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The Dark Side of Doctoring

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Re: The Dark Side of Doctoring

#91

Post by themantalope »

I'm a medical student at a top 20 allopathic school in the U.S. This article resonated with me.

I think the part that struck me the most was his comments about time. I have diverse academic interests. I studied math and bio in undergrad. I love machine learning and software development (esp python). I lived in China to study the language for a year. All that gets sucked out of medical school though. We are expected to learn a ton of material in the first two years. Then in the second two years, we are basically working a full time job in the hospital/clinics while also studying. We are constantly evaluated. We are also expected to do research and publish papers. I've forgotten what a guilt-free day off feels like.

Re: The Dark Side of Doctoring

#92

Post by rayiner »

karpodiem wrote: post #49
pixelmonkey wrote: post #18

My wife is a medical resident and the issues described by this doctor are absolutely pervasive in residency. The strange part is, the overwork also seems to be pervasive among the attending physicians who have been out of residency for decades. Not just the residents. As a tech founder analyzing the system from the outside, I think this writer has nailed the core issue: "... a doctor is just one of the many commoditi…

Western medicine has turned into a ponzi scheme. The verifiable proof of this is to have an elderly family member in a nursing home who goes through the usual monthly trips to the hospital from 'falling'. While Medicare covers almost all of it, it became so nauseating to read the outrageous EOB totals that I tried to put a end to it - I requested that unless the on call nurse (after hours) or physician (during busine…

Everything is really easy if you hand-wave away the facts: https://www.cdc.gov/media/releases/2016/p0922-older-adult-fa....

Elderly Americans experience about 29 million falls per year, which costs Medicare $31 billion. At about $1,000 per fall that seems quite reasonable. 27,000 older Americans die from falls each year. In an institutional setting like a nursing home, the rate of death per fall is even higher.

$700,000 for two people in assisted living for eight years is about $43,000 per year. That's not unreasonable for the cost of assisted care plus medical expenses.

Re: The Dark Side of Doctoring

#93

Post by wighty »

macrael wrote: post #13
protonfish wrote: post #3

The FAA enforces work limitations on pilots, but we schedule our health care workers like this? How are there not even civil cases against errors caused by this kind of administrative foolishness? Overworking doctors like this is insane.

There is a tradeoff that is used to justify the long hours. On the one hand, having a well rested doctor is obviously good for them to be making good decisions. But on the other hand, patient handoffs are dangerous. The more times you change the person responsible for a patient, the longer the game of telephone you are playing with their care. This has been measured as being bad for patient outcomes. Now, that doesn'…

> patient handoffs are dangerous.

I hate when this gets brought up, because it inherently implies that we can't improve them. Everyone talks about increases in handoffs causing increases in medical errors. I think handoffs have a long way to go, and we need to better utilize technology to help in this (ie make better EMRs).

The overworked doctor is just as bad IMO. I've been there on solo 28 hour calls going on my 11th admission. In the morning I'm next to useless and my handoff to that team was less than stellar.

Re: The Dark Side of Doctoring

#94

Post by dikdik »

pixelmonkey wrote: post #18

My wife is a medical resident and the issues described by this doctor are absolutely pervasive in residency. The strange part is, the overwork also seems to be pervasive among the attending physicians who have been out of residency for decades. Not just the residents. As a tech founder analyzing the system from the outside, I think this writer has nailed the core issue: "... a doctor is just one of the many commoditi…

If docs didn't slot 15 minutes per patient, then they would need to charge each patient much, much more or make much, much less. There is no other way around that.

Re: The Dark Side of Doctoring

#95

Post by joshuaheard »

I am a lawyer, and if this was a lawyer's story, this would be my advice for the firm. First, they need to hire more lawyers. This guy is way too busy and will make a mistake. Second, he needs a receptionist, secretary, and paralegal to support him. It is wasteful to pay him a doctor's salary to answer phones. Third, they need to streamline their record keeping so he doesn't spend so much time filling out paperwork.

Re: The Dark Side of Doctoring

#96

Post by dikdik »

pc2g4d wrote: post #45

So... because the supply of doctors is restricted but demand for doctors grows proportionally to the population, the amount of work per doctor gradually increases and doctors, persuaded by their ethical obligation of care, put up with it as long as possible until they snap. Yeah? I just recently had a friend completely burn out of medicine, sell his house, and start traveling the world. He was brilliant, a good docto…

A lot of physicians either push to restrict the supply of docs or look at this "issue" and do nothing about it. They do not want their wages to decrease by opening up the market (have had physician friends say this to me in words that make it sound less terrible).

Cuba decided they wanted more physicians, so they invested in them to the point that they could use them as an export. If we have a shortage of doctors (which I think we do), the people with the power to change that either don't believe we have a shortage or have a vested interest in keeping a shortage.

Re: The Dark Side of Doctoring

#97

Post by thearn4 »

pixelmonkey wrote: post #18

My wife is a medical resident and the issues described by this doctor are absolutely pervasive in residency. The strange part is, the overwork also seems to be pervasive among the attending physicians who have been out of residency for decades. Not just the residents. As a tech founder analyzing the system from the outside, I think this writer has nailed the core issue: "... a doctor is just one of the many commoditi…

I'm not a medical professional, but the whole discussion of handoff risk always seemed to me like it was side-stepping the real issue presented, which is poor documentation and/or communication between peers. Instead, the premise is offered by the AMA that handoff risk can only be minimized by insane shift lengths.

Re: The Dark Side of Doctoring

#98

Post by themantalope »

joshuaheard wrote: post #95

I am a lawyer, and if this was a lawyer's story, this would be my advice for the firm. First, they need to hire more lawyers. This guy is way too busy and will make a mistake. Second, he needs a receptionist, secretary, and paralegal to support him. It is wasteful to pay him a doctor's salary to answer phones. Third, they need to streamline their record keeping so he doesn't spend so much time filling out paperwork.

>It is wasteful to pay him a doctor's salary to answer phones.

This is something I don't understand. I'm a medical student, and the amount of time I've seen wasted watching older physicians type notes is staggering. Just have them dictate the notes and hire a secretary. Perhaps for legal/liability reasons doctors need to write their own notes but it's just such a waste of time, and we pay a lot for it.

Re: The Dark Side of Doctoring

#99

Post by leekyle »

mikeyouse wrote: post #62
abandonliberty wrote: post #53

Earlier quoted context omitted.

How much selective pressure do doctors experience on their performance? Healthcare is one of those fields where there's no guarantee on the quality of the service. There's no pay for performance. Actually, doctors who perform too well would reduce healthcare spending. There are plenty of reasons to keep developers happy because it directly affects the end product and profit.

You should do a lot more reading about healthcare if you think there isn't pay for performance. The payers in the system all have massive incentives to reduce healthcare utilization. Docs and hospitals have been dealing with 'P4P' for decades and the ACA ramped it up significantly for the CMS.

What is a good example of pay for performance in healthcare?

Re: The Dark Side of Doctoring

#100

Post by electriclove »

JabavuAdams wrote: post #55
electriclove wrote: post #39

Let's create MORE doctors.. There is no shortage of capable people interested in becoming physicians.

Do you really believe we've maxed out on capable people with the interest?

Not at all.. the supply is constrained for all the wrong reasons.
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