The darker side of being a doctor (2017) • Hacker News Board

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

#31

Post by bshep » Mon, Jun 17, 2024, 5:28 PM UTC

metalcrow wrote: post #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 themselve…

What would happen if doctors simply refused to do more then 60 hours a week? -> you can get sued for patient abandonment if you refuse to followup on a patient you are responsible for

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? -> in part yes there are ( in some fields) but what would happen is that patients would be shifted to other facilities that have staff to see the patients, also when you have 400-500k of school debt its hard to refuse work

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? -> this happens as well, they hire locum tenens docs to fill in gaps ( higher short term expense in exchange for not giving staff docs what they need)

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

#32

Post by bena » Mon, Jun 17, 2024, 5:29 PM UTC

whoomp12342 wrote: post #25

metalcrow wrote: post #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 themselve…

there is already a massive medical provider shortage

In some large part because of the AMA. They routinely advocate for restricting the number of licensed medical doctors.

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

#33

Post by w10-1 » Mon, Jun 17, 2024, 5:30 PM UTC

I appreciate the candor and the analysis, but I think it's missing the forest for the trees.

Medical providers care about people, and indeed are responsible for the health of their patients. Some of those patients turn around and bite them. Others die - some die at your hands. Providers, especially doctors, take responsibility for that, emotionally and otherwise.

No person and no system of support can be designed to completely avoid that. There is no religion or personal discipline that will erase the emotional and moral cost of hurting people you're trying to help.

Some say their lost patients help them do better for their present patients. It's a bit like Lincoln saying at Gettysburg that these young boys did not die in vain - while knowing many were avoidable.

Medicine may be a business, and it may even be a calling. But just realize that people doing medicine lose their innocence, in ineffable and unsharable ways, and try to respect that.

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

#34

Post by newzisforsukas » Mon, Jun 17, 2024, 5:31 PM UTC

bonton89 wrote: post #23

newzisforsukas wrote: post #10

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...

I'm not sure they really can leave whenever they want. I think once you're far down the education track you will probably feel like you're trapped into continuing even if you decide you don't want to do it anymore, because the education loans will kill you and you need the big income on the other end to fix this. That probably contributes to the creation of a lot of miserable and crappy doctors.

> because the education loans will kill you and you need the big income on the other end to fix this

Being a surgeon doesn't have the same level of demand as a role in family medicine. Both roles provide an income for sustaining oneself, even through student loans. Also, the subject in this article has "been a doctor for 13 years".

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

#35

Post by kristjansson » Mon, Jun 17, 2024, 5:31 PM UTC

Sounds like many of the acute problems are microfrustraions created by poor software design and engineering. Slow login/relogin, unrealistic scheduling, illegibility of pre- and post-surgical tasks to the timekeeper, etc. We can't solve the structural problem, but better software could help create more humane working environment under the constraints.

Of course, the real problem is running medicine like a business, but technology can only serve the megamachine...

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

#36

Post by OldGuyInTheClub » Mon, Jun 17, 2024, 5:32 PM UTC

immibis wrote: post #2

Sounds like the hospital is running a successful business, by all relevant metrics of success. They get the most out of their resources. Sometimes the resources wear out, but that's okay because they can get new ones, and they calculate the rate of resources wearing out is acceptable to increase the overall profit extraction from the resources. Anything else would needlessly increase costs.

I think hospitals (or the companies running them) have cynically exploited Covid on top of everything else. Huge sacrifices from everyone to ensure the facilities didn't get overwhelmed but then also NOT doing anything to improve those facilities or the people that work and are treated in them.

It is no wonder that people have lost whatever little confidence they had in "the system."

No one will give a damn the next time a crisis rolls around and it will.

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

#37

Post by OldGuyInTheClub » Mon, Jun 17, 2024, 5:34 PM UTC

gnarbarian wrote: post #21

stavros wrote: post #9

Earlier quoted context omitted.

I really hope the GP's comment is sarcasm, an attempt to point out how the capitalist incentives steamroll over real people in the pursuit of profit.

even for the most hardcore capitalist these practices are short sighted and will result in bad financial outcomes long term.

I think that's an excessively optimistic assumption about hardcore capitalists.

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

#38

Post by astura » Mon, Jun 17, 2024, 5:34 PM UTC

luminen wrote: post #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 fi…

There's already around 10,000 medical doctors that don't match with a residency program so they can't practice medicine. These are qualified MDs who graduated from medical school who are ready, willing, and able to work but they are told "no."

Expanding residency to cover all qualified MDs would be a great first step.

https://www.nytimes.com/2021/02/19/health/medical-school-res...

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

#39

Post by joe_the_user » Mon, Jun 17, 2024, 5:36 PM UTC

w10-1 wrote: post #33

I appreciate the candor and the analysis, but I think it's missing the forest for the trees. Medical providers care about people, and indeed are responsible for the health of their patients. Some of those patients turn around and bite them. Others die - some die at your hands. Providers, especially doctors, take responsibility for that, emotionally and otherwise. No person and no system of support can be designed to…

Of course doctors and health care providers face inherent challenges. But that shouldn't distract from the many and now know well pathologies that our current health care system has.

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

#40

Post by gnarbarian » Mon, Jun 17, 2024, 5:36 PM UTC

stavros wrote: post #29

gnarbarian wrote: post #21

Earlier quoted context omitted.

even for the most hardcore capitalist these practices are short sighted and will result in bad financial outcomes long term.

While both sides of your comment are true, they don't follow. Yes, they're short-sighted, yes they'll result in bad financial outcomes long term, but the most hard-core capitalists still do them, because the bad outcomes will come long after they've moved to a new area they can exploit.

Maybe the people pursuing these kinds of practices have quick exits in mind.