, who would try to collect from the surgeon’s professional insurers. A small part of why you pay twice as much (as a fraction of GDP) as European countries, for mediocre outcomes.

    More generally, we seem to be extremely bad at assigning risks in public life. Remember the increase in road deaths after 9/11, because people were too frightened to fly.


  3. cjonescu says :

    I’m pretty sure the statistics exist somewhere, but most are private, which is certainly a byproduct of US-style healthcare. You do get things like “Mohs surgery is successful in treating skin cancer 99% of the time”–so somebody is keeping track. And Consumer Reports occasionally passes on ratings of hospitals performing certain surgeries, and they have rates of issues as part of that. One of the goals of the ACA (Obamacare) was to improve outcome-based reporting for the purpose of shifting from procedure-based to outcome-based payment (this was part of how they got a big Medicare savings from hospitals as part of that legislation). Of course none of this would prevent a surgeon from saying “Dr. X has performed procedure Y more than NNN times over a career spanning M years. Of those procedures, nobody has died and only Z patients had complications requiring additional care.”
    Certainly medicine is more complex than, say, figuring the risks of flying in an airplane, but if you’re going to want me to absolve you for my death, you better be able to tell me the risk in some useful form. That’s my beef with the way things are now.


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