Having experienced something that seems to be similar, imagine that you are working on a web server. It is very slow sometimes. Your project leader is absolutely convinced that the problem is due to multiple requests being made to the DB at the same time. He has been lobbying to rewrite the DB layer for some time now. He hates the archetecture that was left to him by the previous lead developer and is absolutely sure that if he rewrites it, it will be much faster and easier to work with.
Unfortunately, you've been profiling the code and you've found that the there is an inordinate amount of time being spent allocating a date. It seems like the code is pathologically looping around and hitting that date code hundreds of thousands of times for every request. You've tried showing your lead the code that's causing the problem. He doesn't really understand it. He doesn't trust code profiling either. He already knows what the problem is and he's not interested in hearing any more. He ridicules you for having this stupid theory that allocating a date is slowing down the DB.
It's not that keeping the poor behaviour is benefitting him in any way. It's more that the new solution is not his solution and he's got a lot riding on his solution being chosen (justify his code rewrite). He's kind of staked his reputation and career with the company on his solution. If it turns out to be something else -- especially something he's already ridiculed, he'll be toast. He wants to get into management and management is all about politics and being right all the time (ever hear the President say, "Wow. I was certainly wrong about that!" -- and you can pretty much insert just about any President there... not just the obvious one ;-) ).
That's the way I see it anyway. Doctors, just like computer programmers work with complex systems where they are more likely to be wrong than right. I never trust people in these positions who don't know how to be wrong. But they/we are often placed in positions where we are not allowed to be wrong -- and some people handle those situations better than others.
> It's not that keeping the poor behaviour is benefitting him in any way. It's more that the new solution is not his solution and he's got a lot riding on his solution being chosen (justify his code rewrite).
It might also be worth to add that he might have been subjected multiple times to alternative theories that were refuted, and in his eyes this new outlandish theory isn't even the most credible one on that list.
The benefit is in punting off complicated case quicker, because the insurance pay out is the same, regardless if you spend 30 seconds or 30 minutes on the patient.
There is often nothing you can do to help anyway, but you can certainly bill 250 bucks every 5 minutes, and many, many do so.
In fact, some physicians will not even accept complicated cases, especially if they involve chronic pain treated with opiates, thanks to the hysteria around overdoses today.
And that is the reason why universal healthcare will fail, and why the NHS has a private tier, and routinely pays for treatments outside of the UK, done in private hospitals.
> And that is the reason why universal healthcare will fail, and why the NHS has a private tier, and routinely pays for treatments outside of the UK, done in private hospitals.
This does not logically follow from what you said at all. The NHS has not "failed", nor does it have a private tier - it commissions some treatments from private clinics for purely political reasons. These treatments are still completely free to the patient.
An NHS hospital isn't receiving insurance payouts, so it has an incentive to treat people quickly and efficiently, with complete cures being preferred over long-term management when possible.
1) I should've said the UK has a private tier for clarity.
You will get to see a private consultant a lot quicker, than the very same physician via NHS referral.
Quite literally you could wait months, or pay a few hundred and see the same exact person in a couple of days. In fact, when paying private - the private consultant himself will be treating you, vs. when on NHS - it will likely be his students/trainees that will be hands-on.
NHS hospitals are on a fixed budget, but of course cost controls means nothing - only putting patient interest first /s.
2) As for the insurance payouts - that was regarding systems where physicians bill on fee-per-service model, the most predominant setup in the US:
https://www.ncbi.nlm.nih.gov/pubmed/20467910
