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Old 05-29-2013, 02:28 PM   #61
acrosome
 
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Mathulhu View Post
Many skills can be augmented by Techniques, we see this predominantly with combat skills. There is no reason this cannot be extended to specific applications of non combat skills There are some Techniques that specifically reduce predictable penalties, are there any penalties that seem suitable for Medical Techniques?

Example
Chest Surgery, Surgery/A
Default Surgery -3, cannot exceed Surgery
Yes, buying off the -3 for chest or head surgery are obvious candidates, I'd say. Most of the rest of the penalties are for equipment or time spent or whatever.

One technique that I'd particularly like would be one that lets you buy off part of the default penalty when you default from Physician to Surgeon to stabilize a mortal wound. This would represent a non-surgeon having taken the Advanced Trauma Life Support (ATLS) course, and would obviate the ridiculousness of giving an ER doc or Special Forces medic full-on Surgery skill. (Which would give him far too decent odds to remove that gallbladder, as I have mentioned ad nauseum.)

Similarly, I'd like to see a technique to allow one to buy off at least part of the default penalties when one defaults from Physician to Surgeon to set a bone (as in Low-Tech). This is also to model those ER docs and the more highly-capable medics.

I'm sure that I could come up with others.
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Old 05-29-2013, 02:28 PM   #62
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Kromm View Post
You can see things that way, but I don't. Few tasks truly don't allow retries that waste only time.
Failed surgeries lead to significant complications (including malpractice lawsuits). Failed civil-engineering rolls lead to building collapses. But that isn't really the issue I was raising.

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Even "high-risk" ones are like that . . . the risk develops if nobody retries, not the instant someone fails at all. I'd use accumulated odds of success for this. At skill 12, say, two tries are like 14, three are like 16. I'd only go with those as baselines for tasks at which failure is tantamount to critical failure, which is a rare set of tasks indeed. I really don't buy into the belief that we have so much intellectual and professional capital that we're expecting holes in one from just about everybody. That doesn't match reality as I've experienced it anywhere I've lived.
The issue is that you have to define holes-in-one. There is no reason to say "expecting to succeed at a TDM=0 task is a hole-in-one". If it is a hole-in-one for one cohort, it isn't a hole-in-one for a different cohort. A run-of-the-mill surgeon may be expected to face many "tricky but routine (top end what he should face rather than kicking upstairs)" surgeries a year. Neither he, nor his hospital, can afford him failing on 15s.

Does this mean both high skills and low TDMs for modern medical care? Yes. But that doesn't pose any problems in GURPS. In fact, it removes problems: as a "universal" game, you want to be able to distinguish between societies where 10 years of aggregate medical training is standard from societies where 4 years of aggregate medical training is standard.
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Old 05-29-2013, 02:32 PM   #63
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Rocket Man View Post

Agreed. If anything, 12 is sometimes generous ... ;-)
Yeah, I think so. Considering just a few examples from my life:

I first presented symptoms of cholecystitis in 1987. Two different family doctors failed to diagnose it. I moved to a different city where at least three clinic physicians failed. Then I got a new GP who saw me annually for five years and failed. Then I went to an ER with an attack and they failed. My second visit in 2007 netted me the sonogram that finally revealed the problem.

I had a tax problem that took close to 10 filings to resolve, with the people at the government end consistently arriving at different, wrong conclusions and being unable to advise me on what forms to use.

I've accidentally carried things through airports that . . . well, I probably should not have. Only one security agent ever caught that.

A man came to fix our kitchen sink recently. He was back twice because the first two times failed.

And so on. The first was potentially life-threatening (the eventual surgery lasted six times as long as planned, and I almost lost important body parts). The second was certainly livelihood-threatening (the specter of legal consequences was looming large). The third could've been life-threatening to others had I been a terrorist. The last could have destroyed a lot of my property. However, there were retries in some sense in each case.

Really, unless you disarm IEDs or reassemble people's skulls in the field after one goes off, I have doubts that skill 13+ is necessary.
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Old 05-29-2013, 02:36 PM   #64
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Kraydak View Post
A run-of-the-mill surgeon may be expected to face many "tricky but routine (top end what he should face rather than kicking upstairs)" surgeries a year. Neither he, nor his hospital, can afford him failing on 15s.
Meh, having read more into all of the equipment, time spent, difficulty, etc., bonuses involved... 14 seems reasonable for most specialist docs.

Wow, there are a lot of equipment bonuses for surgeons...

I mean, doing an average difficulty surgery (and as we have discovered, most routine surgeries are some degree of favorable or easy) in a modern TL8 OR nets you +4, so with skill-14 that's an effective 18. That ain't failing on 15s...

And a failure isn't necessarily death- it's more likely a lesser complication, like a minor wound infection, cosmetically disappointing scar, prolonged postop ileus, etc. And, as much fun as it is to complain about it, the truth is that most people who have minor complications understand and don't sue you. Granted, for some surgical procedures even a 5% complication rate would be high, but you can't escape that due to the basic game mechanics. That's just how it is.

And to borrow your metaphor- a failed civil engineering roll doesn't necessarily lead to a building collapse. It might just lead to settling and a cracked foundation, necessitating the expense of correcting it. Or a on-ramp that turns too tightly, leading to traffic jams as drivers slow down. Or a bunker that only has 75% of the DR you had planned, due to poorly-cured concrete. Etc. Critical failures would be more serious in both cases, of course.

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Originally Posted by Kromm View Post
I first presented symptoms of cholecystitis in 1987. Two different family doctors failed to diagnose it. I moved to a different city where at least three clinic physicians failed. Then I got a new GP who saw me annually for five years and failed. Then I went to an ER with an attack and they failed. My second visit in 2007 netted me the sonogram that finally revealed the problem.
Well, this was clearly your fault. It's always annoying when patients don't read the textbooks. :)

But seriously- this is a very common scenario. I have all sorts of people sent to me who have had "dyspepsia" for a decade or two, and then finally got a sonogram when they had a bad episode that sent them to the ER. Can you imagine how many patients must present to primary care complaining of a tummy ache and nausea, but with normal labs? Should they all get a $200 sonogram? But, yes, if that many folk were actively working on the issue for that long then someone was failing somewhere. But, being Canada, it might have been a system failure not a doc failure. As you mentioned, in tax supported healthcare sometimes tests get put off if you don't meet "criteria," and in the 80s sonograms weren't as fast/easy/cheap/universally available as they are now. But OTOH a Tylenol doesn't cost $20. Pick your poison.

More seriously- you're also making the error of normalizing yourself. You may be an outlier. You should be lumped with all of the other cholecystitis cases.

P.S.- your cholecystectomy definitely wasn't very easy... :)

It's bedtime here. Later.

Last edited by acrosome; 05-29-2013 at 03:07 PM.
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Old 05-29-2013, 02:57 PM   #65
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Kromm View Post
...
I first presented symptoms of cholecystitis in 1987. Two different family doctors failed to diagnose it. I moved to a different city where at least three clinic physicians failed. Then I got a new GP who saw me annually for five years and failed. Then I went to an ER with an attack and they failed. My second visit in 2007 netted me the sonogram that finally revealed the problem.

I had a tax problem that took close to 10 filings to resolve, with the people at the government end consistently arriving at different, wrong conclusions and being unable to advise me on what forms to use....
Thank you for making my point for me. The people in question weren't incompetent. They complete nearly every task in front of them successfully. For your medical complaint, their final effective score would have been somewhere around the 7-8 range. That means that your complaint has a TDM about 8 points worse than already slightly tricky cases. While *most* patients are easy, doctors (and tax officials) face huge TDM penalties on a *routine basis*, and are expected to cope. Once you accept that even non-combat TDMs can easily be very negative, any desire to pin skills levels low should evaporate.

Remember, you *can* make the numbers work for professional=12 *only* if the actual profession level of competence varies only slightly (which won't be the case in, for example an IW campaign), and only if you ignore the amount of education that goes into a lot of jobs. On the other hand, you can also make the numbers work for much higher skill levels, in which case you recover GURPS-Universality, and CPs spent start to actually compare reasonably with the education investment.

Why would you possibly want to go with the former rather than the latter?
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Old 05-29-2013, 03:21 PM   #66
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Default Re: What level Physician skill should an MD have?

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I just don't see any proof that they're better at being physicians than most mechanics are at being mechanics or most nannies are at being nannies, or that they're smarter and more talented than the next person.
Except that mechanics and nannies have one Average skill each, and physicians have two Hard skills. So the physicians have clearly invested more points somewhere.
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Old 05-29-2013, 05:14 PM   #67
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Default Re: What level Physician skill should an MD have?

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Originally Posted by acrosome View Post
There is no such specialty as a "diagnostician." Every physician is a diagnostician, with few possible exceptions. (Radiation oncologists?) Trust me, Dr. House is an internist- albeit one who has carved himself a very specific niche in his institution. And you'll note that he also treats his patients- or at least the ones that are treatable. That's Physician skill.
If there isn't such a specialty there should be.

My wife has been mistreated by the US medical profession for the last decade. She has, supposedly, Chronic Ideopathic Intestinal Psuedo-Obstruction. I quit work about then to be her full time caregiver.

She goes in for hernia surgery at one of the best hospitals in the world for her problem, The Cleveland Clinic. She goes there to be operated on about twice a year. She has some major nerve problems resulting in something like cauda equine syndrome (sp?), but the docs in our home town refused to diagnose her as such nor to have checked surgically, so she has had a foley for the past four or five years.

I would give a lot for a specialist in diagnosis who could look at her case with a fresh head and actually figure out what is wrong. As it is, because medicine is so compartmentalized she's in a wheelchair (bilateral patellar tendon rupture due to the antibiotics prescribed by her former family care doctor).

So for those rare cases which are more difficult than a cold, somebody who can give the difficult cases a look would be wonderful!
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Old 05-29-2013, 07:10 PM   #68
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Default Re: What level Physician skill should an MD have?

Fresh eyes sometimes means not telling a new doctor what your previous one decided. Confirmation bias is insidious.
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Old 05-29-2013, 09:39 PM   #69
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Default Re: What level Physician skill should an MD have?

Your doctors are rushing. In Ontario to bill for an FP/GP consultation one must spend at least 50 minutes with the patient, 75 to bill for a comprehensive consultation.

http://www.health.gov.on.ca/english/...v/a_consul.pdf
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Old 05-30-2013, 04:52 AM   #70
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Default Re: What level Physician skill should an MD have?

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Agreed. If anything, 12 is sometimes generous ... ;-)
Yes. Just remember that all things being equal, your doctor has a 50% chance of being in the lower half of his class. :(
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