What is “fair evaluation”?


What is “fair evaluation”?

You want to be able to determine without experiencing it yourself
(saving time, trouble, cost, pain, suffering, etc.) the qualities of an
experience that are important to you.

An experience in the general sense means a service provided by a
person, device, institution, etc. Such as health care, insurance,
entertainment, dining.

Some aspect of experience is subjective and different individuals will
rate differently. Other aspects of experience such as price and time,
incident occurence (such as failure) could be thought of as objective,
but different individuals will rate differently due to memory recall
error, variation of experiences over time with the same service.

Statistical correctness is one aspect of fairness — that ratings are
not biased one way or other, or if they are, that bias can be noted so
the end-user can evaluate.

Coverage is another aspect — if you are rating x,y,z and leave
out a,b,c which are measurably better than x,y,z, you’ve limited
information. The decider may be unaware of a,b,c because no
information is provided about them. On the other hand, we can argue
that if a,b,c are worse than x,y,z, then the decider’s situation is
not any worse if no information is provided about a,b,c.
I.e. information regarding good experiences is better than information
bad experiences.

Perhaps a fair evaluation is one that tells the author’s biases and
experiences more verbally in addition to or instead of a number
ranking.

Here’s an example of bad experiences (and the requisite comparison of
good experience):

My personal experience with Mills-Peninsula medical group has been
inconsistent. For some services, I have received “marginally
acceptable” treatment — a physical that took heart and blood tests
and “come and see me again in N [N > 1] years”.

For other services, I have received questionable treatment. Surgery
without a second opinion is always risky, but then again, the risk is
due to the variance of doctor competence in diagnosis. A second
diagnosis is more like a comparison of (and search for) physician
competence rather than a “vote” on the recommended treatment. You
could say that some physicians are consistently more competent than
others, such that for certain good physicians you don’t need a second
opinion. I.e. successfully treated patients are the evidence — if
such information could ever be made publically searchable.

My wife’s experience with Mills-Peninsula ER team has been fairly poor
the one time she was taken to the ER after passing out after
having blood drawn. In Dr. Google’s estimation, she
experienced syncope.
Now that in itself is no reason to be alarmed about the quality of
health care at Mills Peninsula. However, when in the ER (which she
was for over 2 hours), no diagnostic tests other than listening to the
heart with a stethoscope were performed on her. However, 4 more vials
of blood were drawn to complete the blood test panel. The blood was
continued to be drawn from her while she was sitting up even though
Dr. Google recommends to
lie down for blood drawing

Here’s some symptoms and search-engine-driven diagnosis:
* Her blood pressure was 90 over 60 and later 107 over 70. The blood
pressure was taken from different arms. Dr. Google thinks this is
somewhat significant. The ER doctor didn’t ask about such in their
observations.
* In another
reference
, Dr. Google states that “Although the yield of
electrocardiography is low (5%), the test is risk free and relatively
inexpensive. … Electrocardiography is therefore recommended in
almost all patients with syncope”. However, no EKG was performed
during the 2+ hours in the ER. Such a test takes no more than 10
minutes of pasting on electrodes and letting the computer run.
Instead the ER folks persisted in taking the rest of the blood
samples.
* There is a family history of fainting in her immediate family.
Again, no such questions were asked although patients with
a suggestive history should get more testing.
.

You can’t expect ER (triage) doctors to know everything. But you
might reasonably ask how sick do you have to be to get attentive
treatment by a knowledgable doctor? i.e. the process of treatment by
Mills Peninsula is somewhat lacking in depth or conclusion.

Here’s an example of a good experience:

After over one year of wound care after surgical removal of a
retrorectal abscess with a wound that still wouldn’t heal and before
an upcoming third surgery with no planned presurgical tests or
communicated surgical plan, I got a “second opinion” at UCSF where I
was scanned with an MRI to determine that a tiny hole in rectum
(perhaps newly appeared) was causing the chronic infection preventing
the wound from healing. I had originally asked for an MRI two years
earlier before the initial surgery, but Mills Peninsula only had CT
scan facility. This in itself isn’t a bad mark against mills
peninsula, but reluctance to refer to a more capable facility is one
bad mark. Dr. Google thinks MRI is slightly
better than CT scans
.

When I was examined initially at UCSF, the first person I saw
wasn’t even a doctor, but a second year medical student. She
interviewed me for about 30 minutes to take a complete medical history
of the particular condition I was asking treatment for. This goes to
show that experience does not necessarily indicate quality, but
process is an indication of quality. i.e. inexperienced, but
following a good process (of detailed interview) produces a good
experience and I think a good result.

You can infer from these comparisons that I prefer UCSF over
Mills-Peninusla. I have hope for a good treatment result. I also
expect to have my wife see a cardiologist there about her fainting.

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