Yeah I came here to write more or less this exact comment -- the doctor absolutely did make a medical judgement on the patient, and frankly it was an astonishingly bad one. To declare, sight unseen, that a patient with several severe signs of infection is simply prediabetic, is negligent in the extreme, especially when the medical professional who is actually with the patient doesn't agree.
Also I'd like to point out that the headline is, at best, highly misleading -- the doctor didn't see the patient, no, but that's the problem not an exculpatory factor. This isn't a random doctor being sued by a random patient it's a doctor whose medical judgement arguably led to the patient's death.
Moreover, the Dr's argument that he was just "giving an opinion", but did not actually accept or prevent her admittance, absolutely does not pass the smell test. He was in a position of power, and from the description of the phone call with the nurse practitioner in the article it is extremely clear he wasn't just "offering an opinion", but was in fact denying admittance.
Honestly, I feel awful for the patient and her family, but I also feel awful for the NP who tried to do the right thing but was shot down by those with greater seniority than her. I hope her employer changes their training so that if something like this happens in the future that they just tell the patient to go directly to the ER.
The NP did not try to do the right thing. Given the facts outlined in the article, a qualified medical professional would have sent the patient to a hospital (emergency room) regardless of the opinion of the consulting MD's who did not see the patient. Why? Because the NP did see the patient. Why take an off the cuff opinion of a MD who hasn't examined the patient or seen his charts (all info was given verbally over the phone) as absolute? Note, many seem to interpret the refusal of admission as an inability to go to a hospital, that is not the case. The emergency room was still available.
IMO, there was failure at all levels. The NP failed, the consulting doctors failed, the hospital chain failed. Systemic failure.
Except they all seem to be part of the same company so I assume they have rules saying that the NP needs to give the Dr’s opinion more control over the decision. After all it sounded like they contacted multiple (of the company’s) drs and they said the same thing.
If they are part of the same network the dr probably had access to the charts, and if not I assume nurses who are required to call doctors can communicate the content of a chart.
It also makes no sense to say: NP you are required to contact a doctor to get permission to admit a patient, but if you think the doctor is wrong you should admit them anyway. If that isn’t the rule then you should save money by not having drs who only exist to answer the phone and trust you NPs to admit patients who need it.
> Why take an off the cuff opinion of a MD who hasn't examined the patient or seen his charts (all info was given verbally over the phone) as absolute?
While it doesn't change the overall point much, she didn't take the opinion of an MD that way; after getting the response from yhe hospitalist, she attempted to bypass the refusal by taking the case to a physician at her own clinic who had admitting privileges at the hospital, but who reached the same conclusion as the hospitalist had.
The NP in this story is one of the people that fucked up. A, because she should have sent them to the ED. B, because hospitalists have nothing to do with the ED, and she was trying to /bypass/ the ED. C, because she didn't need her supervising physician's permission to send the patient to the ED. D, just for kicks, diabetes absolutely causes a white count bump, especially during uncontrolled episodes, with the degree of one correlating to the other - something every med student is expected to know, and it's ridiculous that the NP didn't.
"Legally motivated to do the right thing"? She's significantly more guilty than the hospitalist, who is a red-herring in this entire discussion ("I'm not the ED attending. Send her to the ED. The ED attending decides who gets admitted for non-elective admissions. Also, she might need urgent care, so she shouldn't wait the 12-24 hours hold-up that would occur if I admitted her directly." would have been the response of any hospitalist I've worked with) and yet he's vulnerable to a malpractice suit, and the NP is not. What legal motivation?
> The NP in this story is one of the people that fucked up.
And was sued for it and presumably (the case with regard to her was settled on undisclosed terms) forced to pay. But she fucked up by passively accepting the judgement of the MDs involved, so the upthread comment that this case might encourage (or “legally motivate”) NPs to act more independently is reinforced rather than negated by the fact that the NP fucked up and was held to account here.
> and yet he's vulnerable to a malpractice suit, and the NP is not.
You mean “he got out of even having to face malpractice liability at the trial and first appellate level, while the NP was forced to settle before even reaching trial.”
Not a medical professional, but if you're positive that the patient is going to be admitted then bypassing the ER may make a lot of financial sense for the patient. Going to the ER is expensive, so moving directly to admitting cuts a lot of cost.
If you don't believe me and are in the US, call your insurance company and ask "what's my out of pocket if I'm admitted to the hospital for 1 night going through the ER vs going through an urgent care center?" There's a pretty good chance the ER route will be at least $1000 higher.
Urgent Care centers do not have hospital privileges and cannot admit to the hospital.
That surprises me since (at least in my area of the Chicago suburbs) all of the urgent care centers I've seen are associated with hospitals or hospital networks. I have no experience with their admitting capabilities though, having never actually used one.
I dunno how independently NPs can practise in MN. Sometimes they’re always under an MD and anything that happens is that MD’s responsibility. This can be relatively more true if they’re an employee vs. a contractor (at least where I live, dunno about MN).
The NP settled their case out-of-court. So they were held liable, and we don’t know how much.
The consulted MD felt like fighting it in court, and lost.
That’s what makes this case a bit unusual because something bad happened and one person involved thought they weren’t accountable.
It depends on how many hours they've practiced. Initially, under a physician. Eventually, completely independent. The article describes the second doc as a "collaborating physician," but I went to the underlying court documents and, no, they were just a second informal consult - this NP was practicing independently.
The case isn't that unusual. Malpractice lawyers name everyone even tangentially related to a case, because malpractice insurance has a cap on payouts and you'll never go to court and win more than that cap, so you want to pull in as many people's policies as possible. Everyone that wasn't directly involved in the care of the patient gets their names dropped from the suit pretty quickly. Normally.
So, it's not unusual that the person that actually fucked up (the NP) settled, and someone not part of the patient's care said screw that (the MD).
Docs also don't choose for themselves whether they fight it in court. The malpractice insurer does. If you go against the insurer's wishes, you basically give up your malpractice coverage. In this case, I'm guessing that the fact that this is a slam-dunk "get thrown out of court" situation is why they didn't settle, as they do the vast majority of the time, regardless of the underlying merits of the case. Usually settling is cheaper than litigating, but a single "get this thrown out" motion is cheaper than settling.
The unusual thing here is just that MN is somewhat unique as one of the few states that doesn't explicitly require a doctor-patient relationship for its malpractice suits, so instead of getting thrown out, the case is going ahead.
What he lost was the appeal of the dismissal of the case. The MN Supreme Court ruling merely means the case will go to trial. He may yet prevail, but from what I read in the article, seems to me that it's unlikely he will prevail.
It's more the other way around, at least in a US context. Concern of the impact of AI/physician disagreement is a problem from a malpractice point of view. Physicians in the US have a huge amount of professional leeway - hence the expansion of off-label use - but this is counterbalanced by a large amount of professional responsibility/liability.
Unless she's in the process of joining Uber and working on the feedback component, she's not "trying to make the system useful", she's just refusing to engage with material reality.
Direct action needs to actually affect the people who have the power to make changes. Stubbornly rating drivers 3/5 for a good ride just makes their lives harder, and let's be clear, nobody who is working at Uber gives a shit about that.
"cover instances in which science and social-justice-advocacy get in fights"
This is especially funny when you remember that Singal has a long-standing problem with the American Academy of Pediatrics, and objects to their evidence-based protocol for treating transgender children, and he personally prefers the approaches advocated by a discredited conversion therapist.
"Singal's Atlantic article was cited by seven states in their lawsuit to overturn sex discrimination protections for trans people." is a fun recent addition to the pile.
Folks here who are interested in SCPs might enjoy http://www.scp-wiki.net/antimemetics-division-hub specifically -- it's a really cool series that plays around with knowledge and memory. In particular I really love the "There Is No Antimemetics Division (2015)" and
"Five Five Five Five Five (2017–)" series.
An antimeme is an idea with self-censoring properties; an idea which, by its intrinsic nature, discourages or prevents people from spreading it.
Antimemes are real. Think of any piece of information which you wouldn't share with anybody, like passwords, taboos and dirty secrets. Or any piece of information which would be difficult to share even if you tried: complex equations, very boring passages of text, large blocks of random numbers, and dreams…
But anomalous antimemes are another matter entirely. How do you contain something you can't record or remember? How do you fight a war against an enemy with effortless, perfect camouflage, when you can never even know that you're at war?
That's going to be a huge surprise to the people, both tech workers and otherwise, who live in one of the major tech hubs where all the tech workers congregate.
That's not great! I wonder if Ebola is especially quick to mutate. This article: https://jvi.asm.org/content/early/2015/12/08/JVI.02701-15 suggests that it is. A mitigating factor is that it doesn't seem to tolerate mutations very well (i.e. lots of mutations lead to non-viable strains), but I guess with a large enough patient pool it could have out-run the vaccine.
What's the alternative to "build your own platforms" though. Are you willing to compel Stripe by threat of force to keep processing credit cards for nazis? Are you willing to completely torpedo freedom of association, as long as the people demanding your company continue associating with them are sufficiently monstrous?
What makes the 'deplatforming' threat viable is that so many critical aspects of an online business are a choice between private-enterprise players. Stripe or Authorize.net. AWS or DigitalOcean. GoDaddy or Namecheap.
As you suggest, they have no individual legal obligation to serve a business that may cause bad press/high risk/whatever. But when you can enough of them pointing in the same direction, it creates the chilling effect-- a business that's technically legal but can't get the services they need. It basically creates am unspoken private regulation well beyond the actual law of the state.
I tend to think the answer might be non-profit or state-run "service providers of last resort" -- charter-bound to provide service for any legal purpose, no matter how distasteful. Not necessarily cheap or slick, but they won't pull your plug because people complain about your content. Such a provider would defang the deplatforming strategy pretty fast.
> it creates the chilling effect-- a business that's technically legal but can't get the services they need
They can get it, but have to pay for that. Just like the porn industry had to build their own payment providers.
The chilling effect is working as intended. You need something in society to make people find common ground and live in a similar reality. The current US seems like a great example of people not being able to do so. They blame more and more blame other side for their problems. And i wonder if that trend can be reversed before you guys start shooting each other.
Recent developments like social media made and the US TV landscape make it easier than ever to live in your favorite filter bubble. Algorithms getting better and better at giving you what you want to hear. I don't see developments emerging to counteract that.
If de-platforming is bullet we have to bite for society to keep functioning, than so be it. It's still somewhat mild tool you can work around... i take that over government intervention any time.
>They can get it, but have to pay for that. Just like the porn industry had to build their own payment providers.
There are two problems with that argument.
First, it's nowhere near as trivial as you make it sound. A one man shop could potentially build and maintain a custom forum service himself, but trying to create a real-world ready payment processing infrastructure from scratch is going to mean a team of tens of specialists.
The porn industry was able to solve it because it was a big, industry-wide problem that left a lot of money on the table-- a need big enough to create a market for specialists.
Second, it may not be possible to bypass every firm that presents a deplatforming risk. The porn industry may have avoided rejection by the mainstream gateway providers, but they're still dependent on retaining good relationsips with Visa and Mastercard at the end of the day. I'd think those guys are the nuclear option for deplatforming-- no matter who you line up to take your payments, if you can't accept 90% of the cards on the market, you're not going to be able to monetize effectively.
I don't want my tax money used for that. Not because I object to the content, but because it's a waste of money and government officials have more important things to focus on.
I'd love to see Republican senators voting to fund an antifa 24/7 channel. I mean, they can't even get behind Sesame Street so I'm sure that wouldn't be a problem.
> But when you can enough of them pointing in the same direction, it creates the chilling effect-- a business that's technically legal but can't get the services they need. It basically creates am unspoken private regulation well beyond the actual law of the state.
Yes, but this is how the free market works. That my $.25 artisanal dog cupcake business can't get the services it needs at the price I can afford doesn't raise complaints.
But when we replace dog cupcakes with Nazi chat rooms, suddenly we need the government to step in and subsidize a business which the market has shown is not worth it. In economic terms, the "distaste" of a client is an externality, and there is an increase in price associated with that externality. If the company can't afford it that's just the market at work. So the government providing a platform like this is just the government subsidizing business with negative externalities that the free market was correct tly pricing. It's like subsidies for strip mining or fracking or rhino poaching. But this is something you support in this case.
It's odd to me.
> I tend to think the answer might be non-profit or state-run "service providers of last resort" -- charter-bound to provide service for any legal purpose, no matter how distasteful.
And what if my distateful venture needs redis or windows 10 or a spanner like distributed database, or whatever other service your unflashy system doesn't provide?
Then either I can't get off the ground anyway, or you require that the government service maintain feature parity with all the others, neither of which seems viable.
The is no evidence that Gab can't find a price at which to run its service. Again: even Stormfront is still up and running. And Stormfront is just Gab without the pretend rules forbidding threats and harassment.
In the 1950s, your question would've been "Are you willing to compel Stripe by threat of force to keep processing credit cards for leftists and commies?" You believe because your political faction has a little leverage currently that it will always remain that way; not so. If you legitimize deplatforming, it is a weapon that will someday be turned against you.
Given the unwelcome resurgence of the right worldwide, that day may come sooner than you think.
If memory serves, at least in the US this was the opposite. The free market was fine with serving least wing groups. It was the government that stepped in and told individuals to not be leftist, under threat of force.
Only then did businesses stop associating with those people, because the government was implicitly threatening them.
It was exactly the government's interference that caused the deplatforming of potential leftists during the red scare.
The government isn't an entity with its own independent will; the US public broadly voted in officials that put in place those policies. Leftists who openly identified as such faced all sorts of problems doing business even without government intervention.
You're just repeating the same invalid argument. Go and look up the history of widespread small scale anti-lefist incidents in that era that occurred before the HUAC existed.
The onus is on you to provide examples. Most of what I know of, and what I can find documented, was government sanctioned or under (implied) threat of government retaliation.
Please cite examples of these widespread small scale, grassroots anti-leftist incidents.
"Somebody someone else really doesn't like" != Nazi
When we start throwing that word around, along with describing groups as "far right" (or indeed "far left") when they've started getting more votes than the [previously] mainstream groupings, we appear have a problem with nomenclature.[0]
I assume that you have a proposal that would differentiate between the two? So that they would be forced to serve "somebody someone else really doesn't like", but not be forced to serve Nazis?
There are four levels of power (kind of) => government, employer, social, individual. Whenever you're in an argument, assume that the other side is advocating for the top level to enforce something so you can call them oppresive, and claim that you're advocating for the bottom level (and that that level should be free to do as it likes).
Nothing in this article mentions passing a law and he even mentions several times that it's within their rights. It's therefore clearly discussing level 3 and 4 (trying to effect cultural change at the level of the individual. For you to weigh in as if he's arguing for passing an insane freedom of speech is disingenuous.
>Nothing in this article mentions passing a law [...] For you to weigh in as if he's arguing for passing an insane freedom of speech is disingenuous.
I think you've inadvertently overlooked how the 3 parent replies above you were discussing hypotheticals. In other words, each reply tried to elaborate what the alternate universes of free/censored speech might look like:
- evrydayhustling's hypothetical: "What would it look like for an "anti-deplatforming" initiative to succeed? [...]"
- im3w1l's hypothetical: "What reason is there to assume those platform platforms will not get kicked off the platform [...]"
- amputect's hypothetical: "What's the alternative to "build your own platforms" though. Are you willing to compel Stripe by threat of force [...]"
Commenters can bring up hypothetical laws or attempt to predict hypothetical outcomes even though the article itself doesn't mention creating a new law.
(It's also possible that the middle reply in the chain of hypotheticals by im3w1l was misinterpreted as a call for a government law even though he doesn't explicitly state it. Sometimes people read between the lines and misconstrue the commenter's intent. It does seem like im3w1l's statement of "These people are not arguing in good faith" is implying that the mechanisms of the free market and free association wouldn't work for marginalized ideas. Therefore, it's not unreasonable to assume that the alternate universe he's thinking of that would work would be a government law that prevents de-platforming.)
I agree with you, but your four levels really need to be refined by a fifth level, corporate power.
That is, power that is wielded over you by corporations even though they're not your employer because you essentially have to do business with them (Visa and MasterCard come to mind - they're essential infrastructure to the point where it really should just be a function of government, but isn't for historical reasons)
No need to jump to the idea of compulsion. If there were an established social norm that "platform platforms" should make an active attempt to be viewpoint-neutral, chances are that enough of them would voluntarily follow that norm to allow platforms like Gab to continue operating. If the norm isn't established, well, good luck passing a law to force anyone to follow it. Right now, the trend seems to be against such a norm.
Why should "platform platforms" establish a norm attempting to actively appear "viewpoint neutral"?
"come a little closer mouse so that I may better catch you and eat you..."
Why on earth should society bend over backwards to aid spoiled deliberate attention-seekers when there are 7 billion other people who are actually trying to resolve problems that need our actual attention.
These "malingerers" are using up valuable medical staff's time they could be spending upon actually ill patients!
I'm not sure what you mean about medical staff. I'm not suggesting that anyone bend over backwards to aid organizations like Gab, merely that they don't go out of their way to ban them merely because they don't like them. For example, in the case of Stripe and PayPal, there doesn't seem to be any suggestion that Gab falls under any of the normal categories that would cause a financial services platform to ban a merchant – e.g. suspicion of fraud or money laundering, high chargeback rates, high rates of fraud among people giving money, anything like that.
The issue isn't whether you in particular care or not.
The issue, as I'm reading the parent comment, is that it's beginning to appear that no one is willing to stand up and say "look, it's not that I support this or that view, it's just that, well, if people are going to spout nonsense it might as well be here where can all observe them", because doing so would be so against current social normal it would be irresponsible.
FWIW the paper mentions that Google's autonomous driving fleet currently has 55 cars, so I suspect the 100 fleet size was picked to reflect a significant improvement over a notable competitor in the field.
The article mentions Google's self-driving fleet size but I didn't notice other companies. I wonder what the fleet size is at other companies that are working on this, anyone know?
The reason I ask is that I'm curious if "making more cars" is really the bottleneck. It's totally possible that the Waymo team doesn't have the headcount to keep up with the data output from the existing 55 units, or the fleet logistics bandwidth to keep up more than 50 or 60 heavily custom self-driving vehicles. It may very reasonably be a staffing issue rather than a money one, and it's possible that even if Google bought the rest of the self driving industry they might not be able to maintain more than a couple hundred cars.
Disclaimer: I work for Google, but not on self driving cars. I actually know almost nothing about our self driving efforts, sorry.
