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Surgeons to be given bonuses for saving lives
telegraph.co.uk — NHS surgeons are to be paid bonuses based on the number of lives they save, in radical plans being drawn up by hospitals across Britain.
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- yayintertubes, on 07/20/2008, -11/+67..because saving a life isn't bonus enough? Another misguided scheme from the govt.
Take this bonus from the surgeons who already try pretty damn hard to save lives.. and give it to the underpaid nurses who work 70 hour weeks.- insomniac8400, on 07/21/2008, -6/+18They are trying to move to a system where you are paid for results. It's going to take time, but in the end you will have a better system.
It's better than the US system where you are paid full pay for a procedure no matter the results and while in a hospital you are gouged for everything such as a q-tip or an advil. Instead they give you the things you need to make you better and more comfortable in the hopes that you will get better faster and they will get paid more. It's kind of like the hospital investing in the patient for a larger return. In theory it will result in better health care for less of a price.- nreynolds, on 07/21/2008, -0/+6god forbid good doctors decide to take tough cases instead of just easy ones they know will get them paid...
edit: below, someone said it better - njcu, on 07/21/2008, -0/+2Well... I still think that not having to tell a family member that their loved one has died at your hands is bonus enough...
- nreynolds, on 07/21/2008, -0/+6god forbid good doctors decide to take tough cases instead of just easy ones they know will get them paid...
- Murdats, on 07/21/2008, -1/+4does it have to be the only reward?
- bwdd, on 07/21/2008, -12/+4Buried.
This is a good decision that encourages surgeons to work harder during surgery.- ejan, on 07/21/2008, -1/+12Surgeons are already paid to save lives, it's called a salary.
- Smegzor, on 07/21/2008, -3/+2And it has the potential to create a situation where a doctor deliberately harms a patient so they can save them.
- Amorn, on 07/21/2008, -0/+1Seeing as most of you are against this, I'd like to say something opposite just for argument sake.
If you think about most office workers (or most jobs nowadays), they are already paid to do their jobs but when they perform well above expectation (like increase sales etc.) they do get bonuses as rewards.
so i don't think it's a bad idea to have this as it might keep the surgeons standard up
- bitt3n, on 07/21/2008, -1/+10damn straight. those greedy leeches ought to survive off of their own sense of self satisfaction. what nerve!
it's almost as if people believe that doctors are motivated by money just like stockbrokers, and if their pay is not proportionate to their effort and their skill, we will end up with lower skilled doctors who don't give a damn. what a concept! - DanielQ, on 07/21/2008, -6/+3Logically, this is a good decision.
Think about it. They'll try harder and be more careful if there's a additional reward.
I'm not saying that's a good thing, but I am saying it's true.- toytoyota, on 07/21/2008, -0/+1you don't know anything about doctors.
- 19quest64, on 07/21/2008, -0/+0And clearly you don't know people. I know that there are plenty of people in the health care system that enter in order to have a fulfilling career where they can help people, but there are many that also want to have a steady job so that they can support a family or whatever else they want to spend their money on. And I'm sure someone will respond that those people don't have the right intentions, but then we would certainly have a huge shortage of doctors. I'm not saying that they have to be greedy, but good will is often times not the only motivation behind becoming a doctor. After spending 7 years at school and then several more being an intern, resident, and concentrating, I think it is safe to say that doctors deserve to be given a certain degree of security. While I guess I would rather not have it be made into a reward system for the reasons that they cite in the article, good doctors should be rewarded. I don't think saving lives should directly correlate into money. Rather, the doctors who take on the hard cases and tirelessly work to be the best that they can deserve to be given bonuses.
- insomniac8400, on 07/21/2008, -6/+18They are trying to move to a system where you are paid for results. It's going to take time, but in the end you will have a better system.
- MellerTime, on 07/20/2008, -14/+6Sounds like they're either trying to encourage good surgeons, rather than can crappy surgeons, or just put the good old capitalist system back into the health industry they took it out of...
Either way, I don't see it working. - cmakvaca, on 07/21/2008, -1/+67I don't know how patient assignments are handled, but this seems like a huge incentive to operate on only the easy cases -- save the quick lives to get the extra bucks, screw the harder cases.
I mean, I'd like to think that those who spend all that time to become a doctor have higher motivations, but apparently the NHS thinks differently.- dsmx, on 07/21/2008, -3/+6Unless of course this proposal has considered this and offers other incentives for higher risk patients. Since we haven't seen the details of this proposal and only what the telegraph is reporting to get sales of it's paper don't you think that it's a bit early to jump on them for it?
- cmakvaca, on 07/21/2008, -0/+9I didn't jump on anyone; I was just musing on a potential problem with this system. And even if they adjust the reward based on the presumed risk, the real issue (as mentioned elsewhere) isn't the amount of compensation, it's the fact that any is needed at all.
- insomniac8400, on 07/21/2008, -2/+5By law they cannot deny patients. It's a government system. And the end results are most likely based on a reasonable best case scenario. That is of course the flaw in the system. Who decides what a successful case is. In this case it will probably be a government board. But in the end they are shifting payment to be based on patient results instead of procedures done. If the hospital wants to make money they now have to make patients better. That incentifies paying more for specialists and top of the line equipment.
- arah91, on 07/21/2008, -0/+4I am not sure on the legal things ,but i am prety sure you can deny some patients. I remember this case a while back where this lawyer who was known to sue hospitals got rejected and tried suing them for that but lost.
- insomniac8400, on 07/21/2008, -0/+2It's the UK, not the US.
- Logrusmage, on 07/21/2008, -1/+7Surgeons already have that incentive. A hard patient that dies is a mark on their record. Marks on their records mean less patients and less pay. Surgeons are already quite motivated to avoid difficult surgeries.
- limoo, on 07/21/2008, -0/+0Depends on what kind of doctor you are. Doctors specializing in oncology (cancer) typically have an exceptionally poor survival rate. The few that have significant successes are paid VERY well though.
If it's difficult, and you're slightly better than the rest, that's good enough.
- limoo, on 07/21/2008, -0/+0Depends on what kind of doctor you are. Doctors specializing in oncology (cancer) typically have an exceptionally poor survival rate. The few that have significant successes are paid VERY well though.
- novemberwhiskey, on 07/21/2008, -0/+0It's not like doctors get to choose who they operate on if they work for a large healthcare provider like Kaiser or a hospital. You get a list of patients and what procedures they need, and they work out the schedules on a white board in the OR.
Private practitioners do choose whom they do and don't take on, but then again I don't imagine they would be part of this positive reinforcement program.
This program makes sense to me personally. How is this different from any other industry where people are rewarded for performing well. What is the problem here?
Doctors are paid whether they screw up or not. There are already disincentives from screwing up as others have mentioned, one being increased malpractice insurance rates.
This will only improve performance.
Why does everyone hate the program? None of your arguments make sense.
- dsmx, on 07/21/2008, -3/+6Unless of course this proposal has considered this and offers other incentives for higher risk patients. Since we haven't seen the details of this proposal and only what the telegraph is reporting to get sales of it's paper don't you think that it's a bit early to jump on them for it?
- netgeek06, on 07/21/2008, -9/+1The population would increase in Briton.
- Owwmykneecap, on 07/21/2008, -0/+2fern briton?
- Tryptomine, on 07/21/2008, -9/+2*Insert stupid joke about getting rich playing Trauma Center here.*
- farfromsubtl, on 07/21/2008, -1/+16Will this give them motivation to let someone nearer the brink of death in order to claim that the life was saved?
- Gazzali, on 07/21/2008, -1/+15Are they neglecting lives right now
- akpwnz, on 07/21/2008, -1/+5Some of them don't want to miss their golf appointments.
- wolvin, on 07/21/2008, -0/+2
I have a fear that if I put a donor sticker on my drivers license I may not get the most a doctor has to offer, for my parts may be worth more to them then my life.
I hope that I am wrong.
- Trav3133, on 07/21/2008, -0/+30Firefighters get bonus money for putting out a fire.
- Chicken, on 07/21/2008, -0/+5Is that true?
- KingGorilla, on 07/21/2008, -0/+5Does it work?
- heliox, on 07/21/2008, -2/+1All fires go out eventually.
Medical corollary: All bleeding stops eventually.- gcnaddict, on 07/21/2008, -2/+2Exception: All fires generally burn their respective buildings down when uncontrolled.
Medical corollary: Severe bleeding generally continues until the victim is dead. - heliox, on 07/21/2008, -0/+1I'll file @gcnaddict as....NO ***** !?!?!
- gcnaddict, on 07/21/2008, -2/+2Exception: All fires generally burn their respective buildings down when uncontrolled.
- CryTekEmployee, on 07/21/2008, -14/+3do they receive the same bonus for saving a cop killer?
- Skooma714, on 07/21/2008, -0/+6They should.
- Lionhart, on 07/21/2008, -1/+3You don't know what the hippocratic oath is do you?
- rudeboyskunk, on 07/21/2008, -7/+25I can only look across the pond at you Brits in frustration that yall at least have universal healthcare, while I have a card in my wallet that says "don't call 911 unless I'm dead, I don't have health insurance and can't afford the medical bills."
- TheTruthHurts, on 07/21/2008, -4/+10what if they let them hit a flat line, just to revive them?
- TheTruthHurts, on 07/21/2008, -2/+5dont hate the truth
- BananaGrabber, on 07/21/2008, -0/+12They're going to get bonus money for what they're already paid to do?
- RegalGSX, on 07/21/2008, -7/+0I heard they decide who gets the difficult cases with paper, rock, scissors.
- backgen, on 07/21/2008, -0/+3"It's about money! It's about money, Dick! It's about mon-ey, Dick! It's about money. " - Samuel Bicke
- dannyboy3020, on 07/21/2008, -0/+2Awesome movie!
- fluffyturtle, on 07/21/2008, -0/+7Hmm, I see what they are trying to do here but still, the enterprising doctors out there are only going to be interested in seeing patients that they have a chance at saving.
- gadgetgod, on 07/21/2008, -0/+3This is already a problem in the US, many surgeons just refuse to operate on tough cases to reduce their operating fatality count. Insurance companies, hospitals, and even patients use these statistics all the time, there just isn't much incentive to do a risky surgery. This UK plan can only make things worse.
- cambo125, on 07/21/2008, -9/+9*** NEW ACHEIVEMENT UNLOCKED ***
:Skilled Blades:
You have been awarded 10 gold- archer104, on 07/21/2008, -1/+8*grabs patient's penis*
*up, up, down, down, left, right, left, right, a, b, select, start*- septicmadman, on 07/21/2008, -1/+2Up, up, down, down, left, right, left, right, b, a, start.
- archer104, on 07/21/2008, -0/+6@septicmadman
no wonder they look at me funny - tehknotte, on 07/21/2008, -0/+1i am apalled
- archer104, on 07/21/2008, -1/+8*grabs patient's penis*
- BehnoodMarvazi, on 07/21/2008, -0/+35"Doctor, you saved my life!"
"I did it for the money."- RoflcopterFUEL, on 07/21/2008, -1/+8I'd do it for the lulz.
- Onechrisn, on 07/21/2008, -1/+7It's better than being paid to "keep costs down"
- b0rna, on 07/21/2008, -3/+3Are we gonna see cases where surgeons will start to avoid/divert or deny patients who they believe to be on the verge of death?
- seastobble, on 07/21/2008, -1/+4football players receive bonuses for touchdowns/sacks/interceptions
- ginogrz, on 07/21/2008, -0/+4When doctors lose a patient they not only have to break the news to a grieving family but they also lose potential money? Sounds like they'll be dying even younger.
- Triskozko, on 07/21/2008, -4/+2Proof that profit incentives are possible with socialized industries.
- AmericanGunner, on 07/21/2008, -0/+5so that means when i go to get my appendix removed, my doctor with his big fat bonus check for removing some cancerous tumor from someone else, isnt gonna give a damn about me.
- Dozernotz, on 07/21/2008, -0/+4Or worse, the best surgeons are now incented to transfer out of burn wards and emergency rooms in order to get jobs at "higher survival rate" locations.
- Tanktunker, on 07/21/2008, -2/+2No, AmericanGunner, they won't especially since your wound, appendicitis related or other, will probably be self inflicted, porribly from all those Guns.
- twiztidsinz, on 07/21/2008, -0/+2And I bet your wounds will "porribly" be related to all those Tanks.
- AmericanGunner, on 07/22/2008, -0/+1i knew it was a bad idea to put gunner in my name, because noone would understand what it really meant :(
- WTF69, on 07/21/2008, -9/+1Socialized Medicine i bet they really want people to die that means less people to more money to go around
- hazard99, on 07/21/2008, -0/+7I couldn't expect more from a post made by a person with the username "WTF69."
- 3toe, on 07/21/2008, -0/+17I sure hope my doctor doesn't need incentive to save my life.
- imightbewrong, on 07/21/2008, -0/+3incentives motivate excellence in every other area of the world why not in medicine???
- bxblox, on 07/21/2008, -0/+5He does, it's called paycheck.
- PhotonCannon, on 07/21/2008, -0/+2They have to come close to death before you can save their life though ; ).
- SilverBlade2k, on 07/21/2008, -0/+7Isn't saving lives the whole point of being a surgeon?? giving bonuses to surgeons for saving lives is like giving bonuses to mail men/mail women for delivering mail...
- imightbewrong, on 07/21/2008, -2/+3OHH NOOOO!!!! not incentives in Medicine!! what could be worse???
- mdisc, on 07/21/2008, -0/+5This is an insult to all the surgeons out there.
- Tanktunker, on 07/21/2008, -1/+4Yeah, how dare they not be perfect and share in the love of money that everyone is the world has?
- NiGHTSChao, on 07/21/2008, -0/+5Memories of Theme-Hospital :D
- 15charmaxwtf, on 07/21/2008, -1/+1I think that was a private hospital so you had profit-loss calculation :P
The NHS get their internal prices from the private sector interestingly enough.
- 15charmaxwtf, on 07/21/2008, -1/+1I think that was a private hospital so you had profit-loss calculation :P
- majordanger, on 07/21/2008, -0/+1"Hmmmm.... that looks pretty bad...No Bonus here......NEXT!"
- Lavarock, on 07/21/2008, -0/+3Does it really take encouragement? :(
- Tanktunker, on 07/21/2008, -0/+2Why, would you go work at McDonald's and give all your money to a homeless person each month to save his life?
- Cyberpoop, on 07/21/2008, -0/+3Despite the serious issues raised in the article, who is to say the patient would have died? Does the doctor himself make that judgment? Would I have died if I had driven to work yesterday? How about this: does death in a simple surgery due to complications represent a "lost premium"? What if problematic parties believe that "prayer" or "divine intervention" was the cause of the patient's recovery? Who is to say what the doctor did was, in fact, the cause of the patient's recovery?
This sounds like a poorly thought out issue, at best.- kholburn, on 07/21/2008, -0/+2Also how long do they wait? If the patient lives for say a month, then dies, do they take the bonus back?
- Ruiner, on 07/21/2008, -0/+1:If problematic parties believe that "prayer" or "divine intervention" was the cause of the patient's recovery?"
Then their idiots
- xDynaBlade, on 07/21/2008, -0/+5"Thanks for saving my life, doctor!"
"Don't thank me, thank the new yacht I was bribed with!" - bonds, on 07/21/2008, -0/+1So what, now you'll have surgeons fighting over the more immediately threatening conditions? On their downtime they'll be forced to operate on the "undesirables." Yeah, I GUESS I can remove that tumor, but where's the motivation? It's not like you're gonna die today.
- HumanRecalled, on 07/21/2008, -0/+2***** great !~~
If i die i'm a statistic.........
If i live i'm a Quota ! .......
- Lateralis1, on 07/21/2008, -0/+2So they'll avoid the more complicated surgeries since the chance of a bonus is less. If only the surgeons were in it for saving lives rather than money. They get enough money as it is at the moment, with doctors they're among the highest paid workers in the UK with salaries in excess of £100k. What's the point of giving them bonuses for something they're already paid to do, well.
- northerngeek, on 07/21/2008, -0/+2Speaking as a Medical Student who will very soon be employed as a Doctor in the NHS (well, F1 at first, then F2 then a full Consultant) I find this appaulling, it's terrible to think that this is how our government handles health care and this goes against parts of the Geneva oath I took when I started, and the four principles of medicine.
We are guided by a moral compass towards doing what is BEST for the patient, and saving a life does not always equal the best solution. The third principle of medicine (non-malificence) says that we should avoid causing extra pain, take a patient I saw last week for instance-
1. He was demented and had a mini-mental state exam result of 4/30.... 10 is severe dementia, 4 is abysmal
2. He is depressed because his wife died five years ago
3. He can no longer recognise family members, remember his name, or tell what time of day it is (even simple judgements like day vs night)
4. He lives in constant frustration and misery due to these limitations of his brain
5. He is diabetic and due to not being able to control his diabetes he has frequent hypoglycaemic attacks which cause him to have more medical problems, wake up in even more unfamiliar surrounding etc
Doctors are trying to IMPROVE his life in every way possible, even though the drugs we give this man will inevitably shorten his life span they enable him to function better coginitively, even though sending him home when he is stable may lead to problems down the road and may not save his life he has the rights of patient autonomy (from the four prinicples AND the human rights act) and benificene (from the fou principles) so we decide to do what he wants and what is best for him- this man who fears being in hospital and just wants to stay home where he recognises a few objects.
Saving a life is not the ultimate goal of medicine, and doing so does not make any one of us "better at our jobs", it is attrocious what this government tries to do in order to make good publicity- laypersons will claim this will improve healthcare and that it's a good idea but ultimately it causes more ethical and legal problems and thus most likely poorer health systems- the NHS should be killed before it's too late.
Also to note:
As a Doctor each person here has my word that if I have any say in it they will never be avoided due to risk and if there is word of such activty it is taken more seriously now than ever - the selfish healthworkers who are caught doing any such activity are disciplined. This entire system in the past 10 years of marking your doctor has caused such issues to arise already- another problem caused by this quick-fix publicity obsessed government in charge- all the while people think this will help them reveive better care. - kevyn, on 07/21/2008, -0/+1so the people who are on their last legs have no chance now... surgeons will want to see people who stand a better chance of life, so they can get the bonus easier
- raf797, on 07/21/2008, -0/+1i can't wait until we start sanctioning medical professionals for being unable to save a life. ten bucks says those fines go to the military.
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