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Doctors, Revolt

nytimes.com

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Re: Doctors, Revolt

#131

Post by YeGoblynQueenne »

waffle_ss wrote: post #100
WhatIsDukkha wrote: post #14

Earlier quoted context omitted.

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.

That's not modern reality according to whom? My spouse is an MD and she spends a minimum of 45 minutes before her shift reviewing her patients' charts. After work, at home she tidies up patient notes to ensure the next person gets an efficient summary of the patient. Then after dinner she's answering a bunch of instant messages from patients on the hospital's patient portal and doing any prep necessary for the next d…

On the other hand, at least some of us would give an arm or a leg to be able to do work as impactful and useful as doctors.

Re: Doctors, Revolt

#132

Post by chimeracoder »

jdminhbg wrote: post #76
wyager wrote: post #32

Earlier quoted context omitted.

I don’t like that wording because it implies that hospitals somehow benefit from government involvement; in reality, it just sucks for everyone. In general, I agree - very few medical institutions in the US actually get to be private. I will say that truly private medicine is, in my reasonably broad experience, excellent. I use a private subscription-only medical service in the US which is excellent (and procedures a…

> it implies that hospitals somehow benefit from government involvement But they very clearly do. A huge proportion of their income comes from government sources (Medicare/Medicaid/VA), they are subsidized by tax exemption for health spending, and government grants them the power to deny competitive entrants into their markets via "certificates of need."

> But they very clearly do. A huge proportion of their income comes from government sources (Medicare/Medicaid/VA)

Hospitals lose money on Medicare and Medicaid patients on the margin. They have to overcharge private insurers to make up the difference.

It's so bad that Medicare has not one but multiple programs to compensate hospitals that don't see enough private patients to make up the difference, because otherwise they wouldn't be able to sustain themselves on Medicare reimbursement rates.

I don't know why you're even mentioning the VA; it's not relevant here at all.

Re: Doctors, Revolt

#133

Post by AnIdiotOnTheNet »

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…

All I want out of a physician is an expert consultant. I have goals for where I want my health to be, and I could use advice on how to get there that doesn't require me to spend so much time separating the wheat from the chaff of google results. This could be handled over email most of the time. But most doctors I've met don't seem to see themselves in this role. They seem to think their job is to take measurements and tell me how far out of spec I am. Worse yet, most of them believe they are infallible. Its fine if you're making educated guesses doc, just don't act so damn confident about them and dismiss the negative results.

Maybe I've had bad luck in doctors. It's not like I get a choice in them, the way the US system works. Three times in my life I have had severe chronic problems that were ultimately solved by my own inexpert research and experimentation or by the inexpert observations of a casual observer. These days I only bother to go to a doctor after I have a good suspicion of what's wrong already, like if I broke a bone or something.

Re: Doctors, Revolt

#134

Post by pishpash »

chimeracoder wrote: post #129
pishpash wrote: post #75

Earlier quoted context omitted.

> ... gets an extraordinary result from a collection of ordinary people Of course doctors are ordinary people. The ones that become doctors these days aren't even the brightest in school -- those go into STEM or, god forbid, finance. But if they are ordinary people why are they paid like the superhuman healers that they aren't and still hold themselves as such?

> But if they are ordinary people why are they paid like the superhuman healers that they aren't and still hold themselves as such? They're not. The lifetime after-tax expected earnings of a person entering medical school today, after work and operating expenses are taken into account, is probably a lot less than the equivalent figure for the average Hacker News reader. Doctors make nowhere near as much money as peop…

I speak of labor cost, so don't include student debt, delayed employment due to training, and taxes as they are kind of irrelevant. Malpractice insurance counts, not sure what other "work and operating expenses" are unique to doctors.

Re: Doctors, Revolt

#135

Post by YeGoblynQueenne »

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, they do. In my GP's surgery there's even an automated machine in the lobby that will print out your BP and a sign advising to take your BP if you haven't "recently" and bring the printed slip with you to show the doctor or nurse.

Re: Doctors, Revolt

#136

Post by dominotw »

bawana wrote: post #67

Hospitals should post prices of their procedures in the lobby. A surgeon gets $500 to repair a hernia and the hospital pulls in $5k for the ancillary services. The surgeon has to see the patient,make the diagnosis, provide the treatment, provide the aftercare and be the 'face'. The hospital-insurance complex has managed to create this fantasy world with complicated rules and somehow have sequestered themselves from t…

> Hospitals should post prices of their procedures in the lobby. A surgeon gets $500 to repair a hernia and the hospital pulls in $5k for the ancillary services

Cost for repairing hernia is not exactly the same for every patient though. Depends on the severity, general health of the patient and a million other things.

Not sure if its even possible to put an upfront price. Even if they did, how do patients know beforehand what exactly they need to figure how much they are going to pay. Maybe that works for simple things like a flu shot but seems impossible to for anything even slightly more involved.

Re: Doctors, Revolt

#137

Post by gaius »

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…

What's the alternative?

Methodologies such as Kepner-Tregoe explicitly make handovers very easy, used very effectively in manufacturing, energy, and other industries. But God forbid that almighty doctors should ever take any advice from outside their profession.

Re: Doctors, Revolt

#138

Post by gaius »

chimeracoder wrote: post #127
mikecsh wrote: post #120

Earlier quoted context omitted.

And this certainly isn't the case in the NHS in the UK where doctors have no financial incentives interfering with their clinical decisions (barring saving the service money). What you describe is a pitfall of private medicine.

> And this certainly isn't the case in the NHS in the UK where doctors have no financial incentives interfering with their clinical decisions (barring saving the service money) This meme really needs to die. The NHS has massive financial incentives that impact clinical decisions. In fact, you literally go on to mention as such in your next sentence. It turns out that having an incentive to "save the system money" res…

This meme really needs to die. The NHS has massive financial incentives that impact clinical decisions.

Not to mention that many if not most NHS-employed doctors run private practices on the side. Some only spend a day or two a week on their NHS duties. Others such as GPs are NHS-branded, but every GP practice is a private business that bills the NHS for time and materials.

Re: Doctors, Revolt

#139

Post by chimeracoder »

YeGoblynQueenne wrote: post #130
chimeracoder wrote: post #127

Earlier quoted context omitted.

> And this certainly isn't the case in the NHS in the UK where doctors have no financial incentives interfering with their clinical decisions (barring saving the service money) This meme really needs to die. The NHS has massive financial incentives that impact clinical decisions. In fact, you literally go on to mention as such in your next sentence. It turns out that having an incentive to "save the system money" res…

The NHS does worse in treating cancer than other countries, but many of those countries (Germany, France, etc) have public health care also. It's not clear that the difference in performance is because of public, vs privately, funded medicine.

> The NHS does worse in treating cancer than other countries, but many of those countries (Germany, France, etc) have public health care also. It's not clear that the difference in performance is because of public, vs privately, funded medicine.

Right, I'm saying that the difference isn't simply a matter of private vs. public funds, the way OP claims. You can really trivially create a private system that has the same bad incentives with respect to costs and care as the NHS does. You can also trivially create a public system that has the same bad incentives with respect to costs and care as the US does.

That said, Germany and France aren't really publicly-funded as well the way people think. Both rely on a private network for care delivery (unlike the NHS), so it's a bit of a stretch to say that they're "public health care" systems. Even if you're looking at funding, in those two countries, taxpayer funds only cover 75% and 70% of expenses, respectively.

Re: Doctors, Revolt

#140

Post by milesdyson_phd »

WhatIsDukkha wrote: post #14
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…

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.

5 minutes lol. From a surgery perspective: Getting a consult as an intern on a patient with a big case file is like (at least) 30 minutes of reading notes, then you talk with the patient, then you talk with your senior, then you and the senior go talk to the patient, then the senior talks to the attending (depending). Sign out (patient hand off) can take a while depending on the size of the list but I don't know any other interns that don't stalk the charts before they are about to come in so it's usually just a quick brief on each patient and what therapies are going on. Did I mention you do sign out (on trauma) after having been at the hospital for 24+ (sometimes 30 depending on attending) hours? Things can and do still get missed.
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