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The Dark Side of Doctoring

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Re: The Dark Side of Doctoring

#101

Post by mklim »

epmatsw wrote: post #83
markroseman wrote: post #17

Earlier quoted context omitted.

Absolutely it's about the administrative end and not patient care. We've got a situation in our regional health authority (Vancouver Island, BC, Canada) where they're trying to roll out a significant update/expansion to their EMR (Cerner-based) in the hospital in Nanaimo. Despite immense pressure, some docs have been now suspended for refusing to use it and switching back to paper, despite the massive increase in tim…

This is a pretty shocking opinion to see expressed. Like, you may as well have said "A bunch of developers at decided to go back to C89 because writing code in Rust was too slow, plus did you see the bugs in its borrow checker?" . Do you really believe that paper is a safer alternative?

Can't chime in on safety issues, but on usability: I know a physician who transitioned to using EMR roughly five years ago. It doubled the amount of time they need to take notes, to this day. They can't see nearly the same amount of patients they used to because so much of their day is spent going into and out of full screen surprise submenus in the EMR software and flipping through different tabs and re-entering information into multiple forms and scrolling through dropdowns with multiple hundreds of options. GP's post is 100% believable for me. It's nothing like Rust vs C89. It's more coding with punch cards vs an IDE, except the EMRs are the punch cards.

Re: The Dark Side of Doctoring

#102

Post by maxerickson »

rayiner wrote: post #92
karpodiem wrote: post #49

Earlier quoted context omitted.

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…

Medicare wouldn't be paying for the assisted care: https://www.medicare.gov/what-medicare-covers/part-a/paying-...

A facility generating large numbers of fall investigations that don't lead to ongoing medical care seems like it would be pretty easy (potential) fraud to go after though.

Re: The Dark Side of Doctoring

#103

Post by wernercd »

dikdik wrote: post #94
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.

Or, perhaps, do something about the layer (lawyers) after layer (coders) after layer (nurses) after layer (administration) after layer (...) of "support" staff?

I'm willing to bet that something to relieve the massive amount of "other" stuff needed besides the Doctor would go a LOOOOOONG way...

That doesn't even tackle stuff like inability to see how much something actually costs - and shop around for stuff other than the ER.

15 minutes per patient isn't the answer...

Re: The Dark Side of Doctoring

#104

Post by krallja »

yakult wrote: post #84

According to my GP, selection for doctors include psychiatric profiling designed to select for the most compassionate. While I can see why the hospitals would want this - compassionate doctors are good PR -this seems to be a case of misaligned incentives. Those with less compassion would suffer less and cope better when surrounded by death and suffering on a daily basis. On the whole, this probably means they'll do a…

What country are you in?

Re: The Dark Side of Doctoring

#105

Post by maxerickson »

nkurz wrote: post #63
karpodiem wrote: post #49

Earlier quoted context omitted.

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…

We have two family members in an assisted car facility for almost eight years now, and between the two of them, they've tapped Medicare for just under $700K. Together, the sum of both their incomes throughout their entire working lives never totaled that amount. Oh, but it gets worse. It's bad enough that the government is being bilked for hundreds of thousands of dollars on behalf of those without the ability to pay…

Medicare doesn't examine assets.

Medicaid does.

Medicaid is the payer of last resort for nursing care though, not Medicare (which doesn't really cover long term care).

Re: The Dark Side of Doctoring

#106

Post by smitherfield »

epmatsw wrote: post #83
markroseman wrote: post #17

Earlier quoted context omitted.

Absolutely it's about the administrative end and not patient care. We've got a situation in our regional health authority (Vancouver Island, BC, Canada) where they're trying to roll out a significant update/expansion to their EMR (Cerner-based) in the hospital in Nanaimo. Despite immense pressure, some docs have been now suspended for refusing to use it and switching back to paper, despite the massive increase in tim…

This is a pretty shocking opinion to see expressed. Like, you may as well have said "A bunch of developers at decided to go back to C89 because writing code in Rust was too slow, plus did you see the bugs in its borrow checker?" . Do you really believe that paper is a safer alternative?

But EMR are usually some incomprehensible black box involving MUMPS and/or COBOL. Paper might very well be less error-prone.

Re: The Dark Side of Doctoring

#107

Post by nkurz »

maxerickson wrote: post #105
nkurz wrote: post #63

Earlier quoted context omitted.

We have two family members in an assisted car facility for almost eight years now, and between the two of them, they've tapped Medicare for just under $700K. Together, the sum of both their incomes throughout their entire working lives never totaled that amount. Oh, but it gets worse. It's bad enough that the government is being bilked for hundreds of thousands of dollars on behalf of those without the ability to pay…

Medicare doesn't examine assets. Medicaid does. Medicaid is the payer of last resort for nursing care though, not Medicare (which doesn't really cover long term care).

You are right. I can never keep straight which is which. I edited to my repetition of the mistake, but left the original quote as it was.

Re: The Dark Side of Doctoring

#108

Post by slackingoff2017 »

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…

It's well known within the medical field that being a doctor is really really tough. It takes a lot of smarts and grueling years in residency before you officially become a doctor.

However it also pays incredibly well. Even moreso for specialities and surgeons, who can make over 200k a year even in low cost of living areas. Despite the difficulties of being a doctor it's harder to get into medical school than ever. The difficulties are not deterring med students.

I don't feel bad for people that go into this profession then complain about how hard it is. It's extremely well known within the medical field that being a doctor is grueling. That's why it pays so well. And it's not like this is a new development. It's been like this for decades.

Complaining about it is akin to working on an oil rig and complaining about poor work conditions. It's pretty damn obvious that you're going to have poor work conditions from the start.

Nobody is forcing you to be a doctor, your school credentials plus MD is probably enough to swing a decent job in almost any field. Doctors are some of the most employable people out there.

I just find it rediculous that were having a "poor doctors" discussion when it's the second highest paying profession in the richest country in the world. Get over it.

Re: The Dark Side of Doctoring

#109

Post by andy »

What other dark side of doctoring issue can I think of? Well, the doctors and nurses at Fairmount kept me prisoner without the ability to call my friends or family, denied me water, physically tackled me and tied me down. I was not allowed to use a lawyer of my choosing. I did not hit back when they tackled me. I never committed a crime. I feel like I am being repetitive. That is completely on purpose. The dark side of doctoring is at Fairmount Behavioral Health in Philadelphia, PA. It's a hellhole and should be closed. https://surroundedbyspies.com

Re: The Dark Side of Doctoring

#110

Post by andy »

What other dark side of doctoring issue can I think of? Well, the doctors and nurses at Fairmount kept me prisoner without the ability to call my friends or family, denied me water, physically tackled me and tied me down. I was not allowed to use a lawyer of my choosing. I did not hit back when they tackled me. I never committed a crime. I feel like I am being repetitive. That is completely on purpose. The dark side of doctoring is at Fairmount Behavioral Health in Philadelphia, PA. It's a hellhole and should be closed.
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