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The darker side of being a doctor (2017)

drericlevi1.substack.com

11–20 of 69 posts

Re: The darker side of being a doctor (2017)

#11
a couple things to consider:

* high turnover impacts efficiency.

* Exhausted doctors make mistakes which will lead to malpractice lawsuits

I think incentives are misaligned across the board in the medical industry. This goes for doctors, patients, hospitals, insurance providers, pharmaceutical companies, medical device manufacturers, medical equipment/material supply companies and probably everyone else connected to the industry.

These poor incentives lead to pathologies that drive up costs and result in poor patient outcomes.

Anyone who has encountered a "prior authorization" when trying to get a time sensitive medication filled has experienced this.

Some doctors are opting to "drop out" of the counterproductive insurance game by accepting only cash payments, but that only solves a small part of the problem.

Re: The darker side of being a doctor (2017)

#12

I strongly dislike the way people talk about mental health as if it is just a personal problem or a disease when, often, it is a reasonable reaction to the world as it is. When we conceive of it entirely as a disease we fail to focus on making positive social changes which might make everyone's lives better. Somehow it doesn't feel like a coincidence that in capitalism the "individual problem" narrative seems to alwa…

I think the challenge is that no matter the circumstances our minds are designed to adapt to the situation. This is often called the hedonic adaption. If you live in a modern western country, your life is likely significantly better than the wealthiest and most powerful people from the 14th century. Most likely if you're prone to depression, you will reset to a negative viewpoint even if societal issues are addressed. Below is an excerpt from article discussing research into lottery winners and paraplegics.

"In 1978, a trio of researchers at Northwestern University and the University of Massachusetts attempted to answer this by asking two very disparate groups about the happiness in their lives: recent winners of the Illinois State Lottery — whose prizes ranged from $50,000 to $1 million — and recent victims of catastrophic accidents, who were now paraplegic or quadriplegic. In interviews with the experimenters, the two groups were asked, among other things, to rate the amount of pleasure they got from everyday activities: small but enjoyable things like chatting with a friend, watching TV, eating breakfast, laughing at a joke, or receiving a compliment. When the researchers analyzed their results, they found that the recent accident victims reported gaining more happiness from these everyday pleasures than the lottery winners.

This is how the study is usually written about, in a “gee whiz, ain’t that counterintuitive?” kind of tone. But what’s really striking when you look at the results reported by the researchers is how close their answers actually are: On average, the winners’ ratings of everyday happiness were 3.33 out of 5, and the accident victims’ averaged answers were 3.48. The lottery winners did report more present happiness than the accident victims (an average of 4 out of 5, as compared to the victims’ 2.96), but as the authors note, “the paraplegic rating of present happiness is still above the midpoint of the scale and … the accident victims did not appear nearly as unhappy as might have been expected.”

This is partially because of what’s become known as the hedonic treadmill, or hedonic adaptation, that annoying tendency humans have to get used to the things that once made them happy. I particularly love how the authors of this 1970s paper phrased it:

    Eventually, the thrill of winning the lottery will itself wear off. If all things are judged by the extent to which they depart from a baseline of past experience, gradually even the most positive events will cease to have impact as they themselves are absorbed into the new baseline against which further events are judged. Thus, as lottery winners become accustomed to the additional pleasures made possible by their new wealth, these pleasures should be experienced as less intense and should no longer contribute very much to their general level of happiness."
From the following article: https://www.thecut.com/2016/01/classic-study-on-happiness-an...

Re: The darker side of being a doctor (2017)

#14

I strongly dislike the way people talk about mental health as if it is just a personal problem or a disease when, often, it is a reasonable reaction to the world as it is. When we conceive of it entirely as a disease we fail to focus on making positive social changes which might make everyone's lives better. Somehow it doesn't feel like a coincidence that in capitalism the "individual problem" narrative seems to alwa…

I agree that somethings like depression can sometimes be rational responses to the environment the person is in and can't just be medicated away. However, I don't think it's right to ignore the disease aspect, nor to politicize problem.

Re: The darker side of being a doctor (2017)

#16
Heartbreaking pieces like this do make me wonder... what is the better way to approach healthcare? For both doctors and patients, what would need to change? Is it like this everywhere, or does the US have a unique problem?

I heard a theory once that there is an artificially high barrier for who can become a doctor, and lowering that barrier by allowing doctors to specialize early on/not spend as much time studying fields they won't work in, we would have a higher supply of medical staff. As a layperson, this makes sense to me, but I also don't know what I don't know.

I have a lot of respect for anyone who works in healthcare.

Re: The darker side of being a doctor (2017)

#17

This isn’t a mental health issue of an individual. Medicine is severely understaffed and professionals are burned out, worldwide. Doctors should be as common as plumbers given the demand but often, I can’t get an appointment with a doctor within 30 days.

Exactly like plumbers, then?

Re: The darker side of being a doctor (2017)

#18

Slightly off-topic: I know the Substack says 2024, but I remembered reading this very same post before. Turns out it's from 2017 [0]. [0] https://www.medicalrepublic.com.au/dark-side-doctoring/1063

Also, two months ago: https://news.ycombinator.com/item?id=40025261

Re: The darker side of being a doctor (2017)

#19

Why do doctors have families on top of a demanding career then complain about it when they are over burdened? They put themselves in that situation. They can also leave that situation whenever they want. Then to go on sadfishing with this border-line masochism in a blog post...

Kinda what I was thinking -- why not retire or change careers? Being a doctor for many years presumably affords one that option.

Re: The darker side of being a doctor (2017)

#20
It seems to me the only way to fix this problem, aside from some sort of large regulatory changes by the government, is for doctors to start unionizing or striking to force better conditions. What would happen if doctors simply refused to do more then 60 hours a week? Is there really enough supply of new doctors coming in that the hospital can just fire them all and replace them with doctors willing to burn themselves out? Or would it mean the hospital would have no choice but to hire additional doctors so that each one would only have to work a sustainable number of hours?
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