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Doctors, Revolt

nytimes.com

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Re: Doctors, Revolt

#51

Post by techman9 »

GiorgioG wrote: post #34
maxerickson wrote: post #29

Earlier quoted context omitted.

An awful lot of hospitals are organized as non profits. Same with insurance. Spending goes up because a majority of politically engaged people have good access to care that they don't directly see the cost of.

> An awful lot of hospitals are organized as non profits. Same with insurance. Yep, and they all have administrators that make a ton of money. I worked for a Blue Cross Blue Shield franchise a decade ago. It is/was a "non-profit", the CEO made 2.1 million dollars per year. Non-profit != Money well spent

While I see your point, "CEO/Executive Pay" is a poor indicator of waste in these organizations. Fundamentally, Non-profits need to operate like businesses, in the sense that their balance sheets need to remain stable and their income needs to cover their costs. The difference between a non-profit and a corporation of course exists, in their respective names imply, in who they're beholden to. Non-profits exist to not make a profit, where "for-profit" corporations exist to deliver a profit to their shareholders. For-profit corporations pay their CEOs exorbitant amounts as well, and for non-profits to recruit talent, they have to do the same.

Re: Doctors, Revolt

#52

Post by civilitty »

kbenson wrote: post #25
araes wrote: post #22

Earlier quoted context omitted.

This was the desired behavior. Its not that they reviewed existing info to check for changes, its that they knew nothing. Like the last 30 minutes of questions and chart didn't exist. On the side of the patient, this does not inspire confidence. It projects a sense of confusion and disorganization.

Twenty years ago when I did tech support for a living, I had a series of questions worded in very specific ways I would ask at the start of a call. Sometimes the content of the answer was the useful part of the response, sometimes how the answer was said. More often than not, if I got someone on the other line that seemed to know a bit, skipping the questions ended up being counterproductive, as I would assume some k…

> When faced with a choice of behaving in a way making you think they care, or behaving in a way that makes you think they don't but actually provides better care and outcomes, what would you prefer? I think we need to be careful about jumping from "this is what it looks like" to "this is what's going on" without evidence clearly pointing to one over that other.

This is an important point but I feel you're approaching it from a very short term view. Look at Pakistan, for example: after the CIA used a vaccination program as cover for a genetic testing scheme meant to find Bin Laden [1], there was (and still is) a significant impact on the Pakistani and other population's trust in their domestic healthcare industry [2]. Even if it was a real Polio vaccination program that saved thousands of lives in a purely utilitarian short term calculation, the damage that distrust causes long term can far outweigh the benefits. Worst of all, due to the nature of that distrust, measuring that damage becomes so much harder.

The point is, doctors don't just need their patients to trust them, but to trust the institution of modern medicine and healthcare as a whole. They need the patients to trust their nurses, pharmacists, specialists, and technicians just as much as the primary doctor. Given how critical patient cooperation/honesty and preventative care are to clinical outcomes, I don't see any convincing evidence that patient perception isn't just as important as the rest of the process.

[1] https://www.theguardian.com/world/2011/jul/11/cia-fake-vacci...

[2] https://www.scientificamerican.com/article/how-cia-fake-vacc...

Re: Doctors, Revolt

#53

Post by Parcissons »

Spooky23 wrote: post #16
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.

Oh, the old ones where too - the stories just never circulated.

Someone i know worked as a surgery nurse - by now almost 40 years ago. The surgeon was quite choleric - and once, when a cotton -wad was unaccounted for threw a sewn off hip joint twoards those who dared to assist him.

All praise be upon the anaesthetist.

Re: Doctors, Revolt

#54

Post by kingkawn »

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…

Much better for each doctor to directly interview patient than to rely on previous histories that may have omitted crucial info or asked questions in a way that led patient to not realize what was being asked.

Re: Doctors, Revolt

#55

Post by araes »

kbenson wrote: post #25
araes wrote: post #22

Earlier quoted context omitted.

This was the desired behavior. Its not that they reviewed existing info to check for changes, its that they knew nothing. Like the last 30 minutes of questions and chart didn't exist. On the side of the patient, this does not inspire confidence. It projects a sense of confusion and disorganization.

Twenty years ago when I did tech support for a living, I had a series of questions worded in very specific ways I would ask at the start of a call. Sometimes the content of the answer was the useful part of the response, sometimes how the answer was said. More often than not, if I got someone on the other line that seemed to know a bit, skipping the questions ended up being counterproductive, as I would assume some k…

His very countenance rippled like the sea, and the sound of my own voice came back to me, distorted. ... it was how I affected his sounds and how she affected mine that transmitted the message. - SMAC

I don't disagree with what I interpret as the intent of your message - that there is real value in process, question repetition, and not jumping to conclusions.

I do think it implies a false choice at the end though. A doctor can imply they care / listen / are familiar with your case, while still asking insightful questions and probing for relevant changes.

[Analogy] As there are many engineers here, consider this contracting example: how would most companies respond if, for a project, at each meeting, the contractor sent a new representative, who asked all the same questions as the first meeting, could provide no status updates, and many reps suggested apparently different solutions, platforms, or approaches?

Re: Doctors, Revolt

#56

Post by BurningFrog »

mikecsh wrote: post #13
kbenson wrote: post #10

Earlier quoted context omitted.

> 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 thi…

Each doctor also has an incentive to re-examine the patient so they can bill for that examination.

Re: Doctors, Revolt

#57

Post by RA_Fisher »

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…

Yep and the common thread in both is the government.

Re: Doctors, Revolt

#58

Post by GuiA »

bsder wrote: post #50
whatthesmack wrote: post #35

Earlier quoted context omitted.

> HOWEVER, that is going to cost money. Quite a lot of money. And, really, nobody is actually interested in doing that in the US. This seems to imply that the US doesn’t spend enough money on education, even though it is (one of?) the highest spender(s) on education in the world (just from a quick Google search). I believe the real change needed is better management of how the existing money is spent.

You are regurgitating a "misused funds" talking point that Republicans always fall back on when facts don't support their position. The US isn't that out of line with spending: US is $15,171 per student while Switzerland is $14,922 per student. US is 7.3% of GDP while Denmark is 8% of GDP. Source: https://www.cbsnews.com/news/us-education-spending-tops-glob... There is not some magic bank of "misused" money waiting t…

1) any SUSTAINED focused resource improves educational outcomes 2) resource allocation is strongly sub-linear--it takes FAR more than 10% more resource to cause 10% improvement in outcome from our current system

I’d like to learn more about these 2 points, particularly the first (how it’s measured, etc). Is there any specific work of the Gates foundation you could point to?

Re: Doctors, Revolt

#59

Post by motohagiography »

The health sector is the Afghanistan of the tech business. It's entire history is of empires arriving to solve its problems, and after a decade and massive losses, they leave, mystified at how something so contained could be so intractable. The only people who survive there are the ones who don't try to change it.

When you can send your diagnostic images to get a consult from 2 clinics in India and an expert system for less than the price of a three block ambulance trip in the US, prices for domestic care will come down.

Re: Doctors, Revolt

#60

Post by craftyguy »

RA_Fisher wrote: post #57
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…

Yep and the common thread in both is the government.

Specifically, the government's mostly laissez-faire approach to handling both and, for education at least, its inability to prioritize it above other priorities like declaring war on vague concepts (drugs, crime, terrorism, etc)
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