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The Dark Side of Doctoring

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Re: The Dark Side of Doctoring

#141

Post by stale2002 »

pixelmonkey wrote: post #77
kem wrote: post #66

Earlier quoted context omitted.

There's one big difference between software engineers and healthcare: regulation. A software engineer is hired for their skills (at least ostensibly). No one is required by law to hire someone with a specific degree and specific post-degree training and specific exams. Contrast this with healthcare. To do certain sorts of procedures, you have to hire a physician. Not because it's demonstrably necessary to have someon…

I think the credentialing in medical practice has more to do with the stakes involved than in some salary-padding or labor-control scheme. Patients want to be able to enter a hospital and have confidence that, when push comes to shove, even the worst MD on call is a better option than a "no-op" treatment. Also, exorbinant salaries and good hours are not to be found in the hospital system. Yes, specialist doctors get…

Why would you as a consumer reward cronic care, vs a one time cure?

I myself would prefer the one time cure, and would be willing to pay for it.

In a perfectly free market, my demand for the one time cure would be represented by market forces.

Now ask yourself, what is it about the healthcare market, that PREVENTS my market demand for a one time cure, as a consumer, from effecting the market?

Re: The Dark Side of Doctoring

#142

Post by stale2002 »

467568985476 wrote: post #70
kem wrote: post #66

Earlier quoted context omitted.

There's one big difference between software engineers and healthcare: regulation. A software engineer is hired for their skills (at least ostensibly). No one is required by law to hire someone with a specific degree and specific post-degree training and specific exams. Contrast this with healthcare. To do certain sorts of procedures, you have to hire a physician. Not because it's demonstrably necessary to have someon…

I have a hard time believing that the "free market" can solve healthcare given that the demand for it is more inelastic than pretty much any other product.

It is absolutely NOT as inelastic as everyone assumes.

Most health issues are not emergencies. I as a consumer would be perfectly happy to shop around the market, and find the best deal on healthcare, if my efforts were rewards.

Unfortunately, prices are not transparent, and the costs are not payed directly by me. They are paid by my insurance provider, so why would I bother trying to reduce my bill by thousands of dollars, if someone else is paying for it anyway?

Re: The Dark Side of Doctoring

#143

Post by micahbright »

467568985476 wrote: post #70
kem wrote: post #66

Earlier quoted context omitted.

There's one big difference between software engineers and healthcare: regulation. A software engineer is hired for their skills (at least ostensibly). No one is required by law to hire someone with a specific degree and specific post-degree training and specific exams. Contrast this with healthcare. To do certain sorts of procedures, you have to hire a physician. Not because it's demonstrably necessary to have someon…

I have a hard time believing that the "free market" can solve healthcare given that the demand for it is more inelastic than pretty much any other product.

That's not hard to believe, it only requires an ignorance of economics. Cheers

Re: The Dark Side of Doctoring

#144

Post by [deleted] »

mklim wrote: post #101
epmatsw wrote: post #83

Earlier quoted context omitted.

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 inf…

[deleted]

Re: The Dark Side of Doctoring

#145

Post by epmatsw »

vacri wrote: post #139
epmatsw wrote: post #83

Earlier quoted context omitted.

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?

A better analogy would be ticketing in Jira versus ticketing with Post-It Notes. The main job of the professional (medicine/programming) is not what's at stake here. We're talking about documentation. Jira is a heavyweight ticketing system that is okay, but a lot of people are really slowed down by it, and if there are problems with the network, no-one gets much effective work done. Post-its are less visible to all s…

The Jira analogy falls a little bit flat, because the information entered into an EMR is often the actual product, not just documentation. Orders entered into the EMR directly affect the outcome of the patient, and errors can be fatal. Having a free-text hand-written system for something like that just seems pretty crazy. It'd be like going to a dev shop where no one used linters or wrote tests and the check for deploying to prod with no rollback option was one (admittedly extremely skilled) guy in the basement signing off after a quick code review.

Re: The Dark Side of Doctoring

#146

Post by ad_hominem »

aabajian wrote: post #6

It's worth noting that the incredible success of Epic EMR software is because it tightly controls all of the administrative billing issues, NOT because it makes clinician's lives easier. There are endless check boxes in Epic and each site has its own interface. It's a huge mess and difficult to navigate...but arguably still better than the other vendors.

My wife is an MD who has used a lot of different EMRs at various hospitals during medical school and residency rotations. She said she actually likes Epic the best compared to all the others she has used.

She said she likes it because she can define her own templates and "dot phrases" that make it easy to set up her own workflow. Also that it's nice that everything is all in one app - in other systems you'd have to be jumping between apps to look at lab results and patient messages for example.

Re: The Dark Side of Doctoring

#148

Post by throwaway5752 »

seanp2k2 wrote: post #130
slackingoff2017 wrote: post #108

Earlier quoted context omitted.

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. T…

200k is also on the low end. A friend of mine just finished her residency and is making almost twice that now. I did some on-site PC service for a few doctors in a job about a decade ago. They literally all had 911s and mansions. Anecdotal sure, but from what I've seen, doctors here are loaded. Anesthesiologist always seemed like the best gig....you work a few days a week, set up your schedule months ahead of time, b…

It's great until a patient dies and you have to inform their families. You are keeping a living being in a state between life and death chemically while they are undergoing massive trauma. Do you know how much their malpractice insurance is?

It's not just hard work to become a doctor. It's hard work and sustained excellence. You don't just put in the hours, you have consume an enormous amount of information and are tested on it constantly through the education process. You have to take on enormous personal risk financially in loans. You very frequently have to make large personal sacrifice in your life to get to the point of board certification.

Some get paid great, most get paid well, but if you know more than a few doctors you would probably be less glib. /me not a doctor.

Re: The Dark Side of Doctoring

#149

Post by kyouens »

killjoywashere wrote: post #123
kyouens wrote: post #61

Earlier quoted context omitted.

The limiting factor to creating more skilled physicians is not medical school admissions. It's residency training slots. Most residency training slots rely on federal government funding. Pretty much everyone, including the AMA, agrees that there is a looming undersupply of physicians. There may be disagreement on the best way to address the issue, but there is little disagreement among physicians about the fundamenta…

Depends on who's complaining about a bottleneck. The AMA caters to a base that is not happy with the influx of IMGs and DOs. The AMA inflates their numbers by auto-enrolling every allopathic medical student. The AMA is equally unhappy that the government using large scale funding levers at the residency level to overwhelm their efforts to tighten supply. By using money and their exclusive access to legislate, the gov…

I'm also a physician. I am generally satisfied with my work, but I do feel distressed by what feels to me like erosion of the social contract between doctors and society that flourished during the second half of the twentieth century. It sounds like we agree that some of that erosion has occurred because of nakedly self-serving political action by medical professional societies.

When I made the decision to become a physician twenty years ago, I thought medicine was my calling. I believed that the personal sacrifices one makes to be a physician--and there are many--would be rewarded with professional pride, the respect of my community, the gratitude of my patients, and a secure and well-paid living. I have gotten a little wiser, I think. I make a good living, my work is interesting, and I still think medicine is a great career. But times have changed, and I no longer consider medicine a calling for which one should be willing to sacrifice one's personal well-being. I find myself defending my profession on the internet a little more than I'd anticipated :)

Those who control the business of medicine take economic advantage of the patient-first mindset of our medical tradition, and it cheapens what we do, both literally and figuratively. It is for that reason that, despite its many flaws, I do think organized medicine does have redeeming qualities. It gives physicians at least some voice in politics, where they would otherwise have none at all. Maybe one day health care reform will right the ship.

Re: The Dark Side of Doctoring

#150

Post by dikdik »

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.

Most medical operations have an army of people supporting physicians.

I used to work at a medical lab and there were transcriptionists, billing dept, a dept. for quality assurance of every report a doctor wrote, customer service, etc. Hospitals have all of that plus nurses (RNs, CNAs, etc.), physician assistants, and probably many others.

Part of the problem is how much paperwork/procedures/diagnostic reporting is legally mandated to be done by doctors. The other part is...money. Businesses want to/need to squeeze as much money out of the doctors and that requires seeing as many patients as possible.

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