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The darker side of being a doctor (2017)

drericlevi1.substack.com

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

#61

Post by altruios »

nathan_compton wrote: post #4

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…

paper straws, conserve your water, wear your mask...

Just don't fix society, let capitalism sell you solutions to a broken society: it's more profitable... /s

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

#62

Post by rickydroll »

gnarbarian wrote: post #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…

My neurologist has said that she will give you all the information you need to go through the whole preapproval process but she is not going to drive it. I suspect she is doing this because she was not getting paid for the effort and she is tired of fighting insurance companies.

My eye doctor (damn good specialist) told me about how bad private equity folks over the medical industry. He is grateful to his practice has been able to avoid the private equity vacuum cleaner.

You're right that incentives are misaligned. It seems that the choice is either to provide good-quality medical care or feed the ravenous beasts of the finance industry.

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

#63

Post by newzisforsukas »

jimbokun wrote: post #52
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?

Not much can be done to change the ethical stance of the hospital or the surgeon that decides to work for them.

I assume many doctors and hospital administrators, like the overall population, are money or status hungry, and they are willing and able to hurt people to maintain their lifestyles.

There are no regulations enforcing transparent reporting of less than optimal surgical outcomes or what those optimal results are. I would be more worried about that.

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

#64

Post by dang »

schu wrote: post #18
strongpigeon wrote: post #3

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

Thanks! Macroexpanded:

The darker side of being a doctor (2017) - https://news.ycombinator.com/item?id=40025261 - April 2024 (500 comments)

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

#65

Post by jimbokun »

tivert wrote: post #59
jimbokun wrote: post #50

Earlier quoted context omitted.

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 int…

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

It requires physicians to read and verify the LLM output before signing it. And not just rubber stamping.

There is a precedent for this with speech recognition, which a lot of doctors use to dictate their documentation. Speech recognition isn't completely reliable either, so the doctor needs to be diligent to review before signing. And not just assume it's all correct.

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

#66

Post by DamnInteresting »

meany wrote: post #12
nathan_compton wrote: post #4

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…

The hedonic treadmill also helps to understand why wealthy people--regardless of how they acquired their wealth--seem desperate to increase their fortunes. They have more money than they could ever need, yet they want more. See Elon Musk and the $50 billion pay package.[1]

I feel like this happens a lot with creative people as well--an artist can become successful and widely respected, but still become deeply unhappy if their skill or audience declines, regardless of financial success. It is the first thing that comes to my mind when I hear about celebrity suicides--Robin Williams, Naomi Judd, Anthony Bourdain.

If there's no increase in wealth or station, there's no dopamine. And that is depressing.

[1] https://www.washingtonpost.com/technology/2024/06/13/tesla-s...

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

#67

Post by tivert »

jimbokun wrote: post #65
tivert wrote: post #59

Earlier quoted context omitted.

> 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 int…

> No, LLM's are not reliable enough for that. It requires physicians to read and verify the LLM output before signing it. And not just rubber stamping. There is a precedent for this with speech recognition, which a lot of doctors use to dictate their documentation. Speech recognition isn't completely reliable either, so the doctor needs to be diligent to review before signing. And not just assume it's all correct.

> It requires physicians to read and verify the LLM output before signing it. And not just rubber stamping.

Then what's the point? That's not going to provide a "more efficient system and greatly improve job satisfaction for physicians."

AI would only improve the situation if it can actually be trusted. You're actually making things far worse if you replace a "production" task with a "continuous monitoring for errors. Humans are terrible at the latter.

> There is a precedent for this with speech recognition, which a lot of doctors use to dictate their documentation. Speech recognition isn't completely reliable either, so the doctor needs to be diligent to review before signing. And not just assume it's all correct.

The one transcript like that I've seen had obvious speech recognition errors, when the notes got to my primary care doctor.

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

#69

Post by bshep »

metalcrow wrote: post #57
bshep wrote: post #31

Earlier quoted context omitted.

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)…

You are correct in your points.

In the end I don't know where the solution lies, sometimes I feel the best solution is to re-design everything from the ground up. Other times I feel like regulation would help, but it would have to come from someone who practices actual medicine, bureaucrat.

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