Doctors, Revolt
nytimes.com
Doctors, Revolt
1–10 of 178 posts
Re: Doctors, Revolt
#2>Despite his reputation, Dr. Lown was treated like just another widget on the hospital’s conveyor belt. “Each day, one person on the medical team would say one thing in the morning, and by the afternoon the plan had changed,” he later told me. “I always was the last to know what exactly was going on, and my opinion hardly mattered.”
yes, this is what it is like to be a patient at a hospital these days. And good luck if the patient wants to speak to a physician. and don't ever go to a teaching hospital if you have the choice. some intern will have the brilliant idea to adjust every medication you are taking.
Re: Doctors, Revolt
#3> implying doctor’s don’t want 6-figure salaries
The manufacturing operations-ization of hospitals is both good and bad. Good because that means we have standard care (as desired by regulators and single-payer advocates) but bad because doctors lose the ability to perform customized care solutions.
I’m in favor of single-payer but we have to guard against turning healthcare into a manufacturing operation while also bouncing out bad actors and poo-quality physicians.
Re: Doctors, Revolt
#4For better or for worse, everything in America is a business -- healthcare is no exception. Helpful to keep in mind when you think about potential improvements or solutions.
Re: Doctors, Revolt
#5> implying doctor’s don’t want 6-figure salaries The manufacturing operations-ization of hospitals is both good and bad. Good because that means we have standard care (as desired by regulators and single-payer advocates) but bad because doctors lose the ability to perform customized care solutions. I’m in favor of single-payer but we have to guard against turning healthcare into a manufacturing operation while also b…
The issue with hospitals controlling healthcare is that they are the group with the least incentive to lower the cost of care
Hospitals account for the largest chunk of healthcare spend (30%). Hospitals make money by increasing inpatient admissions, particularly for profitable surgeries. The standardization of care in hospitals is intended to maximize profit under the constraints of various regulations around readmissions penalties, reimbursement limited length of stay, etc. If you look at the financials of public hospital companies like HCA and Community Health and Tenet, their major metrics are growth in admissions and surgeries. Even non profit hospitals are driven by this
The expansion of hospitals into owning tons of formerly independent specialist and generalist physicians is scary. Once in a hospital's system, these physicians act as loss leaders funneling patients into the hospitals profit center
Having hospitals in charge of the healthcare system is like having a fox in charge of the proverbial chicken coop
Re: Doctors, Revolt
#6Health care and education are IMO the next two major car wrecks coming for America. Both are like patients with similar symptoms (indicative of the general disease of America.)
- They treat the customers like replaceable widgets
- Costs are spiraling out of control. ($2-3000/day hospital, $3.4 TRILLION in total health spending [this equals the entire federal budget])
- Doctors / teachers often don't seem to communicate / care. (Friend's mother was recently in hospital, multiple doctors thru a single day, each one had to completely relearn what was going on.)
- The infrastructure systems are counter motivated (hospitals, drug companies, ect.. are profit not care motivated corps w/ "high" administrative overhead, schools are often public, yet view students as revenue and spend large amounts on noneducational costs to attract "talent". [$500k-$1.5M admin salaries])
No wonder many just want to self educate these days, and their health would be about as well served going to a shaman who cared about them.
Re: Doctors, Revolt
#7Going to a doctor in America, for whatever reason, the first thing that happens is that a nurse comes and takes your blood pressure. I wonder why? Never happened to me in Europe.
Re: Doctors, Revolt
#8>The medical team was concerned that because Dr. Lown was having trouble swallowing, he was at risk for recurrent pneumonias. So we restricted his diet to purées. Soon the speech therapist recommended that we forbid him to ingest anything by mouth. Then the conversation spiraled into ideas for alternative feeding methods — a temporary tube through the nose followed, perhaps, by a feeding tube in the stomach.
Maybe not the main point of this article, but there are numerous occasions where I’ve encountered just this. Allied health professionals, all of whom are very well intentioned, making recommendations that physicians readily follow without taking into consideration the needs or desires of the patient and family. If as a physician you are being advised to declare a patient NPO or to send them off to a skilled nursing facility instead of home - please remember that this is just a recommendation and that it’s your job to look at the patient as a whole, including their general medical condition, likelihood of their family supporting them, etc. before following through.
Re: Doctors, Revolt
#9Going to a doctor in America, for whatever reason, the first thing that happens is that a nurse comes and takes your blood pressure. I wonder why? Never happened to me in Europe.
When I asked, they said the insurance company forces them to collect two metrics or the insurance will reject the claim. That's why a nurse always gets your weight, temperature, and/or blood pressure regardless of the reason you're seeing a doctor.
Re: Doctors, Revolt
#10Health care and education are IMO the next two major car wrecks coming for America. Both are like patients with similar symptoms (indicative of the general disease of America.) - They treat the customers like replaceable widgets - Costs are spiraling out of control. ($2-3000/day hospital, $3.4 TRILLION in total health spending [this equals the entire federal budget]) - Doctors / teachers often don't seem to communica…
> Friend's mother was recently in hospital, multiple doctors thru a single day, each one had to completely relearn what was going on.
What's the alternative? 24 hour shifts for the doctor and the new doctor each day needs to relearn everything?
Having to relearn everything might be a problem, depending on what it actually means, but as long as we want a normal human being as a doctor, they will cycle over time as people start and end shifts, and they will need to learn what happened before their shift started (and they may receive patients from multiple doctors leaving over their shift, making 1-on-1 hand-off infeasible).
It's easy to call this out as a problem, the question is what's the alternative that's better?