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Why doctors are sick of their profession

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Re: Why doctors are sick of their profession

#51

Post by jrapdx3 »

nhstanley wrote: post #28
ihsanyounes90 wrote: post #2

In my opinion(and general opinion), this is the most important job. Maybe we can find someone depressed(like in the article), but come on they save lives.

> but come on they save lives. I'm going to say something controversial here, but please bear with me. Your statement sort of encompasses several parts of this problem. Some doctors are miracle workers (see [1] below), but most doctors are glorified auto mechanics. I don't say that to downplay the amount of intelligence/skill required for the job, but if you think of most doctors as "saving lives", then you obviously…

Practicing medicine for decades gives me some "perspective" on the subject. No one in medicine is a "miracle worker", though many of us work hard to the job responsibly.

You are wrong. We do "save lives", and not just in the ED. Every day, if not as dramatically, immediately or even noticeably, our incremental toil helps patients progress bit-by-bit toward better health. Managing chronic, debilitating conditions really does enable patients to live longer and more fully.

You are also wrong regarding income. Doctors in the US are getting paid less and less, while expenses of practice go ever higher. My own income is probably less than most of the people I know in other professions.

The "mess" of the health care system (to the extent it is even systematic) is the result of the constant assault of corporations and governments at all cost to "reduce costs", but the result has been the degradation you and others notice.

The most conspicuous evil has been perpetrated by the insurance industry. For example, amazingly short-sighted insistence on paying for a "generic" medication $3/mo cheaper than the drug already working is an every day challenge. If patients don't get what is really needed, they wind up getting sicker, need more care, the result is more money spent, not saved.

The problem is that the industrialization of medicine makes it increasingly difficult to be helpful. People are not neat little uniform units produced in factories. People are enormously complex organisms that defy all rules we invent to "explain" illness and treatment. People are unique entities that require individual attention and customized approaches if true "health care" is going to be provided.

If doctors are given the resources, time and respect to do their work, I believe almost all will strive to do it right.

Re: Why doctors are sick of their profession

#52

Post by pyre »

bps4484 wrote: post #41
wirrbel wrote: post #35

Earlier quoted context omitted.

What has always confused me is that the perceived gap between doctors and nurses is so big. I have the impression that nurses could benefit a lot from better training and there could be a good case for positions somewhere between a nurse and a doctor. Considering the effect that _care_ (time with patient) has on patients the current model with a demi-god in white just does not scale. My optometrist (the guy selling g…

"positions somewhere between a nurse and a doctor" I think this is what a physicians assistant and nurse practitioners are. At least that's my understanding. They don't have an MD but are able to do a number of diagnostics and can prescribe medicine.

I have relatives that are nurse practitioners. Even at that level, there are a lot of doctors that view nurses in the way that you would expect a character on Mad Men to view a female secretary (below them, just there to do their bidding, don't know anything, etc).

Re: Why doctors are sick of their profession

#53

Post by jkestner »

wirrbel wrote: post #35
727374 wrote: post #11

I think it's funny that the first picture in the article is of a doctor taking a patient's blood pressure. It's a little ironic because I've never actually had a doctor take my blood pressure (in the US). I'm not even sure if I've had a nurse do it, but more likely a physician's assistant or phlebotomist. Just like other industries medicine has been turned into an assembly line where patients are herded through the s…

What has always confused me is that the perceived gap between doctors and nurses is so big. I have the impression that nurses could benefit a lot from better training and there could be a good case for positions somewhere between a nurse and a doctor. Considering the effect that _care_ (time with patient) has on patients the current model with a demi-god in white just does not scale. My optometrist (the guy selling g…

> positions somewhere between a nurse and a doctor

They call that a physician's assistant or nurse practitioner. The latter has the nurse's more user-centric approach but can do pretty much everything a general practitioner does, including writing prescriptions (though not in Texas, yeehaw).

Re: Why doctors are sick of their profession

#54

Post by k-mcgrady »

exstudent wrote: post #10

You can definitely feel this as a patient. If I could give my vitals to an app and have it diagnose and prescribe remedies, I would do it in a heart beat and never visit a doctor again (of course you would need robot surgeons too :). I've never seen a doctor research anything either (although I'm sure they do behind the scenes). They seem to be pulling from whatever information cache they have in their head which I o…

>> "I've never seen a doctor research anything either"

I have. It's terrifying. I recently went to the GP, told them my condition (which had been diagnosed by a different GP) and their first response was to look it up on Wikipedia. Seriously. I understand that a GP isn't going to know every condition you come in with but Wikipedia as the reference material?

Re: Why doctors are sick of their profession

#55

Post by DanBC »

k-mcgrady wrote: post #54
exstudent wrote: post #10

You can definitely feel this as a patient. If I could give my vitals to an app and have it diagnose and prescribe remedies, I would do it in a heart beat and never visit a doctor again (of course you would need robot surgeons too :). I've never seen a doctor research anything either (although I'm sure they do behind the scenes). They seem to be pulling from whatever information cache they have in their head which I o…

>> "I've never seen a doctor research anything either" I have. It's terrifying. I recently went to the GP, told them my condition (which had been diagnosed by a different GP) and their first response was to look it up on Wikipedia. Seriously. I understand that a GP isn't going to know every condition you come in with but Wikipedia as the reference material?

Being charitable the GP wanted to know what misinformation the patients come in with.

Being realistic: yes, it's terrifying. GPs are subject to the same biases and prejudices as everyone else.

Re: Why doctors are sick of their profession

#56

Post by Shivetya »

venomsnake wrote: post #44
javert wrote: post #42

Earlier quoted context omitted.

The actual experience in the US has been that healthcare functioned best when it was closest to a free market, and the more we socialize it, the worse it gets. (We have been slowly socializing it for many decades through regulation.) You can argue that we haven't been socializing it "properly," but the way we are doing it is just the way government works in the US, and that's not going to change. In general, we don't…

In US you have socialized the costs. Not the healthcare system. I think the only social type of medicine in US is the VA (they have the purse, their own hospitals and staff IIRC) and last time I read their costs of delivered product were much lower that the US average.

lets be honest, the VA is not a shining example of health care. Much lower costs are not worth it considering the stories coming out of the VA.

Re: Why doctors are sick of their profession

#57

Post by grimtrigger »

praptak wrote: post #36

All this sounds quite a bit like Marx's theory of alienation: "The theoretic basis of alienation within the capitalist mode of production is that the worker invariably loses the ability to determine his or her life and destiny, when deprived of the right to think (conceive) of himself as the director of his actions; to determine the character of said actions; to define their relationship with other people; and to own…

The article makes the opposite point - that government bureaucracy (and the mal-incentives it creates) is what is killing the relationships between doctors and patients.

Re: Why doctors are sick of their profession

#58

Post by anon13434 »

venomsnake wrote: post #44
javert wrote: post #42

Earlier quoted context omitted.

The actual experience in the US has been that healthcare functioned best when it was closest to a free market, and the more we socialize it, the worse it gets. (We have been slowly socializing it for many decades through regulation.) You can argue that we haven't been socializing it "properly," but the way we are doing it is just the way government works in the US, and that's not going to change. In general, we don't…

In US you have socialized the costs. Not the healthcare system. I think the only social type of medicine in US is the VA (they have the purse, their own hospitals and staff IIRC) and last time I read their costs of delivered product were much lower that the US average.

The VA is not a good example of a working system though, it has been heavily in the news for denying timely treatment, see http://en.wikipedia.org/wiki/Veterans_Health_Administration_...

Re: Why doctors are sick of their profession

#59

Post by pinkyand »

jrapdx3 wrote: post #51
nhstanley wrote: post #28

Earlier quoted context omitted.

> but come on they save lives. I'm going to say something controversial here, but please bear with me. Your statement sort of encompasses several parts of this problem. Some doctors are miracle workers (see [1] below), but most doctors are glorified auto mechanics. I don't say that to downplay the amount of intelligence/skill required for the job, but if you think of most doctors as "saving lives", then you obviously…

Practicing medicine for decades gives me some "perspective" on the subject. No one in medicine is a "miracle worker", though many of us work hard to the job responsibly. You are wrong. We do "save lives", and not just in the ED. Every day, if not as dramatically, immediately or even noticeably, our incremental toil helps patients progress bit-by-bit toward better health. Managing chronic, debilitating conditions real…

> The problem is that the industrialization of medicine makes it increasingly difficult to be helpful.

Atul gawande, which is a doctor and a healthcare journalist ,and knows the medical system from inside, thinks that industrialized medicine is exactly what's needed:

http://www.newyorker.com/magazine/2012/08/13/big-med

And in general the positive results from decision support systems seem to agree with him.

Re: Why doctors are sick of their profession

#60

Post by jrapdx3 »

exstudent wrote: post #15
secabeen wrote: post #13

Earlier quoted context omitted.

Every doctor is different. If you show a desire to engage with a doctor, and get the right one, you can have one that does research. When I started on cholesterol-managing medication, my physician emailed me three recent journal articles on the effectiveness of different options and the dosing considerations. It all depends on who you have, and how they run their practice.

I agree that there are good doctors, but I'd rather not have it be such a crap shoot. The consistency and depth of knowledge provided by an expert system of some sort seems like the way to go.

I'd imagine the proportion of "good" doctors might be about the same as good programmers, or good teachers, though probably exceeds the supply of "good" politicians.

Point is medical care is only as good as the quality of the "team" consisting of the doctor and the patient. It's a partnership, an expression of the doctor-patient relationship. Not every two people will form a natural team, after all, many marriages fail.

It's kind of a cliche, but still true, find a doctor you can work with, someone you can trust and relate to. More likely than not, that's the the definition of a "good" doctor.

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