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# Death, Raising the Bar vs Maximising Outcomes, Big MedTech's Strategy
- URL: https://marginsofcare.com/death-raising-the-bar-vs-maximising-outcomes-big-medtechs-strategy/
- Published: 2026-09-07T18:53:50.000Z
- Updated: 2026-09-07T18:53:50.000Z
- Author: Eva Worst

At my husband’s insistence we started watching [Scrubs](https://www.imdb.com/title/tt0285403/episodes/). If you are looking for something delightfully packed with original humour, I highly recommend it! It’s also a great example of the moat of human creativity against AI - no way an AI could have made those jokes!

In one of the episodes, a patient dies and J.D. is really struggling through that. So his mentor Dr. Cox tells him: 

> "You are afraid of death, and you can't be. You're in medicine, you gotta accept the fact that everything we do here—everything—is a stall. We're just trying to keep the game going; that's it. But, ultimately, it always ends up the same way.”

I thought this was profound und very reassuring: the natural way of things is the standard, not whether we succeeded in reaching the raised bar. Sure, we strive to achieve the maximum - and not just in healthcare - but we should also put this effort in the right perspective and shouldn’t beat ourselves up if we didn’t reach that high mark (tell this to every perfectionist). It’s not just about control; it’s about knowing that the norm is 1+1 equals 2 and not 3 as we might wish, work and hope for. When it comes to death, we do live in the golden age and it’s so easy to forget that this is very much unnatural.

### The Quality Bar

“First do no harm” addresses very much the opposite direction: if the bar is 0, then our goal - no, duty! - is to ensure it does not shift to minus. This is why there is so much regulation, testing and oversight in healthcare - a clinical intervention should strive to have a net positive impact at best and net neutral at worst. (Here the net part is the tricky one - [where do you draw the line](https://marginsofcare.com/agentic-ai-in-medicine/)? What’s the proportion of good vs bad that makes for an acceptable net positive?) 

Indeed, it is why as a patient we are reassured when we get assigned to the senior physician and not the medical student, and why we’d like to have our blood collected with a clean syringe and not a leech. Quality matters, even if we can’t always measure it. And while outcome maximisation is a great strategy, it’s not a measuring stick.

### Top Line vs Bottom Line

This is where the current AI discussion hits a wall. Innovators often argue about the potential of maximising clinical outcome with AI and how regulatory requirements are preventing them to do that. At the same time, practitioners and patients report how AI is helping them bridge the gap from bad to good, and from good to great, rising the bar for how we provide healthcare. In both cases the healthcare reality is improved, but at the different ends of the spectrum.

There is value to be extracted in each case, but perhaps just like in tennis, most points we win are actually the mistakes the opponent makes. A point is a point, and a dollar is a dollar, so that instead of developing a fancy new technique, we may be better off first eliminating those stupid mistakes in the first place. This is surely not as sexy as finding a cure for a new disease - and I surely don’t mean to discredit the immense value and potential doing that - but it may be the most obvious high-gain place to start fixing.

### Big MedTech

Of course, that doesn’t make it easy. It if were, we wouldn’t be talking about it. The fact is, any workflow change requires the buy-in from multiple stakeholders within a clinic, and well - that’s tough to do for boring IT improvements. Maybe then, to get a foot in the door, a company should get individual departments on the hook with a fancy diagnostic, only to later pivot to fixing the workflow. This is exactly what has been happening with Big MedTech and other diagnostic companies, which are [increasingly focusing on owning the workflow](https://marginsofcare.com/the-ways-of-the-workflow/) instead of simply being the new diagnostic gold standard. It remains to be seen how well this strategy works long-term with AI now [entering the HIS](https://marginsofcare.com/chatgpt-connects-to-ehr-epics-ai-game/) directly.