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The Dark Side of Doctoring

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Re: The Dark Side of Doctoring

#181

Post by cmdrfred »

m_fayer wrote: post #169
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…

I'd like to see you maintain your "cry me a river" perspective when the doctor tasked with saving your kids life is burnt out and going through a divorce because of his chosen career. And even if I were to agree with your premises, do we really want a system that selects for the kind of doctors who are willing to put themselves and their loved ones through years of hell in exchange for an eventual high and stable pay…

You act as if the alternative is free. Will you maintain the same "life at any cost" mentality when your insurance premiums or taxes increase to the point that you can no longer afford them? If you lower the cost of healthcare you increase access, you can raise the costs involved and provide better care but less people will be able to use it. It isn't as simple as you postulated.

Re: The Dark Side of Doctoring

#182

Post by ownagefool »

wighty wrote: post #87
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…

House of God is indeed an interesting book and a good read. I read it during second year of my residency, and it is incredibly sad how the stuff that is talked about in the book has gotten worse in some ways, though better in others. I'm actively against the "bowel run" mentality. I do my best to avoid even the CYA test ordering, though I'm not in the ED where this can be the most rife. I see first hand the "ponzi sc…

I think the term is "gravy train".

Re: The Dark Side of Doctoring

#183

Post by azernik »

mikeyouse wrote: post #122
leekyle wrote: post #117

Earlier quoted context omitted.

Medicare is obviously a big part of healthcare, but is this same pay for performance happening with private insurance? How has the consolidation of hospitals impacted this? Has it become harder to negotiate these deals with massive hosptital networks?

Private insurance actually started a lot of these initiatives. If you're a physician with a busy practice, at the end of the month, you'll get a check from all of the big insurance companies detailing how much they're paying you. It doesn't read, "You saw 100 patients at $100/patient, here's $10,000." It's more like, "You saw 100 patients, here's your per-patient fee of $50. You prescribed 87% generic medicines, whic…

I can second the testimony about lots of upheaval and consolidation in the industry. A family member recently worked at a Big Law firm on antitrust cases, and a large portion of them had to do when recent M&A activity among hospitals, specialty clinics, and small practices. The days of the doctor as small-business proprietor are waning.

Re: The Dark Side of Doctoring

#184

Post by markroseman »

epmatsw wrote: post #145
vacri wrote: post #139

Earlier quoted context omitted.

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 depl…

Two bad things that can happen... one, the order entry procedure on the computer (besides being more time consuming) has usability problems that make it easy to enter the wrong thing accidentally. And an incorrect order looks as official as a correct order. In the old scribble system, where everyone deals with the same physical chart, things that may be a bit more ambiguous/indecipherable are more apparent. Plus, equally importantly, there's more communication between different professionals around the chart. The EMR takes a lot of the ad hoc communication out of the equation. For an example of this in another domain, air traffic controllers used paper "flight strips" to represent current state; initial attempts at computerizing these completely missed that the strips were not only information but also a vehicle for ad hoc communication, and that latter part, critical to work actually being done, was missed in the computer systems.

Re: The Dark Side of Doctoring

#185

Post by markroseman »

kapauldo wrote: post #177

Hard to feel sympathy for millionaires living a life of their choosing.

My wife is a doctor, over a dozen years in practice. Tell our mortgage about how she's a millionaire. And to me, a life of her choice would likely have a lot less stress and shorter hours, and not worrying that the income would dry up if she has to stop working.

Re: The Dark Side of Doctoring

#186

Post by wfo »

pdonis wrote: post #138
pixelmonkey wrote: post #77

Earlier quoted context omitted.

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…

You are blaming the failings of the US healthcare system on "the market", but the market in health care in the US is not anywhere close to a free market. Some key reasons why not: (1) The supply of doctors (and other health professionals) is restricted by licensing, not driven by the demand for their services. (2) The price of health care is not determined by supply and demand, but by various regulatory arrangements…

Good list, but one is missing:

(6) basic health care is not a market and pretending it is has been nothing but a moral and economic catastrophe in the US.

Re: The Dark Side of Doctoring

#187

Post by markroseman »

Ericson2314 wrote: post #176

So clearly healthcare in the US is fucked end to end. Has anyone (government or private sector) tried or proposed some sort of trial hospital where we just clean-slate redesign and evaluate the whole thing? *Probably would need to be government as would need exceptions from tons of laws.

Or look outside the USA at dozens of other countries that may have some problems with their healthcare systems, but aren't anywhere close to as completely fucked up.

Read the comments and listen to the debates, and understand that it isn't going to get better until Americans believe that the availability of healthcare shouldn't be solely dependent on income, and that "freedom" around payment and insurance shouldn't be the primary value.

Re: The Dark Side of Doctoring

#188

Post by markroseman »

hourislate wrote: post #20

Perhaps the solution to the unreasonable demands placed on Doctors/Surgeons is moving forward with A.I, Stem Cell research, Robotic surgery, etc. Technology should relieve some of the pressure.

Keep in mind the technology has to fit into the existing regulatory and legal framework. Which also includes, if something goes wrong, who are you going to sue?

Re: The Dark Side of Doctoring

#189

Post by wfo »

pdonis wrote: post #140
467568985476 wrote: post #70

Earlier quoted context omitted.

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.

The demand for food is also pretty inelastic, yet the free market seems to handle that fine.

No actually it does not. The government subsidizes food production and food for the poor HEAVILY.

Also food is cheap and plentiful to create.

And most importantly, food is easy to steal; the one important factor in a functioning free market libertarians tend to forget about is the natural control at the bottom, for the poor: if the poor need something in order to survive and can't afford it, they act as a check on greed and neoliberalism run amok by ignoring the fake magic pieces of paper that the wealthy wave around as tokens of power and take what they need.

It's a lot harder to steal health care so there's no incentive for the rich to modify the system to help the poor like there is with food.

Re: The Dark Side of Doctoring

#190

Post by JoeAltmaier »

wfo wrote: post #189
pdonis wrote: post #140

Earlier quoted context omitted.

The demand for food is also pretty inelastic, yet the free market seems to handle that fine.

No actually it does not. The government subsidizes food production and food for the poor HEAVILY. Also food is cheap and plentiful to create. And most importantly, food is easy to steal; the one important factor in a functioning free market libertarians tend to forget about is the natural control at the bottom, for the poor: if the poor need something in order to survive and can't afford it, they act as a check on gr…

Maybe its similar. My last 30-day dose of blood pressure medicine cost be 54 cents. And the store had shelves full of medicine all around me, thousands of them, all easily pocketable.
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