The profession as a whole is profoundly hostile to any serious considerations of mental health, and it’s going to take many more suicides before even the smallest steps are taken toward obvious quality of life improvements.
The darker side of being a doctor (2017)
51–60 of 521 posts
Re: The darker side of being a doctor (2017)
#52The shit we make doctors go through is unnecessarily insane. It takes 300-400k of debt and grueling 7-8 years on top of a bachelors degree, with bunch of uncertainty on where you'll be or whether you ever make it, just to start working. If you ever quit before then, any progress made counts for zero and you have to start all over again in a new field with a ton of debt.
Why doesnt an MD or even credits at a medical school count toward nursing, physician assistsnt, etc?
Lastly, med school is unnecessarily long. You don't need most of the material to do family medicine for example.
I really don't understand how such inefficiencies could be tolerated.
Re: The darker side of being a doctor (2017)
#53"Medicine used to be a meaningful pursuit. Now it has become a tiresome industry. The joy, purpose and meaning of medicine has been codified, sterilised, protocolised, industrialised and regimented. Doctors are caught in a web of business, no longer a noble vocation. The altruism of young doctors have been replaced by the shackles of efficiency, productivity and key performance indicators."
That's textbook Marxist alienation of work. It was not supposed to happen to middle class workers though.
Re: The darker side of being a doctor (2017)
#54Most of the issues mentioned in the article and the included email are concerning, however they also oddly seem to be common in many places across the globe. The surgeon mentioned was in Australia, I have seen these issues first hand in the Netherlands and am aware of very similar of the first 2 out of 3 issues (caused by overwork/understaffing/over-fatigue etc) in Belgium, Germany, the UK, India and god knows how ma…
The understaffed healthcare system works with overworked doctors on the basis that having a tired and overworked doctor is a lot of the times better than having no doctor at all, because (s)he most likely can end up saving more lives than taking with their tired brain. If your operations have a 90% survivability rate it could still be considered a success despite those 10% they end up killing, because 90% is a lot be…
IMO this is doctors acting as enablers of a toxic administration. They need to refuse outright to not work crazy hours and force the system & administration to come to a crisis. The admins are not working those hours and thus do not feel the consequences of their actions and by enabling their bad behavior they are not getting consequences from their bosses, which are politicians and customers.
Re: The darker side of being a doctor (2017)
#55Most of the issues mentioned in the article and the included email are concerning, however they also oddly seem to be common in many places across the globe. The surgeon mentioned was in Australia, I have seen these issues first hand in the Netherlands and am aware of very similar of the first 2 out of 3 issues (caused by overwork/understaffing/over-fatigue etc) in Belgium, Germany, the UK, India and god knows how ma…
For inpatient hospital care, research has shown that transitions in care are particularly risky for patients. When one doctor goes off shift and hands off a patient to another doctor, sometimes things fall through the cracks. In theory all of the data needed for a smooth transition should be documented in the patient chart, but in practice this doesn't always get done plus there is some tacit knowledge which clinicia…
I haven’t read that literature very closely, but will say that I have seen lots of handoffs, and they generally involve someone who has been working 12+ hours, very often 24+ hours, who needs to hand off 10s of patients to 3+ people, all of whom have things to do and can be hard to schedule around, before they can go home.
It is not at all surprising to me that these kind of hand offs result in things being missed, and equally obvious that decreasing the patients per provider and increasing hand off window hours would at least reduce some of those errors, if not outright improve them. Bonus points for putting the peak of handoffs into late morning hours, where much more of the decision making is completed.
Of course, the only way to do that is to either:
1) drag hours out longer, which I think lots of MDs would be fine with if they weren’t expected to turn around and do it again in 18-36 hours, requiring increased staffing
Or 2) increase staffing all around and just maintain more reasonable ratios
Re: The darker side of being a doctor (2017)
#56My not so generous and extreme take is that the medical profession has a “hero culture”.
There is prestige in working your ass of and living for work. Work life balance is for the weak people who can’t take it, they are not real health professionals. They don’t have what it takes.
I have seen the same culture in aid work.
I find it ironic that both health professionals and aid workers are there to help people, but not for each other. Then it’s cut throat.
Re: The darker side of being a doctor (2017)
#57Something I've never quite understood is why, in the UK, we cap the number of medical students per year. I've known very bright people who aspired to be doctors but had their applications turned down only to go on to do phds and become scientists instead. I'd rather have twice as many doctors who work sensible hours rather than the status quo burn out. Looks like there are calls to change this. https://commonslibrary…
Supply and demand. If you artificially cap the supply of doctors, then the doctors can ramp up their prices.
Perhaps there's a little of that going on here in the UK. Doctors can certainly command a decent salary especially if they specialise, run private clinics etc. That said, I feel it's probably more complicated than that. Each place costs approx £230k (only £65k paid by student by way of loans). This means increasing supply is a costly endeavour. The government also says that they wish to maintain teaching and learning standards; although, I don't really buy that part.
Re: The darker side of being a doctor (2017)
#58Earlier quoted context omitted.
Sure, it's very easy! Just do things that prevent burnout ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/ ) and the job gets more attractive, drawing more students and producing less attrition: - Valuing work gives meaning (money, appreciation) - Autonomy gives feeling of control - Managing burden prevents overwork, exhaustion and fatigue
Sounds good, but healthcare already constitutes 17% of US GDP. And with an aging population, spending has been growing faster than the rate of inflation. Most of the funding ultimately comes from governments, self-insured employers, and individual patients. Those groups have no appetite for spending more. The bottleneck right now in producing more US physicians is lack of Medicare funding for residency slots (graduat…
The entire medicare residency slot system seems a bit self inflicted, why hasn't an alternative system popped up?
Also this is a global problem, not just the USA. You look at videos of student doctors in the UK for example and there are similar abusive schedules. https://www.youtube.com/watch?v=KE1XwEMGm0I
Re: The darker side of being a doctor (2017)
#59Earlier quoted context omitted.
Supply and demand. If you artificially cap the supply of doctors, then the doctors can ramp up their prices.
That explains why doctors like the status quo. Insurers like it, too, because expensive tests and expensive procedures must be ordered by a doctor (at least if insurance is going to pay for it) and if the patient gives up on getting in to see a doctor, then the insurer does not need to pay for the expensive test or expensive procedure. In the US, employers like it, too, because they end up paying the insurance premiu…
And the schools prefer it (at least in the US) - limited highly paid doctors means they can charge exorbitant tuition.
Re: The darker side of being a doctor (2017)
#60"Medicine used to be a meaningful pursuit. Now it has become a tiresome industry. The joy, purpose and meaning of medicine has been codified, sterilised, protocolised, industrialised and regimented. Doctors are caught in a web of business, no longer a noble vocation. The altruism of young doctors have been replaced by the shackles of efficiency, productivity and key performance indicators." That's textbook Marxist al…
Oddly enough medicine has never been more regulated and financed by government so hard to say this is some sort of marxist dynamic, more like the consequences of centralization that happened after (because of) WWII. You see this in the US/UK/Canada regardless of whether they're "socialized" it's a mess everywhere.