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The Dark Side of Doctoring

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Re: The Dark Side of Doctoring

#201

Post by Para2016 »

arjie wrote: post #199
EvanAnderson wrote: post #23

Earlier quoted context omitted.

Here's the go-to that I send people to when this comes up: https://skeptics.stackexchange.com/questions/4561/does-the-a...

Classic. They moved a big ship and then tried to move it back and hysteresis took hold. This is what unions do. They're like giants without brains, pulling and pushing levers they do not understand. They're driven by short-term fear and reactive behaviour. The fact that they hold any sort of power here is an outrage. It's quite clear to me what needs to be done here. America needs to import medical professionals. The…

Oh yea? A lot of them can barely pass STEP 2 CS which just tests your ability to communicate in English and whether you can make two empathetic statements per patient encounter. You think FMG are on the same level as American educated MD/DOs? Some are and some are better, but as a cohort they are mediocre.

Re: The Dark Side of Doctoring

#202

Post by arjie »

Para2016 wrote: post #201
arjie wrote: post #199

Earlier quoted context omitted.

Classic. They moved a big ship and then tried to move it back and hysteresis took hold. This is what unions do. They're like giants without brains, pulling and pushing levers they do not understand. They're driven by short-term fear and reactive behaviour. The fact that they hold any sort of power here is an outrage. It's quite clear to me what needs to be done here. America needs to import medical professionals. The…

Oh yea? A lot of them can barely pass STEP 2 CS which just tests your ability to communicate in English and whether you can make two empathetic statements per patient encounter. You think FMG are on the same level as American educated MD/DOs? Some are and some are better, but as a cohort they are mediocre.

Well, considering there's a damned army of them, we can just filter them down to the top few (which will be a massive set on America's scale).

Re: The Dark Side of Doctoring

#203

Post by upvotinglurker »

m_fayer wrote: post #166
hammerzeit wrote: post #32

Earlier quoted context omitted.

My spouse is a doctor as well, and I've also observed the issues the author discusses. I don't think your read of the causes here is correct. It's worth reading more about the history of medicine to truly understand what's going on here -- the culture of abusive overwork in American medicine goes at the very least back to Osler and the invention of the modern residency program, and has as much to do with cocaine than…

Yes I think this is an important point, medical culture plays a big role in this. The only place I've seen a similar culture is in the army. If you're exhausted or in physical pain or have a cold, you not only power through it but you suck it up and refrain from complaining, even if you're assisting a surgery. You may be officially encouraged to know and respect your limits, but if you actually do this you quickly go…

> If you ... have a cold, you not only power through it but you suck it up and refrain from complaining, even if you're assisting a surgery.

Where all those hospital-acquired infections come from?

Re: The Dark Side of Doctoring

#204

Post by abfan1127 »

PickledJesus wrote: post #180
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…

This is what horrifies a lot of us (British) about the NHS being further privatised. You create perverse incentives, beyond just providing the healthcare required.

Medicare isn't private. If it were, the premiums would be so high, that people would be forced to choose...

Re: The Dark Side of Doctoring

#205

Post by Para2016 »

arjie wrote: post #202
Para2016 wrote: post #201

Earlier quoted context omitted.

Oh yea? A lot of them can barely pass STEP 2 CS which just tests your ability to communicate in English and whether you can make two empathetic statements per patient encounter. You think FMG are on the same level as American educated MD/DOs? Some are and some are better, but as a cohort they are mediocre.

Well, considering there's a damned army of them, we can just filter them down to the top few (which will be a massive set on America's scale).

There are a ton of them, that's true. I do have one issue with a lot of them though. Many of them try to come into the US system just for the pay and they don't have a debt burden at all. For example, many of the FMG I have spoken with actually have their medical education subsidized by their home country, and then they leave for the US. I feel like doing that is unethical. Their home countries are making a direct investment via their taxpayers' dollars to educate medical doctors for their underserved populations. And then the FMGs try to leave as soon as they can without ever serving the communities that need them.

I have 250k in debt from undergrad+medical school, almost all of it loaned to me by the department of education. If I saw some international position open that was high paying and I could just desert my debt and the US, would that be right? I don't think so, that seems like a morally bankrupt thing to do.

Re: The Dark Side of Doctoring

#206

Post by pak »

killjoywashere wrote: post #35
maxerickson wrote: post #31

Earlier quoted context omitted.

In recent years residency slots have become the bottleneck.

There are ~30,000 PGY-1 spots and only about 18,000 allopathic medical school graduates. (1) All the native allopaths and all the osteopaths together can't fill all the residency spots. We inhale foreign medical graduates. (1) Pages v and 14: http://www.nrmp.org/wp-content/uploads/2017/04/Main-Match-Re...

So what good does increasing US medical school graduation rates do? OK, it would displace some IMGs/FMGs from residency positions, but it doesn't ultimately create more doctors. You can't be licensed to practice independently in the US unless you enter a residency, take the USMLE Step 3 after intern year, and typically you also take a specialty board exam at the end of residency.

See this to understand why the bottleneck is residency positions, not how many US medical students there are: https://www.nytimes.com/2014/07/20/opinion/sunday/bottleneck...

Re: The Dark Side of Doctoring

#207

Post by trowawee »

IIIIIIIIIIII wrote: post #160
trowawee wrote: post #48

Earlier quoted context omitted.

Every single study of the effects of fatigue on human cognitive ability that I am aware of indicate that A) fatigue can have massive deleterious effects on peoples' abilities to perform even simple tasks, and B) people are generally terrible at evaluating their own levels of fatigue. There's a good overview of a lot of this research here: https://hbr.org/2015/08/the-research-is-clear-long-hours-bac... . I don't know…

> The idea that doctors ... are somehow immune to those effects defies logic. That claim was never made by OP. Can we have a discussion without attacking a straw man, please? You yourself acknowledge you only know one side of equation. If the other components are larger it would not matter that you have shown one aspect - that nobody disputes, incl. OP! - to be negative. https://news.northwestern.edu/stories/2016/02/…

The parent comment:

> Also, on what basis do you say that longer hours with fewer tradeoffs don't improve patient outcomes? You frame it as though it's obvious but is there any evidence to back that up? My wife and most other doctors I know all claim they'd rather have longer hours with fewer handoffs.

I responded with evidence.

And yeah, I've seen the FIRST study. The control group, in this case, is working a 16 hour shift. Even if they only need one hour on either side of that shift to go from asleep to work and then back to asleep (which is not what I have seen), that control group is maxing out at 6 hours of sleep, well below the level where all but a tiny percentage of the population starts to see serious performance declines. https://hbr.org/2015/08/the-research-is-clear-long-hours-bac.... A more useful study would look at residents who are actually well-rested - who have gotten the consistently required eight plus hours of sleep over a significant enough period of time to have eradicated their existing sleep debt - and then compare their performance going forward while they continue to get enough sleep to residents working 16 or 28 hour shifts.

Re: The Dark Side of Doctoring

#208

Post by cnnsucks »

yjftsjthsd-h wrote: post #178
dikdik wrote: post #94

Earlier quoted context omitted.

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.

I observe that doctors somehow managed to make a living before 15 minute visits.

Indeed. I observe that women somehow managed without 32% of all births being Cesarean[1]. The last time I looked up that figure a few years ago it was 24%. What a racket.

[1] https://www.cdc.gov/nchs/fastats/delivery.htm

Re: The Dark Side of Doctoring

#209

Post by pdelbarba »

devdas wrote: post #154
pdelbarba wrote: post #16

Earlier quoted context omitted.

Maybe OT, but pilots have a lot of time off between shifts and it's starting to come to light that their depression rates are much higher than anyone is comfortable admitting. This may from a different source though, since flying is very much about precise repetition and less about complex decision making (ADM is hard, but not the same level of mental stress that doctors endure), you eventually realize that you're a…

Regulations for pilots currently mean that any treatment for depression means the pilot will no longer have a valid license. https://www.faa.gov/about/office_org/headquarters_offices/av...

Which is part of the problem. They never report completely treatable issues because of the bureaucracy surrounding the FAA medical program.

Re: The Dark Side of Doctoring

#210

Post by specialist »

abfan1127 wrote: post #204
PickledJesus wrote: post #180

Earlier quoted context omitted.

This is what horrifies a lot of us (British) about the NHS being further privatised. You create perverse incentives, beyond just providing the healthcare required.

Medicare isn't private. If it were, the premiums would be so high, that people would be forced to choose...

As I understand these things... Medicare is single payer and NHS is single payer & single provider. Which would make the British NHS more akin to USA's Veteran's Administration.

FWIW: I advocate single payer (Medicare for All), but not single (sole) provider.

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