'Random Acts of Medicine' Review: Paging Dr. Chance

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Enter “Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health,” written by the absurdly overachieving economist and physician Anupam Jena and his only slightly less overachieving co-author, Christopher Worsham, both of them practicing physicians, researchers and professors at Harvard. Messrs. Jena and Worsham are the Freakonomicists of the medical realm—they specialize in uncovering unique “natural experiments” that shed light on medicine and medical practice.

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People who end up in the emergency room complaining of chest pains a few weeks before their 40th birthday are very similar to people who end up in the emergency room with chest pains a few weeks after their 40th birthday. But on a chart, the former are 39 years old and the latter are 40. The big 40 is a heuristic among physicians for potential heart attack. Looking at more than five million patient records, the economist Stephen Coussens found that patients who were slightly over the age of 40 were almost 10% more likely to be tested for a heart attack than those just under 40. The difference shows up as a discontinuity, a jump up in the probability of being tested as patients cross their 40th birthday.

Messrs. Jena and Worsham show that similar discontinuities appear throughout medicine. Heart-attack patients just under the age of 80, for instance, are more likely to be given coronary artery bypass surgery than those just over 80. Kidneys from patients who die at age 69, just short of their 70th birthday, are more likely to be used for transplant than kidneys from patients just over 70, even though by all objective measures the kidneys are equally viable and valuable. Perhaps most tellingly, “children” just under the age of 18 are less likely to be prescribed opioids than “adults” slightly over the age of 18, even though these groups are statistically indistinguishable. The authors find, for example, that compared to the just-under-18s, the just-over-18s were 12.6% more likely to later be diagnosed for an opioid-related adverse event such as an overdose.

Patients who happened to have a heart attack during a week when hot-shot cardiac surgeons were away at national conferences were found more likely to survive. It sounds like a joke—stay away from hospitals because that’s where lots of people die—but the statistics are solid. The heart surgeons most likely to attend the national meetings also tend to be the go-getters, eager to cut and demonstrate their prowess in the operating theater. When these surgeons are away, mortality rates decrease by about 12.5%, a decrease “similar in magnitude to some of the best treatments we have available for heart attacks.” (Emphasis in the original).



https://archive.is/MgSuf

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I personally have always preferred to be seen by a nurse practitioner