‘Alarming’ burnout is making doctors want to kill themselves • Hacker News Board

Re: ‘Alarming’ burnout is making doctors want to kill themselves

#21

Post by aeternus » Wed, Jan 16, 2019, 10:01 PM UTC

eldavido wrote: post #3

It is a well-known fact that the entire industry under-invests in tech infrastructure. Congress literally paid them to do it using "meaningful use" incentives as part of the ACA, and still can't get them to invest more. Ask yourself who has better front-office CRM: your local car dealership or your doctor? Do you think the audo dealership does it because they like spending money? No, it's because they compete and are…

Patient-perceived quality of care isn't the right measure. Patients don't like being told that they need to exercise, lose weight, drink less alcohol, rest.

A large part of a patient-perceived score is whether they get what they want. This often isn't in the best interest of the patient. With patient-score focused medicine, you get over-prescription of pain-meds, adderall, antibiotics. You also incentivize doctors not to challenge patients with dangerous views like anti-vax.

Re: ‘Alarming’ burnout is making doctors want to kill themselves

#22

Post by eldavido » Thu, Jan 17, 2019, 12:20 AM UTC

aeternus wrote: post #21

eldavido wrote: post #3

It is a well-known fact that the entire industry under-invests in tech infrastructure. Congress literally paid them to do it using "meaningful use" incentives as part of the ACA, and still can't get them to invest more. Ask yourself who has better front-office CRM: your local car dealership or your doctor? Do you think the audo dealership does it because they like spending money? No, it's because they compete and are…

Patient-perceived quality of care isn't the right measure. Patients don't like being told that they need to exercise, lose weight, drink less alcohol, rest. A large part of a patient-perceived score is whether they get what they want. This often isn't in the best interest of the patient. With patient-score focused medicine, you get over-prescription of pain-meds, adderall, antibiotics. You also incentivize doctors no…

That's perhaps true in some cases. But I think patients need to have a little more skin in the game.

Take knee surgery. My surgeon friend does 7 of these each day at $30K/surgery (he "only" gets about 10% of the charged amount). If there was even a 10% copay on this, possibly means-tested if you want to make it fair for poor people (meaning it goes up the more income/wealth you have), you'd better believe more people would choose dietetics (my mom's profession, group classes cost like $10 each) over $30K knee replacements.

You're talking about a procedure that costs roughly the yearly pretax median income of a US adult. Some people have multiple of these per life. We can play the "who pays" game all day, pushing the cost of care around on the plate, as it were, but until we stop prescribing high-cost surgeries and expensive solutions to chronic conditions, the needle isn't going to move on how much we spend on health. 20% of GDP and growing, to be exact.

I just don't think there's a way around this without forcing patients to feel a bit more pain.

Re: ‘Alarming’ burnout is making doctors want to kill themselves

#23

Post by bawana » Thu, Jan 17, 2019, 1:10 AM UTC

0xdeadbeefbabe wrote: post #15

Are there any rogue doctors who don't fill out paperwork?

All of us using EMRs don't fill out paperwork anymore. We just copy-paste. Unfortunately admins think you can quantify stuff by making more measurements. But that's so amusing if you just talk to a few patients. It's like trying to quantify the quality of poetry.There is a HUGE gap between the patient's experience and the actual disease. That's why our ERs are clogged with people who think they are sick. Getting through that thick layer of emotion and still communicating with the patient is hard work.And it often fails. It's like the policeman who comes to the scene of an accident and tries to get the story of what happened from the accident victim (if she/he can even talk). Even if the victim is capable of speaking, the emotional turmoil renders the story moot. And amid all this chaos, they expect us to make cost effective diagnostic decisions? where one slip up can lead to an error of omission or an error of commission? and then a law suit? And if you are an employed physician, there is a bean counter looking to make you word harder. Even if you are part of a private group practice, the old guys take a cut of your money while you sweat, cry and bleed.

Re: ‘Alarming’ burnout is making doctors want to kill themselves

#24

Post by candiodari » Thu, Jan 17, 2019, 1:21 AM UTC

eldavido wrote: post #3

It is a well-known fact that the entire industry under-invests in tech infrastructure. Congress literally paid them to do it using "meaningful use" incentives as part of the ACA, and still can't get them to invest more. Ask yourself who has better front-office CRM: your local car dealership or your doctor? Do you think the audo dealership does it because they like spending money? No, it's because they compete and are…

> The solution is really pretty simple: there needs to be meaningful competition on the (patient-perceived) quality of care.

Competition would require at least a slight oversupply of doctors. Right now there's a shortage: we're training about 80% of the doctors we need for the current levels of procedures. Meanwhile the population is getting older and that means more procedures. This will get worse before it gets better.

So this can only happen if we increase funding quite a bit for medical training programs, essentially country-wide. 25%, absolute minimum.

Re: ‘Alarming’ burnout is making doctors want to kill themselves

#25

Post by woodandsteel » Thu, Jan 17, 2019, 1:31 AM UTC

I have a rule that whenever we have a problem or controversy in the US, one of the things we should do is look at what the situation is in other countries, and in particular see if they are doing things better there.

With that in mind, what is physician morale like in other countries, especially Western European ones? And if it is, as I suspect, significantly better, then what is the reason?