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The darker side of being a doctor (2017)

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

#51

Post by jimbokun »

The part about forcing 14 minutes per operation terrifies me.

If I'm on the table, and something unexpected comes up, how much pressure is the surgeon under to take a short cut to ensure he stays under 14 minutes? Or make a mistake because he's rushing to meet the deadline.

I'm a pretty staunch capitalist, but this further reinforces for me that medicine needs to be completely divorced from the profit motive. Costs should only be considered in order to treat more patients better with the available resources. But never to increase executive pay or shareholders' stock price.

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

#52

Post by jimbokun »

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...

THAT is your take away?

Not, I don't want a surgeon pushed past the point of exhaustion and sanity operating on you?

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

#53

Post by orangesite »

Hard to swallow pills:

- When the goal of medicine is profit instead of helping patients the outcomes will be poor.

- When the goal of education is profit instead of teaching students the outcomes will be poor.

- When the goal of politics is profit instead of collaboration the outcomes will be poor.

- When the goal of business is political, educational or medicinal the outcomes will be poor.

Generic formulation:

Any attempt to apply a metric that works in one context to the entire system will result in poor outcomes.

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

#54

Post by justtinker »

Protestant work ethic Black Swan.

The solution to the problem is 15 years before now, not today when there are so many conflicting force out to crush you.

If you try to get out lots of people blame you or sue you.

I got out. Not by being smart or inciteful but by being, as other people called it "lazy".

IT Director of 45 people, high pressure environment, 6 figure salary in 2001, DOT.COM style but not in silicon Valley. I was at my Peter Principle Level of incompetence. This was my 3rd dot.com job running at a frenzied increase in responsibility.

No golden exits. Just layoffs when money ran out.

Luckily it went bankruptcy too. Dot com bust happened. No new Directorship to step into. To get back on the hamster wheel I would have to get an MBA. Other colleagues did. It was not for me. I would have imploded too, if I tried.

Lots of acquaintances wondered why I was so under employed after 20 years of ladder climbing. In absolute $ I am still not back to the number I made back then. Life since then has given me other stresses that would have made today unbearable if I continued.

Everyone who is under those crushing stress today had a set of decision that (their own and other peoples) that corralled them into the situation. After a while there seems no escape.

The people who "tsk tsked" when I left things behind did not consider the consequence of the future.

I am at the end of my career (45 years since first $ in IT). I have "enough money". People are still telling me I should work hard and achieve more. Really want to retire and contribute to society in another way.

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

#55

Post by hcarvalhoalves »

whoomp12342 wrote: post #28
hcarvalhoalves wrote: post #13

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.

you realize that plumbing is currently one of the highest paid trades because of a shortage?

Yes. I was giving another example of profession that should have plenty of offer since there will always be demand for.

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

#57

Post by metalcrow »

bshep wrote: post #31
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 patie…

> you can get sued for patient abandonment if you refuse to followup on a patient you are responsible for

Sure, but that isn't the case in this linked article, it seems. Being on call for emergencies, doing elective surgeries, refusing to do that doesn't count as patient abandonment as i understand it. Only when you are actively taking care of someone can you not leave them.

> 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

Ah, yeah then that's the main problem. There's such an excess of supply that hospitals can afford to treat doctors like crap. Same idea Amazon has about its workers. In that case, hopefully articles like this will make people realize becoming a doctor is a bad choice, and reduce the supply and allow stronger employee bargaining positions.

Of course stronger regulations would always be a better option for this case, but i don't see that happening.

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

#58

Post by metalcrow »

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

If so, then shouldn't these doctors be able to demand better conditions? Threatening to do less work unless pay is improved or more nurses are hired or some changes to the job are made. That would grind the hospital to a halt.

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

#59

Post by tivert »

jimbokun wrote: post #50
kristjansson wrote: post #35

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, b…

There is a strong argument to be made that paper charts were more efficient and provided better quality documentation with better user experience than modern EMR software systems. Also, this is one place where AI can potentially provide both a more efficient system and greatly improve job satisfaction for physicians. Automatically generating and updating medical records based off ambient recordings of patient interac…

> There is a strong argument to be made that paper charts were more efficient and provided better quality documentation with better user experience than modern EMR software systems.

> Also, this is one place where AI can potentially provide both a more efficient system and greatly improve job satisfaction for physicians. Automatically generating and updating medical records based off ambient recordings of patient interactions fits right into LLMs wheelhouse.

No, LLM's are not reliable enough for that.

If the technology sucks and is in fact a regression, the solution is not to hope yet more half-backed technology will fix the problem. The solution is to dump the technology until someone can actually do it right.

If paper charts are better, go back to paper charts...and maybe hire a digitization/data entry team to realize whatever benefits to electronic records there are.

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

#60

Post by metalcrow »

sandworm101 wrote: post #46
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…

They are unionized already. They have independent state licensing boards staffed and operated by other Doctors. These organizations manage the profession and more or less set the standards to which doctors in the state are held.

Does the union actually do much for them? I know in a lot of blue collar work unions are actually serious, and can do strikes and stop a business in it's tracks if the workers feel they are being mistreated. Why does that not happen with doctors? I've not heard about it happening, anyway.
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