61–70 of 249 posts
This resonates with what I've observed, and in 2012 I wrote an essay that fits this genre: "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" ( http://jseliger.wordpress.com/2012/10/20/why-you-should-beco... ), which explains everything my girlfriend wishes she'd known before she started.
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…
As such, mistrust of social systems and government is deeply ingrained in US culture. Contrast this to Scandinavian countries or European countries who fundamentally trust the government.
Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a n…
There is, however, a significant minority of really horrible, angry, violent, and generally racist people who feel deeply and ideologically threatened by the social contract on which these systems rest. And because of some unfortunate quirks in the American electoral system, they wield a level of political power that vastly exceeds their numbers. In a properly representational system, they'd be just as aggressive, ignorant, and self-defeating as they are right now. However, the body politic would be largely insulated from their rage, allowing us to safely get on with the design and development of a decent, cost-effective system.
In other words, we're being plagued by a really nasty infestation of trolls, and it's making progress in general pretty damn difficult. The good news is that this, too, shall pass. In demographic terms, this problematic political outlook is the rooted in the reactionary portion of the generation that came of age during the Civil Rights era. Their bigotry translated into a life-long political identity that has done everything it can to resist, if not reverse the "loss" they suffered in the wake of Jim Crow ending.
The Drug War is probably the best example of their continued effort to put a boot on the necks of black people. It's worth noting that the militarization of US police forces, combined with an exploding private prison industry, took root in the former Confederate states before spreading outwards to damage the rest of the nation. And of course, opposition to any kind of drug legalization remains strongest in places with the deepest histories of institutionalized racism.
The same perspective that says the state should be used as a weapon to harm black people also says the state should not be used to protect or help them in any way. Thus, the vitriolic opposition to any kind of welfare program than benefits black people. Keeping them out of the health care system was part and parcel of this larger push for institutionalized white supremacy.
But again, all this is a generational reaction to the 1960s, a particularly divisive and transformative time in American politics. When the generation that dedicated itself to obstructing the movement for greater equality finally passes from the stage, there won't be another one with either the size or the depth of hatred to maintain the current levels of opposition. So even in an electoral system as warped as ours, the certifiably batshit-insane won't be able to maintain their dominance. That's bad news for everyone with a stake in Fox News, great news for everyone else on planet Earth.
At that stage, with the right wing of the baby boom dead and buried, America will be able get on with the long-delayed work of creating a more-perfect union. Given how much pent-up demand there is for policies that reflect intelligence, fairness, humanity, and decency, I suspect demand for change - and the consensus to support it - will appear quite swiftly. So it's nice to know that there are already well-developed models we can refer to when the time comes.
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 That's a little surprising to me. One of the coolest things about practicing medicine today is that I can pull out my phone in front of a patient and find guidelines that I'm not familiar with, medication side-effects, and other point-of-care resources that really do enhance my clinical ability in real-time. Granted, I work in a hospital setting. Maybe it's differen…
Earlier quoted context omitted.
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.
No doubt there are instances whereby particular "industrial" implementations function well. But there are also many that function poorly. "Industrialization" is a term that can be applied to mean numerous and distinctly different things.
I was referring to situations I've observed where doctors are restricted from taking time when necessary to evaluate complex cases. Facing a patient with several serious conditions interacting and combining is far different than dealing with a patient having one condition.
It's impossible to do the job well when "bean-counters" insist on scheduling tightly and emphasis is on "production". This is particularly problematic in primary care settings.
Having been involved in quality assurance activities for many years, I fully understand the value of consistency, adherence to rational protocols, etc. But the ability to deal with "outliers", especially when the exception is the rule, is where "industrialization" is at risk of failing.
Just as an anecdote, part of it is the expectations of the patient population in the Bay Area - and I'm only referring to the high income neighborhoods here; the situation differs significantly in low income neighborhoods.
Patients from high income backgrounds tend to be much more demanding than patients from low income backgrounds. At Stanford, the doctors in the emergency department are (informally) expected to stop what they're doing and sing Happy Birthday to certain high income individuals.
A lot of doctors translate this to a lack of respect, which echoes the quoted statement in the article.
Here's another anecdote. While sites like WebMD are fantastic for educating the general public about health issues, it also makes some people falsely believe they know more than the doctors treating them. And I don't mean they simply question their doctors - that is a good practice and everyone should be as educated as they can about their own health. But apparently many people argue and flat out ignore their doctors, even when their own knowledge is tragically incorrect. As one doctor put it, "Why did they come and see me at all, if they are already convinced of what they have? Just to waste their own time and money, not to mention my time?"
Again, there are times when one should definitely question their doctor and be as educated as they can. Second, third, and additional opinions can be very useful. But I'm sure many doctors would appreciate less arrogance and animosity in their attitudes.
One more note. Apparently a very high number (between 75-99%) of all doctors will have faced a malpractice claim at least once in their career. Most of these claims are frivolous, but going through something like this is extremely demoralizing. A couple of doctors I know came close to leaving the profession because of it, even after they were cleared of all wrongdoing.
I once described the job of a project manager to a doctor friend as a "thankless profession," and he immediately said, "that sounds like my job too!"
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 That's a little surprising to me. One of the coolest things about practicing medicine today is that I can pull out my phone in front of a patient and find guidelines that I'm not familiar with, medication side-effects, and other point-of-care resources that really do enhance my clinical ability in real-time. Granted, I work in a hospital setting. Maybe it's differen…
Yep. There's apps to do your taxes. But the average person isn't able to understand double entry accounting without doing a year of study on it.
Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a n…
I think we're the new independent professionals. Nobody has required a license to "practice technology" (yet, but I suspect California will find a way eventually...) and so we can do our job anywhere, for any hours, for any pay. Until bureaucracy swallows us up(as it does all professions ultimately) we'll have our golden age too.
It won't be bureaucracy that kills us but rather the inevitable grind of economics. Once our industry stops growing and the supply of programmers has a chance to catch up with demand, our bargaining position weakens and the impact will be felt across the board. Those in corporations will find higher expectations (even longer hours), less respect, lower pay, and fewer benefits. Those who are "independent" will find it…
Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a n…
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