81–90 of 118 posts
I have zero medical expertise, but it sounds like this situation could be improved with software. Given a database that contains an exhaustive list of every illness and symptoms: illness symptom diagnosis_symptom_set ------- ------- ---------------------- id id id name name symptom_id (FK->symptom.id) illness_id (FK->illness.id) (Pseudo SQL) SELECT diagnosis.name as name FROM diagnosis_symptom_set diagnosis_sympt JOI…
Someone give this guy a nobel peace prize!
> As for Huls, he is finishing up his fellowship at the hospital this summer. Wherever he ends up, he is certain he will find new cases to challenge his curiosity, cases he hopes to solve. No, he won’t, because only early stage residents are given the freedom from economic realities to spend hours digging and thinking through records. Docs aren’t paid for their time, nor even for results - and their employers (read:…
For some time my read on this situation has been that the "doctor shortage" that produces 7-minute diagnoses stems from a restricted number of residency slots, which is set (I believe?) by the federal government. I had thought the AMA was influential in lobbying to keep the number of such slots low to prop up doctors' salaries, but with some research it's unclear how true this is. Anyone know? How strong a lobbying f…
The problem with residency slots is that they’re funded as part of the larger Medicare legislation, and no one wants to push for the bump in funding/taxes for Medicare needed to expand it.
The reason visits are seven minutes long is because part of a trend that started with the HMOs in the 80s. The hypothesis on the part of insurers was that docs have a general target income - that they don’t work at maximum capacity (in general - obviously wonky things happen at the extremes.) If you reduce per-service billing, docs would maintain constant output to hit their personal target income goal. And... that’s exactly what happened. Since then, insurers have continued to hit against per-service fees, and docs and facilities have continued to shrink the time they alot to each service in order to keep afloat. In fairness, docs don’t have an awful lot of flex on this - they have to meet overhead costs which are fixed regardless of how small their reimbursement gets, and even with pitifully short visits doc real earning power has gone down quite a lot in the last 30 years. Docs work about 3x as hard as they used to, for about one third of the real income.
It’s actually a bit scary: there’s not a lot of leeway left in this, and medical education is more expensive than its ever been. Docs carry the financial risk and massive increase in burnout, patients bear the risk of the reduction in time and quality of care, and everyone else is squeezing the juice out of the grapes. Something’s gonna give.
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> Presumably you wouldn't do that to her after she saved your life. Oh, you grossly underestimate what people are capable of. At least in China there are many reported cases of such horrible patients. Maybe US being a developed country have fewer these people, but definitely not zero.
You're right of course, and this isn't limited to the Chinese. It's best to have physicians in the family; marry one if there isn't one already! This isn't practical for everyone, so perhaps it's best to choose a capable young physician early in life, so that by the time such trust is required it has already formed. Probably there are other professions in which one gets better service if one has an inside connection,…
Having a doc in the family is a mixed blessing at best. You can get priority treatment, and the benefit of your family members full attention. On the flip side, all the docs I know that aren’t fools or morons don’t treat their own family for anything more serious than a scrape. You’re biased, you don’t want the guilt of an error, and you don’t want to be the bearer of bad news. I frequently ask my wife not to ask me about her mother’s health developments; I’d rather tell comforting lies than be a source of sour truth.
Being a VIP in a medical center due to your relatives gets you more ass kissing, not better care. People don’t want to step on toes, or give the impression that useful care is being withheld. And if your relative is a worse doc than the one you’re seeing? No one is going to overrule your family member to your face.
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What country is that which doesn’t pay doctors?
Did you really link 'free healthcare' with 'a country that does not pay doctors'? Clearly healthcare can be free to the recipients while doctors still get a good salary.
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What country is that which doesn’t pay doctors?
Did you really link 'free healthcare' with 'a country that does not pay doctors'? Clearly healthcare can be free to the recipients while doctors still get a good salary.
The only thing I can say in their defense is that at least docs in those countries don’t generally take on massive, private, un-dischargeable debt in order to do the job. In the US we treat the medical workforce as a public good, though they have to take on all the risk of entering that workforce through private financing.
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Did you really link 'free healthcare' with 'a country that does not pay doctors'? Clearly healthcare can be free to the recipients while doctors still get a good salary.
I get to drive on most roads without paying, but I wouldn't say that the roads are "free"?
Clinical research types may find this still imperfect tool to be of use none the less.
https://monarchinitiative.org/disease/MONDO:0018304#phenotyp...
Full disclosure: guilty guilty guilty
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Why doctor? It's the most expensive part of your healthcare. But it can be trainee/researcher/AI. Which could be absolutely out of expensive healthcare system. Service which you could buy for additional cost from company which has good guess/prediction ratio based on input parameters from doctor. Service which could be in any part of the world.
I have often thought that the Freestyle Chess model (a variation of Advanced Chess https://en.wikipedia.org/wiki/Advanced_Chess ) could be applied to medical diagnosis. Create a team consisting of one or more human doctors with a medical diagnostic AI. From the article it sounds to me that a lot of the research could have been done by an AI, with the human doctors making the final decision on the "best" diagnosis.
https://en.wikipedia.org/wiki/Clinical_decision_support_syst...
Earlier quoted context omitted.
You're right of course, and this isn't limited to the Chinese. It's best to have physicians in the family; marry one if there isn't one already! This isn't practical for everyone, so perhaps it's best to choose a capable young physician early in life, so that by the time such trust is required it has already formed. Probably there are other professions in which one gets better service if one has an inside connection,…
> Probably there are other professions in which one gets better service if one has an inside connection, but this situation really speaks ill of how medicine is practiced. Having a doc in the family is a mixed blessing at best. You can get priority treatment, and the benefit of your family members full attention. On the flip side, all the docs I know that aren’t fools or morons don’t treat their own family for anythi…
> As for Huls, he is finishing up his fellowship at the hospital this summer. Wherever he ends up, he is certain he will find new cases to challenge his curiosity, cases he hopes to solve. No, he won’t, because only early stage residents are given the freedom from economic realities to spend hours digging and thinking through records. Docs aren’t paid for their time, nor even for results - and their employers (read:…
Is there a way to actually request a specific doctor have some time dedicated to figuring your case out at your expense? i.e. "Please do more troubleshooting for me above what insurance pays." I like your idea - but I fear the industry might have already ruled it out. -edit- Granted, I've done this in my own life by going to specialists at their own offices/outside of a hospital or medical group.