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Things I've noticed while visiting the ICU

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Re: Things I've noticed while visiting the ICU

#371

Post by opportune »

rscho wrote: post #248
opportune wrote: post #218

Earlier quoted context omitted.

Completely agree. Any educated layperson can figure out and follow a clinical decision tree. I mean it can work in your favor if you know you need something and know how to get the decision tree to give you what you want, but otherwise clinicians should definitely be actual experts and not just meat following something a computer could do

> Any educated layperson can figure out and follow a clinical decision tree. 12-15h a day, 6 days a week with not even a lunch break? You're sorely mistaken. It takes an expert to follow clinical workflows.

What I meant is that I can follow it for myself, not do it for others. I don't have the training to know every medical decision tree by heart, but I can look up ones for problems I have and apply them.

I am a bit biased because I have several medical professionals in my family, but a common refrain is definitely that most doctors/nurses aren't going to be that engaged and helpful, and are more of a input/output device to navigate rather than someone you want to completely defer to.

Re: Things I've noticed while visiting the ICU

#372

Post by chromatin »

triceratops wrote: post #368
chromatin wrote: post #350

Earlier quoted context omitted.

It’s unclear to me how removing the requirement for an undergraduate degree (side note, it is not actually required at many or most US medical schools) will lower healthcare costs.

> it is not actually required at many or most US medical schools Source for this? That's surprising to me and a brief Google search tells me the exact opposite.[1] You really don't understand how reducing the number of years it takes to train a doctor, after they complete high school, will lower healthcare costs? Are you unfamiliar with supply and demand, or the relationship between the cost of production and pricing…

The link you posted says this:

> Every U.S. medical school requires the completion of a four-year degree from an accredited college or university.

However, if we look at the University of Chicago's Pritzker School of Medicine as just a single example [1] we see the following:

> "A baccalaureate degree is not required but is strongly preferred by the Admissions Committee."

Given that your reference, "Shemmassian Consulting", appears to be low-quality given that it makes categorically false statements, I won't bother to search for other schools. Suffice it to say that I am aware of quite a few, including my own, that do not require 4-year bachelor's degrees.

Finally, I understand supply-and-demand quite well, and I agree that increasing the supply of licensed US physicians may decrease healthcare costs (but it may not, as excess dollars in the system likely will be vacuumed up by administrators). However, this discussion is about decreasing entrance requirements to medical school, which is completely orthogonal.

[1] https://pritzker.uchicago.edu/admissions/entrance-requiremen...

Re: Things I've noticed while visiting the ICU

#373

Post by chromatin »

triceratops wrote: post #369
cfu28 wrote: post #343

Earlier quoted context omitted.

Is the point you're making here that removing the "premed" undergraduate degree (which doesn't exist) will somehow lead to reduced healthcare costs?

> the "premed" undergraduate degree (which doesn't exist) Yes there's no undergraduate major named "premed". There's no need to be pedantic. But US medical schools generally require a 4-year undergraduate degree (BA or BS) and certain coursework (biology and chemistry, among others). [1][2] > will somehow lead to reduced healthcare costs And yes, I'm saying that if it takes a couple years less to train a doctor - by…

> And yes, I'm saying that if it takes a couple years less to train a doctor - by letting them go directly to medical school after high school and doing the prereq coursework there over maybe 5.5-6 years instead of the current 4 - that will lead to lower healthcare costs. Not sure why that's so controversial of a statement. It's simple supply and demand.

It's "controversial" because you are conflating two issues.

Shortening the path will at most lead to a very minor supply increase at the time it is implemented; the gains don't compound. Without increasing the total number of admission spots (or more critically, residency slots), the overall supply will not be meaningfully increased.

Removing a prerequisite (bachelor's degree; which I point out in another comment is not actually required at many schools) is generally unrelated to the supply of US physicians and this is why you're getting pushback.

Re: Things I've noticed while visiting the ICU

#374

Post by Eleison23 »

Der_Einzige wrote: post #157
Eleison23 wrote: post #98

Earlier quoted context omitted.

Your human dignity is not predicated on how much pain you're in, how awake you are, or how able you are.

Uhh, yes it is to all three of those things. If I'm in pain, am delirious, and am unable to operate in the world. I've lost my dignity.

Just because you feel undignified, or humiliated, or useless, does not mean that you are. Don't swallow the lies.

Re: Things I've noticed while visiting the ICU

#375

Post by oaktrout »

barry-cotter wrote: post #274
oaktrout wrote: post #174

Earlier quoted context omitted.

If you've spent on average ~200K for medical school, how willing will you be to pay to work for 3 to 8 more years before you get a paycheck? Resident doctors already make less than nurses with 4 year undergraduate degrees.

So? People really, really want the prestige that goes with being a doctor. If they could pay for it they would. Physician compensation is heavily weighted towards middle and late career as it is and that hasn’t stopped people beating down the doors to get into medical school. Half the people who currently apply to medical school could look at how crap it is and decide not to and there would still be intense competiti…

I know a lot of doctors and medical students, for the vast majority prestige is not a primary motivator, not sure why you think its the prestige motivating everyone.

Knowing these people, I also get the feeling that if pay were worse / debt was higher they would have pursued alternate careers. If your goal is to make more physicians you don't want to make the job less desirable. There are already paid residency positions that go unfilled every year (not because there arent enough students, but because the students dont want them). I don't know why you think people would pursue positions that they have to pay for.

To your other point on the intense competition: If half the people currently applying to medical school quit applying the quality of your average future doctor would drop.

Re: Things I've noticed while visiting the ICU

#376

Post by triceratops »

chromatin wrote: post #373
triceratops wrote: post #369

Earlier quoted context omitted.

> the "premed" undergraduate degree (which doesn't exist) Yes there's no undergraduate major named "premed". There's no need to be pedantic. But US medical schools generally require a 4-year undergraduate degree (BA or BS) and certain coursework (biology and chemistry, among others). [1][2] > will somehow lead to reduced healthcare costs And yes, I'm saying that if it takes a couple years less to train a doctor - by…

> And yes, I'm saying that if it takes a couple years less to train a doctor - by letting them go directly to medical school after high school and doing the prereq coursework there over maybe 5.5-6 years instead of the current 4 - that will lead to lower healthcare costs. Not sure why that's so controversial of a statement. It's simple supply and demand. It's "controversial" because you are conflating two issues. Sho…

Yes you have to remove the other bottlenecks in the system too (I talked about residency spots in another comment). This seems like an easy win without any accusations of lowering standards.

> the gains don't compound

You give doctors, on average, an additional 2 years of their life to practice medicine instead of spending them in college on a pointless degree (not to mention, slightly lower college debt when starting out). Multiply that over however many doctors we graduate every year, and it'll add up over time. It's not "compounding" in the mathematical sense of the word, obviously. If you assume that a medical career is about 35 years, that's like an 8% increase in available doctor-years over 35 years (or something like that - the math is a bit handwavy). Without doing literally anything else.

I saw your other comment about degree requirements and I'll respond here. In addition to the consulting website, I also looked at Johns Hopkins and they do have a degree requirement. Thanks for providing that counter-example. I wasn't aware and I'll update my understanding of this.

However, your own source said "a baccalaureate degree...is strongly preferred". So it has to be asked - how many non bachelor's degree holders actually get into med school?

Every US-trained doctor I've had has gotten a bachelor's degree (I read bios when they're available). The ones that don't were foreign-trained. If the number of med school applicants greatly exceeds the spots, I'd imagine nearly all serious applicants are going to get a bachelor's degree to improve their chances. It sounds like you're a doctor - what proportion of people in your class got in without a bachelor's degree?

Re: Things I've noticed while visiting the ICU

#377

Post by banku_brougham »

bradknowles wrote: post #351
throwaway2037 wrote: post #309

Earlier quoted context omitted.

I'm not sure if you live in the United States, but Mayo Clinic is probably a top 5 hospital system in the US. It is legendary. Just read the opening paragraph from Wiki: https://en.wikipedia.org/wiki/Mayo_Clinic The Mayo Clinic (/ˈmeɪjoʊ/) is a nonprofit American academic medical center focused on integrated health care, education, and research.[6] It employs over 4,500 physicians and scientists, along with another 5…

IIRC, the Mayo Clinic invented the medical checklist. Like, people actually read the checklist and make sure that they tick off all the boxes they are required to tick off. That's why they are number one. Because they actually use checklists.

"The unreasonable effectiveness of checklists"

Re: Things I've noticed while visiting the ICU

#378

Post by conductr »

tomcam wrote: post #367
conductr wrote: post #365

Earlier quoted context omitted.

Probably no productive discourse to be had. We fundamentally have different views and I respect that.

I didn't express any views, only emotions. What disturbs me is that our views appear to be very similar. It's just at my age it is not exactly comforting.

Sorry I must have assumed you were dissenting with my stated views. But I now see you're actually not saying much at all so I'm having difficulty understanding what views are behind the statements regarding the feelings you've expressed.

Re: Things I've noticed while visiting the ICU

#379

Post by ghufran_syed »

fernly wrote: post #216
ghufran_syed wrote: post #155

Earlier quoted context omitted.

ability to afford the ICU is not relevant at all when the docs decide to put someone there or not, based on my 14 years practicing in the US. Do you have any experience to the contrary? I’m pretty sure that would be illegal in the US

A very quick DDG search turns up stories from reputable outlets: "Americans dying because they can't afford medical care"[1], "66% of Americans fear they won’t be able to afford health care this year"[2], "Nearly 46m Americans would be unable to afford quality healthcare in an emergency"[3], "Nearly 1 in 4 Americans are skipping medical care because of the cost"[4], and more are easily found. If this doesn't reflect…

That’s the patient choosing not to go to the doctor - how is that the ICU doctor’s responsibility? Are they meant to scour the streets looking for people who need intensive care?

Re: Things I've noticed while visiting the ICU

#380

Post by EMM_386 »

xwdv wrote: post #346
EMM_386 wrote: post #189

Earlier quoted context omitted.

Interesting question ... plane of existence. I was hearing voices that convinced me I was not where I thought I was, it was an illusion of sorts and it was best to leave. Immediately. For reasons unclear to me.

I mean where did you even expect to go if you were inside an illusion? Another illusion?

At the time, when you are hallucinating, whatever they are saying to you is the "truth".

May give an insight into schizophrenia or anything else.

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