Medicine

If I were to implement a public health service for a large population using limited resources I would have a number of concerns.  One of these concerns would be about the design of the organization.  Here are a few thoughts about this aspect of the task.

Medical professionals are differently experienced and differently skilled. Experience is gained over time, but some aspects of skill are dispositional or practically immutable.  By this I mean that with lots of resource one might shift some individuals into a more highly skilled bracket, but this is impractical. Moreover, some individual differences across skills are just that - differences between individuals that are fixed strategies.  Personality traits belong to this set.

A principal problem to solve is how to decide on access to medical resource. For now, I am assuming that all types of medical problems are of equal importance. This is a simplification.  Under this assumption some individuals may well need treatment more than others, because their individual token expressions of particular problems can be more or less extreme.  There is variation - or variance - in population level suffering.

A basic moral heuristic would be to apply resource to those suffering the most. This requires assessment and medical assessments are themselves resources that can be expensive.  A good solution to this is to develop simple check-list rules for early diagnoses - something that Gerd Gigerenzer has commented on in the past.  This helps to deal with uncertainty and also deals with allocation.

Another, complementary solution would be to hierarchically organize medical staff in terms of their skill level.  The least skilled individuals would be your initial point of contact with the public health service, the most skilled your last, all being well.

Why?

This structure provides a set of filters.  Under limited resource the default action should be to find ways to reject possible patients from the system before spending too much time and money on them.  One way to do this is to reduce the amount of knowledge accessible during initial assessments. The less a medical professional knows the fewer options they will be able to consider and, perhaps with a dose of professional pride, the greater their certainty will be.

There is another aspect to this filtering model.  Experience and skill does not just apply to medical knowledge, but also to the understanding of patient concerns.  Reduced empathy will be a useful filter, as it will hinder a possible instinct to give patients the benefit of any doubts.  Being blind to various emergent patient registers and ritualized pragmatic inference will also help.  In short, socially crass medical professionals simply looking for evidence to support their limited knowledge and hypotheses will remove a significant percentage of people at the beginning of the process.  This will save money and time.

I do wonder whether someone in Whitehall, at some point in the past, has thought all of this through...  But that is a form of conspiracy theory and, as I suspect with most conspiracy theories, what I have noted here is an emergent set of stable strategies that are a consequence of the constraints imposed by the ongoing economic game and key aspects of human nature.

[There is a possible study lurking: one might look to survey empathy and various other key individual differences across grades of medical professional and their point of contact with patients during the life-cycle of their engagement with public health. The more senior the medic, and the later in the process they meet the patient, then the more empathic and smart they should be.  This is a little messy, but I think it is something to ponder.]