The patient's embarassment just starts the process. After that and a meeting with a lawyer, the embarrassment is secondary to the amount of money up for grabs.
Addiction usually isn't cured. Much like cancer, it just sort of isn't a major issue after a while, but it's still there, and under the right set of circumstances can come back at any time...
Who the hell cares whether the bad doctor is identified and dealt with after he screws up a statistically significant number of times? What is important is whether he has screwed up in MY case.
No, that's what's important to you.
For classifying a doctor as "bad" (which was the point in question), a statistically-significant number of bad cases must occur. Visiting a doctor is not a guarantee that you'll live healthy forever. It's a consultation of the doctor's skill and expertise. As you said, doctors are just people, who can and do make mistakes. I'm terribly sorry if your particular case got screwed up, but that doesn't give you a right to go chasing after an honest mistake.
There are plenty of laws on the books to protect doctors and other health care professionals from the consequences of their honest mistakes--- that's what "best practice" training and following standard of care protocols are all about.
Sadly, that's simply not true. The laws do not protect doctors from honest mistakes, because ther's always other doctors who will say that everything's obvious.
Dust on x-ray exposures can show up as a lighter-than-usual spot. A metal filing would be pure white, but enough of anything can make a "tiny white dot".
Interestingly enough, about the time this story happened, I worked in a photo lab. Processing errors aren't just common, but expected. To process about 5000 prints a day, we had a team of 15 artists whose sole job was to find the errors in each picture and paint over them using a similar color. The lab at the time used a light process for printing, so there were errors (dust, fingerprints, and otherwise) that could appear on both the negatives and the prints. Most errors show up as a "tiny white dot" on the final print.
If someone is sueing a hospital because their medical records contain an episode of explosive diarreha in a hospital elevator and winning, you should maybe find a lawyer worth a lick of salt.
So let's suppose the patient sees the note about the incident, and takes offense. They sue the hospital for libel, claiming that the incident was recorded for the amusement of doctors at the patient's expense. One defense would be to show a medical reason making the note necessary - but if it was isolated with no known cause, that may not be possible. Another defense is to point out how common messy incidents are in a hospital, but that'll skewer the PR department's campaign saying how clean the hospital is (which it was again an hour after the incident). Regardless of how skilled the hospital's lawyers are, an offended patient with a grudge will be expensive to deal with.
Because of this, we wouldn't leave a remark like "Patient questions everything, be sure to only see patient when management is available" because that sounds absurd, and yeah if that comes out during a case where say, the patient wasn't seen quickly in an emergency situation resulting in injury or death, well, too bad.
One comment I saw in actual records: "Patient has dementia and insists on seeing Dr. Johnson, who retired in 1985. Dr. Williams looks similar enough that he can tell her that whoever's on call is 'a good doctor'."
Sure, it's sneaky and underhanded, and a skilled lawyer can turn it into a case where the hospital was intentionally deceiving a patient to mislead them into trusting someone... but it's ultimately what's necessary to get anything done.
Inacuracies dont matter? I'd love to know where you work, so I can avoid whatever idiots you work with.
I worked with data from one of the largest hospital networks in the United States. Good luck avoiding them. The problem is that they've switched record systems a half-dozen times in the last two decades, and some records are known to be wrong. Whe processing their data, I was explicitly told to ignore anything older than 6 years, because anything prior to that was from the last system, and would likely have invalid data. I did still encounter some things like an ingrown toenail on someone's face (wrong ICD9 codes), a patient over 200 years old (invalid dates being sent by a third-party system), and one patient with a hundred different names (but the same social security number: 000-00-0000).
I think a patient has a right to understand everything regarding their treatment. Just dumping raw medical records on them won't do that, though.
(speaking as a programmer now, regardless of my medical-industry history)
Every time someone tells me they "need" to double-check my highly-specialized knowledge to have confidence in my work, I tell them (usually politely) to fuck off. It's Invariably, those that do their own investigations come back with questions that I don't want to try to answer, and they'll never accept "I felt like it" as a valid reason. No, I don't really have an objective reason to prefer Perl over Python for this menial little cron job, but my decades of experience make me like Perl a bit more for tasks like this, while your 10 minutes on Google make you think Python is the language of the gods.
Yeah, one time a thousand there's some oversight that a review will catch. That doesn't justify the time and effort to deal with the self-educated geniuses who aren't qualified to ask their own questions, let alone seek their own answers.
That's a problem with the legal system, not the medical system.
Unless the "tiny white dot" is more than a few millimeters in diameter, it could just be a dust speck or processing error on the x-ray film, which can usually be safely ignored. Of course, in hindsight it's much easier to see that the dot is cancerous. With that liitle detail out of the way, it's easy to blame the doctors, and it's easy to parade the evidence in front of a jury who know nothing about photography or medicine, and it's easy to get a huge judgement out of a judge who wants to be "tough on big corporations" and "sympathetic the the innocent widow". Regardless of the case's merit, paying out a "large wrongful death settlement" is just statistically the cheaper option.
Your friend didn't need full access to records to prevent his death. He needed a second opinion, which he probably should have gotten before eating became impossible. His second doctor could request the records, and get them, and see the mysterious error that happens twice.
There's also the flip side, though, that if a doctor isn't very good, they're going to be easy to catch out with some basic cross checking of their diagnosis.
That's why hospitals (and other medical groups) do reviews, to find those bad doctors by the several screwed-up cases in a random sample. The patient doesn't need to be the one doing their own research, regardless of what misguided bit of awareness they think they'll get.
I worked in the medical industry, handling medical data. This is exactly what they don't want you to see.
Patient records are riddled with notes intended only for internal use. To a doctor, it's nothing special that you suffered explosive diarrhea in the middle of the hospital elevator - that happens once a week, and it could be medically important. To a patient, that's a terribly embarrassing episode that shouldn't be in records, and even considering storing such a thing is grounds for a lawsuit. That lawsuit would be argued in front of people outside a hospital setting, who would be biased in favor of the patient. In front of a hospital ethics board, tthe incident is just another bad day for the janitor.
To use the traditional car analogy, hospitals are much like body shops. You really don't need to know every point that was inspected, every noise source that was considered, or the internal notes from the mechanic about how you question every repair so he should make sure to only finish work on days the manager's available. Most of the information is obvious to someone knowledgable, useless to someone who knows nothing, and ammunition for someone who knows just enough to be dangerous.
On the other hand, what does the patient need to see? Doctors know that old records are unreliable, so history beyond a few years old doesn't really matter if it's slightly inaccurate. Current treatment is usually handled by a single primary doctor, who knows what makes sense for a particular patient, so inaccuracies there don't matter either.
Sure, it's information about the patient, but giving out all the details just causes more trouble than good.
Jokes aside, the "getting justice" days are unfortunately accompanied by the "no idea what's right" days and the "just ruined someone's life" days. I much prefer to work on programming low-impact applications, where I can utterly botch a routine or two and the worst effect is a few new tickets.
I don't think those examples fit quite as smoothly as a lawyer does, but yes, that's the point. Study across a wide range of subjects can contribute indirectly to an otherwise-unrelated field, because there are isomorphic problems whose solutions will rely on similar techniques. Getting back on the topic of TFA, I think that programming can indeed help make better doctors, simply by offering a different perspective on some problems.
Beyond programming and law, I also enjoy live sound reinforcement, robotics, dance, architecture, and I've recently developed a taste for cooking. I don't know yet how those will all benefit me, but it's likely that they will.
I once studied law, intending to become a lawyer, then realized that would make me a lawyer, and I wanted a career where I could sleep at night. So I became a programmer, and I've spent many nights in front of a glowing terminal... but I digress.
I feel that learning a bit of law has actually helped my programming. Lawyers spend much of their time picking which rules best apply to a particular circumstance, while programmers pick which algorithms are best suited to a task. Lawyers then submit their case to a judge for consideration, while the programmers simply run the compiler. Lawyers work around contract loopholes by covering them with other clauses, and programmers work around (some) bugs by covering them with better-written wrappers.
Many problem-solving disciplines use similar skills. Programming, being nearly pure logic mixed with a bit of language, can contribute marginally to a wide variety of other fields, including medicine, law, or even politics. It is important, however, to not become too obsessed with the programming approach. A perfectly-written contract that programmatically describes an agreement can still be thrown out by a judge if he thinks it isn't fair.
Professional gamers are interesting to watch, because they're on a different level than the spectators. Their tactics and speed are impressive, pushing the limits of human ability, making a competitive video game into a sporting event.
Random passers-by at an amusement park aren't quite so interesting. As I understand it, the first few weeks of shows had a pre-show try-out to assert that guests had some modicum of skill, but by the end of the season anyone who could bash on an instrument was considered qualified to go on stage. In the interest of keeping guests happy, the actors had to treat the guests like they were great musicians, no matter how badly they actually played.
Documentation should be the absolute authority on every detail of a system's operation. It should be the reference material for experts. On the other hand, people who aren't experts don't know the available options, and often don't really know the terms to look for in the detailed documentation, and can't spare the time or effort to read (and grok) the whole documentation end-to-end. StackOverflow is a great place to describe the problem you have, and experts (who know the system more fully) can point you in the right direction or even provide a solution. Then you can read the relevant documentation to understand better what's going on, and hopefully provide similar help to others.
Cedar Fair, once had a stage show called "Rock Band, Live", which was a spectacular failure now regarded as a bit of a joke within the company. The audience basically got to watch one lucky person play Rock Band on stage, with some dancers dressed as characters. I'm not sure who thought that "watching other people play video games" would be entertaining enough for a show, but apparently it passed through several layers of management.
It was produced by an outside company, so I find it hilarious to think that the show has now gotten a "second act" by moving to some abandoned dot-com-era data center as a well-powered venue, where participants can play via videoconference, so they don't have to bore a real audience.
From a human perspective, it's just as terrifying. Fear of sea monsters, pirates, doldrums, and gods' anger contributed to early sailors' supposedly-known risks, yet they still went exploring. Eventually we learned that there are no sea monsters or vengeful gods, but that doesn't diminish the courage of those who faced the risk willingly. Likewise, we know that hard vacuum will kill us, but there are still those brave enough to face such a danger willingly for the sake of exploration.
If you look back in history, few real voyages of exploration had an 'escape plan'. If you're not willing to lose a few crews, you shouldn't be sending them out there.
Bingo. The entirety of human evolution, biologically and technologically, has been driven by trying something and not dying from it. As a result, we've made tremendous progress both is achieving stated goals and in escaping from failure. Everyone trying something new should expect that death is always a possibility, despite the remarkable efforts to reduce its chance.
Having worked in the medical world, this is unsurprising. From what I saw, patients often leave treatment against the wishes of their doctors. Some lose faith in the treatment's outcome, some get their first few rounds of bills and realize they can't afford care, and some have other committments that get in the way. What's particularly interesting in this case is that the patient(s) came back. That's promising.
America's Big Pharma certainly won't routinely provide it for free, but they will happily donate a lot of doses in a tax-deductible act of charity. Through partnerships with other charitable agencies, more doses will be sent abroad. Once the medicine gets to those third-world countries, some of it will even get past the warlords and corrupt leaders to make its way to hospitals, where a few treatments might even make their way to trained doctors.
At least one of those doctors will be paid off by a pharmaceutical company from China, Cuba, or another country that doesn't care much about American intellectual property laws, and soon cheap knock-off treatments (that work almost as well) will be produced. Those knock-off cures will be widely available in any country that isn't under the thumb of American pharmaceutical companies... which is exactly what the Big Pharma companies expect and don't mind, because they're not really pushing marketing to those countries, anyway. Sure, they'd love the extra business, but the lax distribution controls are a PR minefield they don't really care to walk through yet.
Making awesome things takes a lot of cooperation. To a certain extent, that cooperation can be bought. Cooperation can be bought more cheaply and more easily, however, if the person being bought is already in favor of the project, and once they're involved, they're far more likely to be passionate about the project's ultimate success, rather than viewing it as yet another boring job in a long career.
Leaders like Steve Jobs and Elon Musk don't just do the "executive" part of the "Chief Executive Officer" role. They act as figureheads leading an army of supporters who believe in the project and are devoted to it. That fanatical love for the goal is seen as crazy by outsiders, but it leads to a quality product in the end - albeit after some major trials and tribulations. A bit of vision, a bit of business, and a bit of distorted reality are the secret ingredients to leadership.
It's not a challenge-response system at all. The website (and I assume the plugin as well) will generate a long hash value based on the website name and a different personal password. That long hash can be used as the password on a website, so if the website's breached, the user's short password is protected. It's not about maintaining the security of that particular account (which is a moot point if the server's been thoroughly hacked), but rather letting the user have one password to remember easily for all sites, without opening them up to the vulnerabilities of password reuse.
Slashdot Mirror
The patient's embarassment just starts the process. After that and a meeting with a lawyer, the embarrassment is secondary to the amount of money up for grabs.
I dare say that a x-ray film lab has a slightly higher quality control than a mere "tourist photo" lab.
That's cute. 5000 prints/day is not a tourist lab, and certainly not 20 years ago.
Addiction usually isn't cured. Much like cancer, it just sort of isn't a major issue after a while, but it's still there, and under the right set of circumstances can come back at any time...
Fuck addiction.
Who the hell cares whether the bad doctor is identified and dealt with after he screws up a statistically significant number of times? What is important is whether he has screwed up in MY case.
No, that's what's important to you.
For classifying a doctor as "bad" (which was the point in question), a statistically-significant number of bad cases must occur. Visiting a doctor is not a guarantee that you'll live healthy forever. It's a consultation of the doctor's skill and expertise. As you said, doctors are just people, who can and do make mistakes. I'm terribly sorry if your particular case got screwed up, but that doesn't give you a right to go chasing after an honest mistake.
There are plenty of laws on the books to protect doctors and other health care professionals from the consequences of their honest mistakes--- that's what "best practice" training and following standard of care protocols are all about.
Sadly, that's simply not true. The laws do not protect doctors from honest mistakes, because ther's always other doctors who will say that everything's obvious.
Dust on x-ray exposures can show up as a lighter-than-usual spot. A metal filing would be pure white, but enough of anything can make a "tiny white dot".
Interestingly enough, about the time this story happened, I worked in a photo lab. Processing errors aren't just common, but expected. To process about 5000 prints a day, we had a team of 15 artists whose sole job was to find the errors in each picture and paint over them using a similar color. The lab at the time used a light process for printing, so there were errors (dust, fingerprints, and otherwise) that could appear on both the negatives and the prints. Most errors show up as a "tiny white dot" on the final print.
If someone is sueing a hospital because their medical records contain an episode of explosive diarreha in a hospital elevator and winning, you should maybe find a lawyer worth a lick of salt.
So let's suppose the patient sees the note about the incident, and takes offense. They sue the hospital for libel, claiming that the incident was recorded for the amusement of doctors at the patient's expense. One defense would be to show a medical reason making the note necessary - but if it was isolated with no known cause, that may not be possible. Another defense is to point out how common messy incidents are in a hospital, but that'll skewer the PR department's campaign saying how clean the hospital is (which it was again an hour after the incident). Regardless of how skilled the hospital's lawyers are, an offended patient with a grudge will be expensive to deal with.
Because of this, we wouldn't leave a remark like "Patient questions everything, be sure to only see patient when management is available" because that sounds absurd, and yeah if that comes out during a case where say, the patient wasn't seen quickly in an emergency situation resulting in injury or death, well, too bad.
One comment I saw in actual records: "Patient has dementia and insists on seeing Dr. Johnson, who retired in 1985. Dr. Williams looks similar enough that he can tell her that whoever's on call is 'a good doctor'."
Sure, it's sneaky and underhanded, and a skilled lawyer can turn it into a case where the hospital was intentionally deceiving a patient to mislead them into trusting someone... but it's ultimately what's necessary to get anything done.
Inacuracies dont matter? I'd love to know where you work, so I can avoid whatever idiots you work with.
I worked with data from one of the largest hospital networks in the United States. Good luck avoiding them. The problem is that they've switched record systems a half-dozen times in the last two decades, and some records are known to be wrong. Whe processing their data, I was explicitly told to ignore anything older than 6 years, because anything prior to that was from the last system, and would likely have invalid data. I did still encounter some things like an ingrown toenail on someone's face (wrong ICD9 codes), a patient over 200 years old (invalid dates being sent by a third-party system), and one patient with a hundred different names (but the same social security number: 000-00-0000).
I think a patient has a right to understand everything regarding their treatment. Just dumping raw medical records on them won't do that, though.
(speaking as a programmer now, regardless of my medical-industry history)
Every time someone tells me they "need" to double-check my highly-specialized knowledge to have confidence in my work, I tell them (usually politely) to fuck off. It's Invariably, those that do their own investigations come back with questions that I don't want to try to answer, and they'll never accept "I felt like it" as a valid reason. No, I don't really have an objective reason to prefer Perl over Python for this menial little cron job, but my decades of experience make me like Perl a bit more for tasks like this, while your 10 minutes on Google make you think Python is the language of the gods.
Yeah, one time a thousand there's some oversight that a review will catch. That doesn't justify the time and effort to deal with the self-educated geniuses who aren't qualified to ask their own questions, let alone seek their own answers.
...because it's not like having stronger painkillers could lead to bigger problems or anything.
Look, that alcoholic's been sober for years! Let's give him a drink!
That's a problem with the legal system, not the medical system.
Unless the "tiny white dot" is more than a few millimeters in diameter, it could just be a dust speck or processing error on the x-ray film, which can usually be safely ignored. Of course, in hindsight it's much easier to see that the dot is cancerous. With that liitle detail out of the way, it's easy to blame the doctors, and it's easy to parade the evidence in front of a jury who know nothing about photography or medicine, and it's easy to get a huge judgement out of a judge who wants to be "tough on big corporations" and "sympathetic the the innocent widow". Regardless of the case's merit, paying out a "large wrongful death settlement" is just statistically the cheaper option.
Your friend didn't need full access to records to prevent his death. He needed a second opinion, which he probably should have gotten before eating became impossible. His second doctor could request the records, and get them, and see the mysterious error that happens twice.
There's also the flip side, though, that if a doctor isn't very good, they're going to be easy to catch out with some basic cross checking of their diagnosis.
That's why hospitals (and other medical groups) do reviews, to find those bad doctors by the several screwed-up cases in a random sample. The patient doesn't need to be the one doing their own research, regardless of what misguided bit of awareness they think they'll get.
I worked in the medical industry, handling medical data. This is exactly what they don't want you to see.
Patient records are riddled with notes intended only for internal use. To a doctor, it's nothing special that you suffered explosive diarrhea in the middle of the hospital elevator - that happens once a week, and it could be medically important. To a patient, that's a terribly embarrassing episode that shouldn't be in records, and even considering storing such a thing is grounds for a lawsuit. That lawsuit would be argued in front of people outside a hospital setting, who would be biased in favor of the patient. In front of a hospital ethics board, tthe incident is just another bad day for the janitor.
To use the traditional car analogy, hospitals are much like body shops. You really don't need to know every point that was inspected, every noise source that was considered, or the internal notes from the mechanic about how you question every repair so he should make sure to only finish work on days the manager's available. Most of the information is obvious to someone knowledgable, useless to someone who knows nothing, and ammunition for someone who knows just enough to be dangerous.
On the other hand, what does the patient need to see? Doctors know that old records are unreliable, so history beyond a few years old doesn't really matter if it's slightly inaccurate. Current treatment is usually handled by a single primary doctor, who knows what makes sense for a particular patient, so inaccuracies there don't matter either.
Sure, it's information about the patient, but giving out all the details just causes more trouble than good.
Jokes aside, the "getting justice" days are unfortunately accompanied by the "no idea what's right" days and the "just ruined someone's life" days. I much prefer to work on programming low-impact applications, where I can utterly botch a routine or two and the worst effect is a few new tickets.
I don't think those examples fit quite as smoothly as a lawyer does, but yes, that's the point. Study across a wide range of subjects can contribute indirectly to an otherwise-unrelated field, because there are isomorphic problems whose solutions will rely on similar techniques. Getting back on the topic of TFA, I think that programming can indeed help make better doctors, simply by offering a different perspective on some problems.
Beyond programming and law, I also enjoy live sound reinforcement, robotics, dance, architecture, and I've recently developed a taste for cooking. I don't know yet how those will all benefit me, but it's likely that they will.
Interesting. I was thinking the opposite.
I once studied law, intending to become a lawyer, then realized that would make me a lawyer, and I wanted a career where I could sleep at night. So I became a programmer, and I've spent many nights in front of a glowing terminal... but I digress.
I feel that learning a bit of law has actually helped my programming. Lawyers spend much of their time picking which rules best apply to a particular circumstance, while programmers pick which algorithms are best suited to a task. Lawyers then submit their case to a judge for consideration, while the programmers simply run the compiler. Lawyers work around contract loopholes by covering them with other clauses, and programmers work around (some) bugs by covering them with better-written wrappers.
Many problem-solving disciplines use similar skills. Programming, being nearly pure logic mixed with a bit of language, can contribute marginally to a wide variety of other fields, including medicine, law, or even politics. It is important, however, to not become too obsessed with the programming approach. A perfectly-written contract that programmatically describes an agreement can still be thrown out by a judge if he thinks it isn't fair.
Ah. I thought the "misleading title" thread would be about a misleading title... and that's what the title led me to think about.
The summary eased my fears a bit.
Well no... but like I said, it should be.
Police should also be unbiased, governments should be fair, and there should be peace and happiness and abundance throughout the world.
Not joking at all, sadly.
Professional gamers are interesting to watch, because they're on a different level than the spectators. Their tactics and speed are impressive, pushing the limits of human ability, making a competitive video game into a sporting event.
Random passers-by at an amusement park aren't quite so interesting. As I understand it, the first few weeks of shows had a pre-show try-out to assert that guests had some modicum of skill, but by the end of the season anyone who could bash on an instrument was considered qualified to go on stage. In the interest of keeping guests happy, the actors had to treat the guests like they were great musicians, no matter how badly they actually played.
When all else fails, read the directions.
Documentation should be the absolute authority on every detail of a system's operation. It should be the reference material for experts. On the other hand, people who aren't experts don't know the available options, and often don't really know the terms to look for in the detailed documentation, and can't spare the time or effort to read (and grok) the whole documentation end-to-end. StackOverflow is a great place to describe the problem you have, and experts (who know the system more fully) can point you in the right direction or even provide a solution. Then you can read the relevant documentation to understand better what's going on, and hopefully provide similar help to others.
Cedar Fair, once had a stage show called "Rock Band, Live", which was a spectacular failure now regarded as a bit of a joke within the company. The audience basically got to watch one lucky person play Rock Band on stage, with some dancers dressed as characters. I'm not sure who thought that "watching other people play video games" would be entertaining enough for a show, but apparently it passed through several layers of management.
It was produced by an outside company, so I find it hilarious to think that the show has now gotten a "second act" by moving to some abandoned dot-com-era data center as a well-powered venue, where participants can play via videoconference, so they don't have to bore a real audience.
...And that's why we haven't done much of it yet.
From a human perspective, it's just as terrifying. Fear of sea monsters, pirates, doldrums, and gods' anger contributed to early sailors' supposedly-known risks, yet they still went exploring. Eventually we learned that there are no sea monsters or vengeful gods, but that doesn't diminish the courage of those who faced the risk willingly. Likewise, we know that hard vacuum will kill us, but there are still those brave enough to face such a danger willingly for the sake of exploration.
If you look back in history, few real voyages of exploration had an 'escape plan'. If you're not willing to lose a few crews, you shouldn't be sending them out there.
Bingo. The entirety of human evolution, biologically and technologically, has been driven by trying something and not dying from it. As a result, we've made tremendous progress both is achieving stated goals and in escaping from failure. Everyone trying something new should expect that death is always a possibility, despite the remarkable efforts to reduce its chance.
Having worked in the medical world, this is unsurprising. From what I saw, patients often leave treatment against the wishes of their doctors. Some lose faith in the treatment's outcome, some get their first few rounds of bills and realize they can't afford care, and some have other committments that get in the way. What's particularly interesting in this case is that the patient(s) came back. That's promising.
America's Big Pharma certainly won't routinely provide it for free, but they will happily donate a lot of doses in a tax-deductible act of charity. Through partnerships with other charitable agencies, more doses will be sent abroad. Once the medicine gets to those third-world countries, some of it will even get past the warlords and corrupt leaders to make its way to hospitals, where a few treatments might even make their way to trained doctors.
At least one of those doctors will be paid off by a pharmaceutical company from China, Cuba, or another country that doesn't care much about American intellectual property laws, and soon cheap knock-off treatments (that work almost as well) will be produced. Those knock-off cures will be widely available in any country that isn't under the thumb of American pharmaceutical companies... which is exactly what the Big Pharma companies expect and don't mind, because they're not really pushing marketing to those countries, anyway. Sure, they'd love the extra business, but the lax distribution controls are a PR minefield they don't really care to walk through yet.
I'll bite.
Making awesome things takes a lot of cooperation. To a certain extent, that cooperation can be bought. Cooperation can be bought more cheaply and more easily, however, if the person being bought is already in favor of the project, and once they're involved, they're far more likely to be passionate about the project's ultimate success, rather than viewing it as yet another boring job in a long career.
Leaders like Steve Jobs and Elon Musk don't just do the "executive" part of the "Chief Executive Officer" role. They act as figureheads leading an army of supporters who believe in the project and are devoted to it. That fanatical love for the goal is seen as crazy by outsiders, but it leads to a quality product in the end - albeit after some major trials and tribulations. A bit of vision, a bit of business, and a bit of distorted reality are the secret ingredients to leadership.
It's not a challenge-response system at all. The website (and I assume the plugin as well) will generate a long hash value based on the website name and a different personal password. That long hash can be used as the password on a website, so if the website's breached, the user's short password is protected. It's not about maintaining the security of that particular account (which is a moot point if the server's been thoroughly hacked), but rather letting the user have one password to remember easily for all sites, without opening them up to the vulnerabilities of password reuse.