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Doctors, Revolt

nytimes.com

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Re: Doctors, Revolt

#11

Post by mikecsh »

sampo wrote: post #7

Going 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.

In the UK (not an insurance-based system), many GPs ("family doctors") will aim to take a BP reading if there is time. This is partly because there is a system called the Quality Outcome Framework that incentivises practices to do so, but the route of it is that those incentives are in place because high blood pressure is extremely common, under-diagnosed, and has huge health consequences if left untreated, which in turn is extremely expensive for a national health service. A BP check is quick, simple, and cheap, and can help to identify problems early on when simpler interventions can stave off bad outcomes.

Re: Doctors, Revolt

#12

Post by slededit »

sampo wrote: post #7

Going 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.

High blood pressure has been a major problem in North America for decades. Its part of early screening.

Re: Doctors, Revolt

#13

Post by mikecsh »

kbenson wrote: post #10
araes wrote: post #6

Health 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 peo…

In addition to this, many doctors want to re-take the history from the patients and re-examine them for themselves, rather than rely on a brief handover or potentially sub-optimal notes from another doctor. Clinical signs can be subtle, as can points in a patient's history that may point to a diagnosis. I see patients often frustrated at being asked the same questions by each doctor they see, but most of the time this is in their best interest.

Re: Doctors, Revolt

#14

Post by WhatIsDukkha »

kbenson wrote: post #10
araes wrote: post #6

Health 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 peo…

The doctors individually spending 5 quiet minutes reviewing the case files of the patients they were about to treat BEFORE they arrived.

That's not modern reality and its shameful.

Re: Doctors, Revolt

#15

Post by WalterSear »

nugget wrote: post #4

For 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.

You've identified the root cause.

Re: Doctors, Revolt

#16

Post by Spooky23 »

tensor_rank_0 wrote: post #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…

You have to bring an advocate who is able to sniff out bullshit, establish rapport with senior nursing staff and be a pushy asshole when necessary.

A modern hospital is a zero trust environment.

Re: Doctors, Revolt

#17

Post by lkrubner »

nugget wrote: post #4

For 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.

"everything in America is a business"

If by "business" you mean a public/private hybrid in which profits are privatized while losses are socialized, then you are correct, in so far as health care goes. And that seems to be the model that is now being adopted in more and more areas of economic activity.

Re: Doctors, Revolt

#19

Post by shawndimantha »

kbenson wrote: post #10
araes wrote: post #6

Health 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 peo…

Part of this can be solved by having better care managers associated with each patient (primary care doctors), who can share relevant information with different parties. Works mainly for chronic care. In the case of acute cases, information needs to be readily accessible in a format that is interpretable by doctors when they go through the process of assessing differential diagnoses. That information is not captured well right now, hence the ask for patient's history with each new physician. Personal health records with smart annotation of key pieces of information can play a part in solving this problem, but are only part of the answer. One of the most dangerous periods in the emergency room is the transition of one care team shift to another. It takes forever, and often leads to key information loss.

Re: Doctors, Revolt

#20

Post by thesagan »

kbenson wrote: post #10
araes wrote: post #6

Health 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 peo…

We can start by treating this as an important problem and tasking ourselves with looking for and finding alternatives and putting political/financial pressure on these institutions to consider them.

Just asking "but what are the alternatives" isn't productive in itself, and doesn't really carry the conversation forward. It more likely shuts it down as a hopeless problem. We can do better. It's not hopeless and we're not powerless as a collective.

I'm sure there are alternatives but we're not looking for them very well. We could start there. I'm doing my part by bringing this up in conversation whenever it's relevant and getting to know my state representative and state senator. I also make noise towards the hospital's admins in the meanwhile.

---------------

Also, the article discusses possible alternatives. Here are a couple of paragraphs from it:

"This begins with our own training. Certainly doctors must understand disease, but medical education is overly skewed toward the biomedical sciences and minutiae about esoteric and rare disease processes. Doctors also need time to engage with the humanities, because they are the gateway to the human experience."

"To restore balance between the art and the science of medicine, we should curtail initial coursework in topics like genetics, developmental biology and biochemistry, making room for training in communication, interpersonal dynamics and leadership."

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