Advertising Failure

The story of Doctor Kim A. Adcock’s approach to solving a problem in the radiology department at Kaiser Permanente in Denver reads like script background for one of those “procedural” TV shows such as CSI. We know who died (far too many) and we know who did it (doctors, sort of) but we’re not sure how to handle the evidence to make sure nobody gets killed next time.

Procedures that seemed reasonable to Kaiser in 1995 because they “had always been done that way,” turned out to be entirely unreasonable, with deadly consequences. And a solution that seemed impossible because of fear, turned out to be the best and most logical of solutions, and has saved countless lives.

I read this story when it first appeared in 2002 and have cherished its insights ever since. Now ten years later, I had to go find it to share it with this class. Since reading it, and other stories like it, I cannot look at statistics of any kind without wondering what they really mean. If the crime rate goes down, does that mean there is less crime? Maybe not. It might mean fewer people are reporting crimes.

For example, in New Orleans since Katrina, distrust of the police runs so high most citizens in some neighborhoods would rather suffer crime in silence than involve the police. The very first thought that came to my mind listening to that story was, “I’ll bet the crime rate has gone down in those neighborhoods” and not because there’s less crime. The mayor though, and the chief of police, can trumpet those statistics as if they’re doing a better job in those same neighborhoods.

But I digress. Your assignment for TUE FEB 14 is to read “Mammogram Team Learns From Its Errors,” and contribute a comment to an ongoing discussion of the counterintuitivities (I’m going to keep using this word until the rest of the world adopts it) it contains.

I don’t need an organized essay from any one of you, but I do need a contribution from everyone in the form of a comment to this post you’re reading now. I’m setting up the assignment this way to encourage you to read the entire comment string and reply to your classmates, not repeat what they’ve already said.

You may make your own original observations, of course, when you see an opportunity to point out something new. Or you may reply directly to a classmate’s observation with rebuttal or clarification. And you may contribute as well or as often as you like for a better grade. The minimum for a passing grade is one substantial comment.

ASSIGNMENT SPECIFICS

  • Follow the link from the sidebar or this link here to the article.
  • Read the article looking for evidence of counterintuitivity. At what points in the story do people think or act contrary to what their intuition told them? How do you explain their feelings or thoughts? At what point in human culture does common knowledge change so that we develop different intuitions?
  • Read the comments to this post that precede yours.
  • If you have something new to say, add your new insight to the conversation in a comment of your own.
  • If your insight is not unique, respond instead to someone else’s comment with refutation or additional support. Never repeat. Never merely agree.

GRADE DETAILS

  • DUE TUE FEB 14 before class.
  • Customary late penalties. (0-24 hours 10%) (24-48 hours 20%) (48+ hours, 0 grade)
  • Quizzes and Exercises category (10%)

About davidbdale

Inventor of and sole practitioner of 299-word Very Short Novels. www.davidbdale.wordpress.com
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27 Responses to Advertising Failure

  1. joeymleczko says:

    Going about research with counterintuitivity in mind is a lot harder than expected. Having preconceived ideas on a specific topic and having to look at them from the opposite direction is like asking a right handed person to be left handed. With that being said, the supplied article proves that some people think counterintuitively to the common views of society.

    Within the first few paragraphs, the reader learns that Dr. Kim Adcock sought to publish the failures of his radiation group. This alone is counterintuitive, because normally successes are commonly heard of not failures. However, from this initial abstract idea, it would make sense that people would approve of full disclosure when it comes to a doctor’s ability to diagnose. Oddly enough, the initial response was that reporting of “false negatives” was a bad idea because it would cause women to not get checked out regularly. Realistically, if reports state that many tumors on mammograms can go unseen, it would lead to reason that more women would get checked more often. However that is up for debate.

    Another great example of counterintuitive thinking is exemplified on page 3, paragraph 4, where an official states, “too many people believe that doctors walk on water, so how can we brag about making fewer mistakes?” This is a great quote, because it shows that common belief in society is that any words to come out of a doctors mouth are 100% true. This is not to say that doctors lie to patients, but it offers the idea of accepting that doctors make mistakes, because assessing these mistakes allows for weeding out of inferior practitioners.

    One last example of counterintuitive thinking that is a major theme of the article, can really be seen on pages 10 and 11. It is basic human nature (intuition) to give something up after failure. Dr Adcock looked at failure counterintuitively when it came to him and his radiology group, where instead of giving up, he saw room for improvement. Many people have trouble admitting when mistakes are made, especially when that person is a doctor that went through years of training. Recognizing faults and then improving on them is a trend that everyone (not just doctors) should practice.

    Society requires there to be a handful of counterintuitive thinkers that allow trends to flip after new ideas gain momentum. Eventually everyone accepts the “backwards” thinking as normal and society adjusts accordingly.

  2. davidbdale says:

    As usual, Joe, you’ve started us off beautifully. Thank you for your prompt thoughtfulness. My own comment here will not be a model of what I hope your classmates will do because I don’t really want to drive this conversation. I hope only to provide interference at times, occasionally cheer, otherwise quietly observe.

    I will say that in the years since I first read this article, I have so absorbed its outlook that I no longer feel its counterintuitivity fully. I hope it’s fresh to you and impresses you as brilliant and brave of Dr. Adcock to place himself at personal risk by confuting common knowledge.

    As you say, the notion of learning from false positives seems so obvious, resistance to such a plan is almost unthinkable. I’m not as clear why you modified that wonderful quote about walking on water into a question of doctor honesty, Joe. Maybe someone else will take up this point. To me the question isn’t whether doctors lie but whether they’re always correct. I hadn’t myself considered the counterintuitive nature of trying again after failure, Joe. It’s a wonderful insight. Picture me standing and applauding.

    Finally, I really like the idea of the counterintuitive thinker as a pioneer who arrives at the new insight early and shows others the way. I hope you’re excited to participate in that sort of exercise deliberately. To me it seems very worthwhile.

    Take the weekend off. Or start reading for pleasure in a topic of your own interest. When you find something there that it disturbs you to question, you may have stumbled onto your research topic.

  3. apdm3 says:

    At first, hearing about a missed cancer situation sounds completely negative and unconstructive, like no good could come of it. However, Adcock finds the positive in the regrettable and sometimes adverse work done by doctors who missed the cancer. “Once a year, Dr. Adcock sends out lists of actual cancers missed, known as false negatives, so the doctors can pull the files and commit their mistakes to memory.”

    In the radiology department, “The doctors’ hits and misses and other statistical variables are displayed in brightly colored charts for all to see.”

    I do understand how Adcock thinks that all this information should be available and presented to others to view. However, I wonder if revealing this information and displaying it in “brightly colored charts for all to see” should be a crucial concern within radiology. I think that the first step once discovering this information would be to find ways to improve these doctors’ skills and use the information to help the doctors, rather than hurt or panic them. Making this information available for all to see frightened many doctors, leading them to do minimal and inconsequential work. “Nearly half the original 20 radiologists were reading far fewer mammograms than the others.” After Adcock’s new approach in radiology, it was stated that several more radiologists were fired or resigned in the face of concerns about their interpretive skill. “If doctors start dropping out of mammography because they score badly in tests or performance audits, where will women go?”

    Thanks to Adcock’s new approach to mammography, “Denver doctors are finding about 15 more cancers a year than they would have at their previous accuracy level. In a country where 192,000 breast-cancer cases are diagnosed each year, that same increase in accuracy could mean finding upwards of 10,000 more annually.” Although Adcock’s novel method has caused a lot of hype and is very contentious, I think that this process has definitely presented more benefit than harm to individuals and society.

    • davidbdale says:

      What a novel idea, Ashley! It hadn’t occurred to me to read the claim about doctors doing fewer readings as an indication that they’d been frightened into cutting back their activities. I’m not sure it’s true, or that it’s actually supported by the facts we’re given, but it’s a very intriguing theory!

      For the rest, you don’t seem to have quite made up your mind whether you’re in favor of the Adcock process or not. You’re sympathetic to the doctors whose mistakes are broadcast, which is lovely of you, but you also allow that the process is more beneficial than harmful. I guess we could say you’re in favor of the outcome and wish it could be accomplished without shaming anyone.

      If you ever feel like saying so in a comment or an essay, it’s a perfectly acceptable attitude to express, and may be persuasive as well.

      Nice work, Ashley.

  4. tcorrao says:

    While reading Mammogram Team Learns From Its Errors, I came across this sentence ”‘Every mammography program in the country should be doing something like this,’ says Dr. Robert A. Smith, the American Cancer Society’s screening chief.” In other words Dr. Robert A. Smith believes mammography programs should remove doctors that are not diagnosing patients as flawlessly as doctors should be. Dr. Kim A. Adcock uses this “keeping score” method and has shown how the method is a success.

    Although this method is effective the method is counterintuitive. In reality, mammography programs are not solving the problem by weaving out doctors who do not meet the method’s standards. Those doctors that were removed from that mammography programs can go practice elsewhere.

    All in all this method does not fix the problem but pass the problem around. Maybe instead of removing these doctors, mammography programs should further educate or teach their staff how to meet the standards that are required to have a successful mammography program.

    • davidbdale says:

      That’s a fascinating point of view, Tabitha! I have to admit that in the anecdotal case that’s offered, the released doctor is still performing readings. I wonder if you’d agree he shouldn’t be. And maybe it’s possible most radiologists weeded out from the program at one hospital probably don’t go looking for similar work elsewhere?

      I also seem to recall plenty of evidence that the Kaiser program offers plenty of opportunity for readers to evaluate their own false negatives, learn from their mistakes, and improve their accuracy. That may or may not meet the standards you require for your demand that the hospitals “further educate or teach their staff,” but if I were arguing against you, I’d try to use that evidence to refute you.

      Nice work!

    • allyhodgson93 says:

      Doctors should be striving to do their best no matter what is at stake.The fact of the matter is peoples lives are always at stake. Breast cancer is a very scary thing that is very treatable when caught early by mammograms; mammograms save lives

      My problem with the suggested method is these doctors have been given numerous chances and ample time to meet said standards. If these doctors cannot meet Dr. Adcock’s standards, they should be removed. Dr. James Walsh was fired because of Dr. Adcock’s system. Dr. Walsh could not do mammograms any more because of this blemish on his record. He is now a fill-in radiologist in North Carolina. The fact that Dr. Walsh is a “fill-in radiologist” tells us he was obviously affected deeply by the rating system. This should make him realize he needs to strive to work his hardest. Walsh had to attend many workshops to get the job he has now. This fact makes it apparent the system isn’t just moving the problem, it is fixing it. Dr. Walsh’s current employers have no problem with his work so it is safe to assume he’s improved.
      .

      • samsarlo says:

        Is it possible that Dr. Walsh’s new employers hired him simply because they have lower standards? Perhaps they weren’t as concerned about the quality of work form their “fill-in” radiologist, or there wasn’t enough money in the budget to hire a more effective doctor. My point is that since Dr. Walsh is no longer tracked by Adcock’s charts, we really have no evidence that his work has improved. I could sleep through a year worth of radiology workshops without learning a thing about mammography, regardless of what others may assume I would have learned. There are millions of incompetent employees who prove that getting a job doesn’t mean you’re good at it.

  5. Blueitem (Jon G.) says:

    “Worse still, if women knew how many cancers their doctors had missed, they might avoid mammograms altogether.” This sentence is so counterintuitive very nearly produces, in the words of the article, “psychic” pain.

    First, a simple rational running of the numbers. The worst reported results for mammography were the 4 of 6 clincs in North Carolina that were maintaining a roughly 65% success rate. So, for every 2 cancerous tumors they found, they missed one. The best in the article was Adcock’s team, who had a 80% sucess rate — for every 4 cancerous tumors they found, they missed one. Not going to any sort of doctor at all produces a 0 percent chance of finding cancer, so every cancer is missed.

    Clearly, 0 percent is less then 65 and 80 percent, so logically no one should choose the option that presents absolutely no chance of finding cancer. Rather, knowing that doctors make mistakes should make a person more likely to schedule more mammograms, in the hopes that at least one doctor will find a problem if it exists. Scheduling less is counterintuitive, perhaps fatally so.

    (I had to rewrite this article 5 times (taking roughly 3 hours), so if this seems a bit lower in quality compared to previous work, that’s because it is. Additionally, I’m barely holding back a rant, so I believe I’m going to stop this comment here and maybe respond to someone else tomorrow.)

    • davidbdale says:

      (You’re doing fine, Jon, although I do want you to fix some specific problems.)

      Yeah, as counterintuitivity goes, this is a doozy. I completely understand your frustration.

      Not scheduling a life-saving test because it might fail is altogether illogical, so why does it happen? Just because people are illogical, or is there another explanation? Perhaps mammograms are inherently unpleasant and traumatic, and women are happy for any excuse to delay or avoid them?

      There’s counterintuitivity about all sorts of results: false positives and negatives, but also true positives and negatives.

      Maybe a 65% capture rate is actually incredibly good, considering what the radiologists are looking for: not black spots on a white field but interruptions in gray swirl patterns that often require several examinations by different trained professionals to spot and biopsies to confirm.

      Telling patients that sometimes tumors are missed might be just as counterintuitive as announcing to passengers before takeoff that wind is invisible and can sometimes bring down a plane without anyone ever seeing it.

      Fails for grammar Rule 8.
      Fails for grammar Rule 5.
      The deal here, Jon, is that you go to Grammar Basics (always available in the sidebar) for help finding the fatal errors. Fix them and this note disappears.

      Nice work!

    • Blueitem (Jon G.) says:

      “Clearly, 0 percent is less then 65 and 80 percent,…” Change the “then” to a “than,” and possibly “less” to “fewer.” (Can percentage be counted? Only if it’s from the same frame of reference (out of 100% in this case), I suppose.)

  6. billbrooks175 says:

    In the beginning of the article I was unsure of how this public humiliation of sorts would be beneficial. However after only a few short paragraphs I was sold on the idea. I think that Dr. Adcock’s system could save lives and it is worth it to fire a few people to accomplish this. This topic really hits home with me because I have seen firsthand the horrors of missing breast cancer at the first screening.

    My personal thoughts aside, there is a lot of counterintuitivity involved in this article. First of all, the idea as a whole seems a little counterintuitive. There has been no precedent for punishing doctors for negative statistics. Understandably there is some negative feedback in-house as the article states because doctors are worried about their jobs, which is a natural emotional reaction. However, the majority of doctors are good at their jobs and should not fear because they will rise to the challenge. Most of the time hospitals boast about positive statistics and ignore the negative ones. It seems like only good can come out of this situation. I do not think any harm can come out of implementing Adcock’s system nationwide, medical school is extremely competitive with a national acceptance rate of only 8.9 per cent so I don’t think that doctors who have risen above this will be flustered or panicked by displaying their statistics.

    Another example of counterintuitivity is the quote “Too many people still believe doctors walk on water, one official explained, so how can we brag about making fewer mistakes” which someone had mentioned earlier, but I have a bit of a different take from it. I see it as counterintuitive but it is also a mistake that should be corrected in society. Doctors are just humans too and the public should be broken of the pretense that anything they say is infallible. This is where society needs to change and develop different intuitions. Another issue that was brought up in an earlier reply was the thought that less women will get checked out if they realize that a mammogram isn’t 100 per cent accurate. However common sense would tell us that women would seek other opinions, get checked more frequently (Joe mentioned this as well), or most obviously look for doctors or hospital with a high percentage of catching tumors. If women only went to hospitals with high detection per cents then a natural selection of sorts would occur in which the bad doctors would be weeded out. Or in other words, the best would rise to the top.

    • davidbdale says:

      Bill, this is keen and thoughtful. Your use of the word punish to describe the posting of statistics might feel accurate to some of the poorer performers, but when you use it in your own essay, you own it in your own essay. You may have made that choice deliberately; you may not have. Either way, it’s a characterization you’ve made, a qualitative or categorical claim.

      There’s some punctuation trouble in your quotation. That one official explained certainly had to be set apart in the original. Your version needs to preserve that status.

      I’m not crazy about the phrase broken of the pretense, but more importantly I very much admire the idea that society develops new intuitions and that somehow we can hasten the development of automatic reactions.

      When you refute the claim that fewer (not less) women might get screened, are you responding to your classmates or to the author of the original statement? You not that others have responded to the claim, but who you’re taking issue with is not as clear.

      You may be hoping for too much when you theorize that patients will seek out the higher-scoring facilities, but I guess it’s worth considering. My own objection to even hoping for that situation I have already expressed: there’s too much incentive for fraud or manipulation (or worse, denial of care) if centers start competing on the basis of these public numbers.

      Nice work, Bill.

      Fails for Grammar Rule 5. Go to Grammar Basics (always available from the sidebar) for the Rule and make your correction to remove this note.

  7. aimelonsdorf says:

    Dr. Adcock first begins to act contrary to popular belief and to his own intuition when he began “keeping score” of the amount of breast cancer missed by him and his staff. The idea of keeping score was not liked by many in the medical field because it was often viewed as an assault on the medical profession. Keeping score was also dangerous: statistics are often misleading and the number of cancers missed could cause a drop in the number of women wishing to receive mammograms. Seeing an opportunity to improve the mammography system, Dr, Adcock continuously fired doctors who were missing large numbers of tumors in small spaces of time. ”‘Every mammography program in the country should be doing something like this,’ says Dr. Robert A. Smith, the American Cancer Society’s screening chief.” Although this left potential for angst between the doctor and his staff, the team has one of the highest proficiencies for catching breast cancer tumors. Although the doctor’s actions angered many, not enough physicians were looking at the real source of the problem: government intervention. The government was ordering higher concentrated x-rays for mammograms, causing a higher chance of missing the breast cancer tumor.

    Over the last several years, one of the largest political issues has consisted of the reformation of the health care system. Although Dr. Adcock was often controversial in his methods of redirecting the skill and the radiology behind mammograms, he accomplished one of the most needed reforms in modern day America. One of the most substantial reasons that Addock’s work has proved and will continue to prove successful revolves around Obama Care. The “universal health care system” for the percentage of Americans unable to provide themselves and their families with private health insurance, denies free or price reduced mammograms to women. This is primarily because they are expensive and often still misleading. It can be hoped that if the research by Adock and his team continues to prosper that the technology behind mammograms will become more reliable and cheeper. However, firing doctors is not the solution. One solution to the problem could be further and more persistent training. Another could result in further government research.

  8. tonyshilling says:

    Before even opening the article, the first assumption is “look for counterintuitivity….oh, this is going to kill me.” Well, as it turns out, that assumption is wrong. The first claim alone in “Mammogram Team Learns from its Errors” is a bold counterintuitive thought: “Seven years ago, Dr. Kim A. Adcock started a revolution in mammography: He decided to keep score.” Yes, doctors keeping score; apparently, programs on television such as Scrubs and House are not that far off base after all.

    It really is quite ingenious. Certainly, it must have been a considered idea before; a man who just happens to be a doctor is out at a sports bar with a few pals, and has the brilliant idea to make their profession more like the football game on the television. Well, fortunately, that is not what has happened here, but it really would not be a surprise either. The surprise is that it took so long to come about, really; yes, doctors feeling the need to “keep score” is absolutely a counterintuitive thought, as the entire point of being a doctor is counting your blessings for saving lives, not counting how many lives were saved.

    Now, I admire doctors; all that they do, they have earned those large salaries and prestige. But that does not mean that, being human, i never wondered just how successful or reputable certain doctors are; it is in our nature. Above all, honesty and justice are much more important that a doctor saving himself. Dr. Adcock, instigator of this change, is a hero in his own right for this “score sheet” idea; cancer is not a piece on a board game than can be messed with or sacrificed to keep one’s personal image sacred. If a doctor misdiagnoses cancer, intentionally (God forbid) or otherwise, he deserves to be fired. In our rich, Capitalist society, we as Americans pay for what we believe is the best healthcare in the world; it would be nice if we were not lied to. Bless counterintuitive thought, as it may have just saved thousands of lives.

    • Blueitem (Jon G.) says:

      Looking for counterintuitives really did kill me though. Nevertheless, since I’m reasonably sure my initial response is probably not enough to fulfill the requirements and your post hasn’t been commented on by the professor yet,, I’ll be trying to provide a rebuttal. No hard feelings?

      I disagree with the claim that doctors do not keep score. Though not traditionally thought of in the same way, records of malpractice are also a reasonable way to keep track of doctor’s failures. The reason this view isn’t more widespread is because most malpractice incidents, while publicly available, are not collected at any one database, and malpractice suits do not stay in a doctor’s record if they transfer between states. So it’s less of a problem with keeping score and more of a problem with obscuring the scoreboard. Dr. Adcock himself isn’t immune to this either, as the article states on page 3: “It’s a tricky business, this question of the doctor’s image. Even today, Kaiser is reluctant to advertise its turnaround, and it would share only some data with The Times.” So Adcock, even while lauding his new tracking system, isn’t sharing all of his information that system provides for him. Perhaps that’s the real counterintuitive?

  9. dalehamstra27 says:

    Dr. Adcock’s method of rating doctors on how many cancers they missed finally turned on him when he realized that he no longer met his own standards. Dr. Adcock had an increasingly large pile of x-rays that he failed to determine as cancerous or noncancerous. When he got his own ratings back, he was surprised to see that he no longer met his own standards. He then decided that it was unsafe to his patients and stopped reading mammograms altogether.

    I believe this is very counterintuitive because Dr. Adcock created standards that he himself could not even meet. This proves that the standards are too high, and unreasonable to ask all doctors to meet them if the creator can’t even meet them.The creation of his standards also cost Dr. Adcocks team fourteen members. Bringing it from twenty to six. The doctors that were fired for not meeting Dr. Adcock’s standards deserve to get their jobs back.

    • Blueitem (Jon G.) says:

      Additionally, Adcock got Dr. James Walsh fired for missing 12 cancerous tumors out of 3,000 mammograms. I assume his tracking system doesn’t use cancers missed over total number of mammograms, but missing 12 in 3,000 would mean he correctly identified the other 2,987 mammograms. Further, as stated in the NY Times article, Dr. Adcock’s team is only averaging and 80% success rate themselves, so if Dr. Walsh managed to find 48 instances of cancer in the 3000 mammograms, he would have roughly the same success rate. That is also ignoring the fact that judging based on cancers caught against cancers missed can lead to wild skewing of data depending on luck. If a doctor views 3000 mammograms, correctly identifies 2,999 of them as clean and misses one cancer, he has a 0% success rate using the cancers found against cancers missed system.

    • davidbdale says:

      I don’t believe I agree with anything you said, Dale, but I do admire that your conclusions are reasonable and that you express them well. Why is it necessarily true that Adcock, very good at what he does, should also be a good enough X-ray reader to benefit patients? Pitching coaches can’t strike anybody out, but that doesn’t mean they should employ pitchers who throw no better than they do.

  10. choffman17 says:

    The entire concept of “keeping score” of doctors’ successes and failures is obviously counterintuitive in itself. It is not general practice to document failures by doctors and realease those reports to the public, allowing them to see the true competency of their doctors. It makes it difficult for doctors to attain patients if their success rate is low, and similarly makes it easier for doctors with higher success rates to take on cases that they are confident will only be able to either maintain or boost their success rate even higher.

    One claim, however, that stands out in relation to doctors’ responses to the “keeping score” method is that, “To many doctors, keeping score was yet another assault on their autonomy and prestige.” What is strange about this is that it immediately takes a defensive stance on the doctors’ behalfs. It is curious that doctors’ initial instinct is to be offended by the method, feeling as if their “prestige” is being belittled, rather than use the opportunity to make themselves stand out as an exceptional medical professional.

    If looked at from this angle, it can be related to a situation that we as students face in our academic writing. For example, in Journalism classes, it is common for a professor to require students to conduct interviews as part of their source material for papers and articles; professors wish to have proof these interviews are legitimate, and so they will often ask students to include the person’s name and phone number so that the professor has the opportunity to double check with the interviewee that the interview actually took place. This places students in the same position that doctors are in under Dr. Adcock’s methodology — as if their “prestige” as an honest, hardworking student is belittled. However, as long as students honestly conduct the interviews they are required to, they have no reason to be reluctant to provide the name and phone number of the person they interviewed — just like if doctors performed their job as accurately as possible and did thorough examinations of their patients, they should not be reluctant to allow their success rates to be measured and distributed to the public.

    Granted, it is impossible for doctors to be 100% successful 100% of the time — everybody makes mistakes in any job they hold; it is unfortunate for doctors, however, that their prevention of mistakes is much more crucial than in most other careers. But then again, that is why it requires a great deal of schooling and dedication to even make it as a doctor, so ideally they should be much more equipped to be as close to perfect as possible than perhaps maybe a sales manager or a travel agent. The “keeping score” method should make doctors more apt to work harder and be more careful, rather than be seen as an insult to their abilities.

  11. jahne92 says:

    Dr. Adcock is breaking boundaries for the medical world, his counterintuitiveness is beyond any that I have seen or heard about. Adcock is making all of his doctors be on top of their work all the time, and in reality people make mistakes and when that happens it is unfourtunate. Adcock does not want any mistakes to be made ever, he wants all of his doctors to be perfectionists. His methods are very unique and they are working, “the ”shame” factor, and manipulating it is the stealth ingredient of the Kaiser method. To really improve your skills, he explains, you have to repeat this shameful moment over and over.” This quote says alot to me, because this technique would make anyone want to work their hardest. If you are thinking about every time you have messed up and every time you missed a tumor, or cancer in someone and you never saw them again that can haunt a person for the rest of their life. Adcock is using that as motivation for his doctors and the doctors are responding by not wanting to let any patient down, and helping every patient that comes into the hospital to the best of their ability. In the article it even said that the doctors can do a breast cancer diagnosis and find if you have had any past mammograms. The doctors are finding other doctors mistakes. When I read that Adcock is “Setting a New Standard” that got me excited because he understands that doctors are capable of life saving procedures, and they are gifted. Not all doctors hold themselves to the accountability that they are responsible for saving lives, and Adcock is making it known that he wants only doctors who are going to perform to the top of their abilities on his team of doctors. Another statement that gets me excited is ” Improving Accuracy,” when I see that and after reading about Adcock and his determination for perfection and the best medical care it makes me feel like why are more people not embracing this man’s vision of excellence. He is begining to start the counterintuitive movement, and other hospitals and doctors should acknowledge this and start doing it too. He is “getting it” that phrase to me means understanding that something is wrong and he is doing something about it to make it better. The thing that is wrong is that doctors are missing cancers and tumors, and he is saying that if you missm those kinds of things you cannot work for me. This article was one I actually enjoyed reading because it shows that there are people in the world who are making differences and I do not even know about them. Dr. Adcock is doing things that I believe should be getting done, people should not be settling for imperfection in their line of work especially when it comes to saving lives.

  12. In the article “Mammogram Team Learns from its Errors,” the story contains multiple examples of counterintuitivity, like on page eight in the first paragraph, it says, “Mammography everywhere is a constant balancing of possible harm: between missing too many cancers and ordering too many needless biopsies.” The whole article is about doctors trying to prevent more cancer cases through better mammograms, but this line makes them seem more worried about paying for biopsies that catching the cancer. They say the biopsies can be painful to the patients, but wouldn’t it be more important to make sure that the patient does not have cancer?

    Another example of counterintuitivity would be on page six in the ninth paragraph when the author states that, “[Some doctors] met the federal minimum of 480 a year, but with the others reading as many as 14,000.” This shows that the statistics for some of the doctors might not be fair because some doctors take more mammograms than other doctors do. The hospital judge the doctors off their statistics for their jobs, but the statistics may be far different from others because of this. Also, it is not just the statistic that could throw off the score, but the actual patients that each doctor gets. Some doctors might happen to get more patients with cancer than other doctors, making their statistics look better. This is all up to chance of which doctors get which patients

  13. martyb68 says:

    The sentence on page two, paragraph two, that reads “Many lack the skill needed to do so effectively…” is definitely a counterintuitive thought. Common sense would cause one to thing that any doctor has the skills necessary to read an X-ray properly. The counterintuitive thought that not all doctors have the skills to do it effectively brings forth the idea that not all doctors know everything. Knowing that not all doctors are experts in reading X-rays allows you to be more careful in believing to everything they tell you.

    “They warned that surgeons might be increasing their scores by avoiding higher-risk patients.” This is a counterintuitive idea located on page four that we also discusses in class. This states that you can not always trust the doctors scores because they could just refuse high risk patients to boost their numbers. This offer up the idea that the numbers are not accurate. A talented doctor who takes on high risk patients could have worse numbers than a less talented doctor that does not. The amount of patients they have and their luck could also have a severe impact on a doctors numbers.

    “An instructor once told him to pretend that each X-ray was his mother’s.” This is a counterintuitive idea on page six that an instructor gave to Dr.John A. Siebert. This is suggesting that a doctor should treat each X-ray as if it was his mother’s. The result would be that the doctor reads the X-ray as careful as possible to not make any mistakes. This could cause a doctor to take too much time on each X-ray and begin to get fatigued. Being fatigued could in result cause the doctor to make more mistakes. The doctor not actually liking his mother could also have an impact on this idea.

  14. langer278 says:

    I wasn’t thinking and messed up and made my reply to this assignment as a post instead of comment.

    • davidbdale says:

      I noticed that, Brett, and it’s fine. The post was on time and I have no objection if you want to paste the text here too. We’ll leave these comments in place as reminders that you satisfied the assignment before the deadline. OK?

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