There's a concept in maintenance theory that you should be careful not to do too much maintenance to a thing because what can happen is a technician could take something that works and make it into something that doesn't work.
In such a way, you can have two devices: one that is diligently maintained and another that is completely ignored, but the one that is ignored is more reliable.
This reliability centered maintenance ideology came about to improve the reliability of airplanes, and it worked. New airplanes ended up having significantly less maintenance, but were significantly more reliable.
I think the same concept can be applied to medicine. We see a lot of procedures done, and in a lot of cases the outcomes of doing something are worse than doing nothing. The problem is that leaving things alone to get a better outcome is unintuitive, and feels like we're just intentionally letting people get hurt.
In some ways it's like the trolley car problem. Maybe there's five people on the track if you do nothing and six of you pull the handle, but the six are invisible behind a curtain and you need to be told that researchers discovered six behind the curtain. By the numbers more people will die if you pull the handle, but you can see the people who will die if you do nothing and you can't immediately see the ones who will die if you do something.
In such a way, you can have two devices: one that is diligently maintained and another that is completely ignored, but the one that is ignored is more reliable.
This reliability centered maintenance ideology came about to improve the reliability of airplanes, and it worked. New airplanes ended up having significantly less maintenance, but were significantly more reliable.
I think the same concept can be applied to medicine. We see a lot of procedures done, and in a lot of cases the outcomes of doing something are worse than doing nothing. The problem is that leaving things alone to get a better outcome is unintuitive, and feels like we're just intentionally letting people get hurt.
In some ways it's like the trolley car problem. Maybe there's five people on the track if you do nothing and six of you pull the handle, but the six are invisible behind a curtain and you need to be told that researchers discovered six behind the curtain. By the numbers more people will die if you pull the handle, but you can see the people who will die if you do nothing and you can't immediately see the ones who will die if you do something.
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