Medical malpractice

8 plus 7 equals 15, carry one, er...

I was listening to a discussion with two medical practitioners on the radio today while driving home from work. I’ll remove the context of the diseases they were debating as the point I want to make is not specifically to do with this aspect and dropping it removes a degree of emotion from the conversation. The bone of contention between the two antagonists was the mortality rate from a certain set of diseases in the UK and whether this was to do with the competency of general practitioners (GPs, or “family doctors” for any US readers) and the diagnostic procedures they use, or to do with some other factor.

In defending her colleagues from the accusations of the first interviewee, the general practitioner said that the rate of mortality for sufferers of these diseases in other European countries (she specifically cited Belgium and France) was greater than in the UK. I should probably pause at this point to note that this comment seemed the complete opposite of every other European health survey I have read in recent years, but we will let that pass and instead focus on the second part of her argument. This was that that better diagnoses would be made if the UK hired more doctors (like her), thereby allowing them to spend more time with each patient. She backed up this assertion by then saying that France has many more doctors per 1,000 people than the UK (the figures I found were 3.7 per 1,000 for France and 2.2 per 1,000 for the UK; these were totally different to the figures she quoted, but again I’ll let that pass as she did seem to at least have the relation between the figures in each country the right way round this time).

What the GP seemed to be saying is summarised in the following chart:

Vive la difference

I have no background in medicine, but to me the lady in question made the opposite point to the one she seemed to want to. If there are fewer doctors per capita in the UK than in France, but UK mortality rates are better, it might be more plausible to argue that less doctors implies better survival rates; this is what the above chart suggests. Of course this assertion is open to challenge and – as with most statistical phenomena – there are undoubtedly many other factors. There is also of course the old chestnut of correlation not implying causality (not that the above chart even establishes correlation). However, at the very least, the “facts” as presented did not seem to be a prima facie case for hiring more UK doctors.

Sadly for both the GP in question and for inhabitants of the UK, I think that the actual graph is more like:

This exhibit could perhaps suggest that the second doctor had a potential point, but such simplistic observations, much as we may love to make them, do not always stand up to rigorous statistical analysis. Statistical findings can be as counter-intuitive as many other mathematical results.

Speaking of statistics, when challenged on whether she had the relative mortality rates for France and the UK the right way round, the same GP said, “well you can prove anything with statistics.” We hear this phrase so often that I guess many of us come to believe it. In fact it might be more accurate to say, “selection bias is all pervasive”, or perhaps even “innumeracy will generally lead to erroneous conclusions being drawn.”

When physicians are happy to appear on national radio and exhibit what is at best a tenuous grasp of figures, one can but wonder about the risk of numerically-based medical decisions sometimes going awry. With doctors also increasingly involved in public affairs (either as expert advisers or – in the UK at least – often as members of parliament), perhaps these worries should also be extended into areas of policy making.

Even more fundamentally (but then as an ex-Mathematician I would say this), perhaps the UK needs to reassess how it teaches mathematics. Also maybe UK medical schools need to examine numeric proficiency again just before students graduate as well as many years earlier when candidates apply; just in case something in the process of producing new doctors has squeezed their previous mathematical ability out of them.

Before I begin to be seen as an opponent of the medical profession, I should close by asking a couple of questions that are perhaps closer to home for some readers. How many of the business decisions that are taken using information lovingly crafted by information professionals such as you and me are marred by an incomplete understanding of numbers on the part of [hopefully] a small subsection of users? As IT professionals, what should we be doing to minimise the likelihood of such an occurrence in our organisations?

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