Why doctors are sick of their profession • Hacker News Board

Re: Why doctors are sick of their profession

#91

Post by lutusp » Sat, Aug 30, 2014, 9:20 PM UTC

georgemcbay wrote: post #88

GreenPlastic wrote: post #62

Earlier quoted context omitted.

In order to understand the US, you have to go back to the formation of the country. The US was started because of distrust in the British government. The constitution was setup on a system of distrust, not trust. 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.

I'm a leftie socialist tree-hugger American who thinks taxes (on the wealthy and corporations) need to go up quite a bit... but I still think a system of distrust is the way to go, because humans, while generally more good than evil, are inherently selfish and flawed and can too easily rationalize injustice in the face of personal gain and that makes them worthy of distrust, especially when organized. The problem, IM…

> I'm a leftie socialist tree-hugger American who thinks taxes (on the wealthy and corporations) need to go up quite a bit...

I agree with that idea, but guess who also agrees ... billionaire Warren Buffet.

http://www.nytimes.com/2011/08/15/opinion/stop-coddling-the-...

Quote: "My friends and I have been coddled long enough by a billionaire-friendly Congress. It’s time for our government to get serious about shared sacrifice."

And even among billionaires, Buffet isn't alone. Buffet, Bill Gates and other billionaires have agreed to leave most of their fortunes to charitable foundations instead of allowing their children to inherit it.

Re: Why doctors are sick of their profession

#92

Post by alexqgb » Sat, Aug 30, 2014, 9:29 PM UTC

mynameishere wrote: post #83

alexqgb wrote: post #63

Earlier quoted context omitted.

It's not true to say that the US, in general, ignores these systems when in fact, a significant portion of the US population pays very close attention to them and would like nothing more than to seem them implemented here. 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…

Dude, chill. Not to intrude on your fantasy world too much, but a few things: 1. The left wing of the baby boom is going to die with the right. 2. The baby boomers were famously a bunch of hippies and radicals. More seriously, they were easily the most liberal-minded generation in America at the time--and they may still be. 3. This country's ongoing demographic transformation into Brazil is not going to help the heal…

Um, you may have missed the point.

1. The thing that distinguishes the values of the Civil Rights era reactionaries is that they're generally failing to transmit themselves from one generation to a next. So unlike the more egalitarian values of the left - which are actually growing stronger with each subsequent generation - the bigotry of the right is uniquely tied to the lifespans of specific people. When they die, their fundamental opposition to social justice dies with them.

The break isn't perfectly clean, to be sure, but enough to make the retrograde electorally insignificant and that's the real point here.

2. The "hippies and radicals" on the Baby Boom's left were actually a distinct minority in the 1960s. Highly visible, yes, but politically (as opposed to culturally) persuasive? Not so much.

However, unlike the reactionary right - which was entering its last generation of social dominance - the lefties were well ahead of their time. In the long run, their ideas and values are the ones that are becoming mainstream, while the overt racism of the right is what's becoming retrograde. That's why gay marriage and drug decriminalization are happening, while the racist cops freaking out in Ferguson are seen as the bad guys in a dystopian nightmare that causes a general sense of recoil.

3. Not sure what you mean by this. Are you saying America needs a white majority to remain functional and prosperous?

So you know, the demographics I'm focused on are those of the millennial generation, which is the largest in American history. In terms of electoral politics, their preferences are going to dominate everything in the decades to come. And unlike the lefties in the BB generation, this is a generation in which broadly egalitarian and progressive views are, for the first time, held by a clear and ascendent majority.

As far as the health care system goes by the time these people hit middle age, it's safe to assume that sanity will be prevailing. Indeed, I suspect that will be true of politics in general.

Re: Why doctors are sick of their profession

#93

Post by wtbob » Sat, Aug 30, 2014, 9:41 PM UTC

johan_larson wrote: post #90

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…

There is very little about the health care industry, at any level, that is "free market". The government funds much of the basic research that generates new medicines and medical devices and then regulates which ones can be sold. It works hand in hand with medical professional associations to determine who can practice medicine and in what capacity; it also funds residencies, the crucial gateway to becoming a physici…

You're right that the current healthcare industry is far from a free market, but javert too is right that the golden age of American healthcare was when it was far closer to a free market.

Interestingly, the golden age for physicians' personal wealth was during the socialisation phase, as they were able to pocket fees increasingly paid by insurers, leading to a quintupling in income. They went from lower-middle class at $50,000/year in 2010 terms to $250,000 in 2010 terms. Doors anyone seriously suspect that we'll ever get back to $50,000/yr physicians? This illustrates why industries are often keen to socialise: they can guarantee outsize personal success.

What our system absolutely rewrites is radical dissolution.

Re: Why doctors are sick of their profession

#94

Post by danieltillett » Sat, Aug 30, 2014, 9:42 PM UTC

im3w1l wrote: post #77

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 wonder if in the future, doctors will become more like bearucracts. You go to the internet, find out what you have. Then you fill out the appropriate form, go to a doctor who stamps the decision with a red mark of approval, granting you access to medication / surgery.

This is exactly how I interact with the medical monopoly. I don't think I have been to the doctor for the last 10 years without knowing my diagnosis and treatment in advance. My job has then been to guide the doctor to the correct diagnosis in a way that keeps their ego intact.

Re: Why doctors are sick of their profession

#95

Post by the_duck » Sat, Aug 30, 2014, 9:58 PM UTC

2mur wrote: post #84

I'm a physician. I love the value I bring to patients, and I enjoy what I do (most of the time). But the industry is disgusting. The people who are creating the real value for patients (nurses, technicians and doctors) have been saddled with increasing regulations and there are incredibly levels of administrators and belt-phone business guys riding them to extract every profit out of the environment. There is no chan…

Huh. "Belt-phone business guy" is a new expression for me. What does this mean, exactly?

Re: Why doctors are sick of their profession

#96

Post by [deleted] » Sat, Aug 30, 2014, 10:00 PM UTC

GreenPlastic wrote: post #62

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…

In order to understand the US, you have to go back to the formation of the country. The US was started because of distrust in the British government. The constitution was setup on a system of distrust, not trust. 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.

[deleted]

Re: Why doctors are sick of their profession

#97

Post by jdietrich » Sat, Aug 30, 2014, 10:02 PM UTC

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…

Here in the UK, in addition to Nurse Practitioners we also have Surgical Care Practitioners - non-doctors who are trained to perform a specific subset of routine surgeries, or to assist in more complex surgery. It really doesn't make much sense to have a highly trained cardiac surgeon spend half an hour stitching up a patient after a surgery.

Our National Health Service benefits from substantial levels of integration, allowing for Fordist division of labour. The per-capita budget is much lower than in the US, but we can use that budget very efficiently.

Another example is the National Institute for Clinical Excellence, which develops evidence-based care pathways and makes key decisions on drug prescribing and purchasing. Because our drug buying is done centrally (giving the NHS considerable negotiating power), and because NICE are prepared to reject a drug on the basis of an inadequate cost-benefit ratio, we pay far less than most industrialised nations for medicines. It is my understanding that competition legislation would prevent insurers and HMOs from implementing such a system in the US.

Re: Why doctors are sick of their profession

#98

Post by [deleted] » Sat, Aug 30, 2014, 10:03 PM UTC

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…

[deleted]

Re: Why doctors are sick of their profession

#99

Post by dalke » Sat, Aug 30, 2014, 10:06 PM UTC

ArkyBeagle wrote: post #81

[deleted] wrote: post #75

Earlier quoted context omitted.

[deleted]

Very good point - although you'd think it would be possible to have models and feedback for models that would scale. I expect the "higher GDP" tells us a lot. I first discussed this with my Dad when we took one of us the the Emergency Room for stitches ( it just wasn't a summer as a kid without a bike wreck or something leading to stitches ) and I was shocked by the bill - in 1972. I'd be pressed to find the referenc…

> I'd be pressed to find the reference, but people have shown that proportional percent of income ( in the aggregate, GDP ) spent on medical care has been consistent between countries.

There's a couple of tables related to that at http://en.wikipedia.org/wiki/List_of_countries_by_total_heal... . US is an outlier, with a total health expenditure of 17.7% of GDP. Otherwise, yes, most similar countries (Germany, France, etc.) spend between about 8 and 11% of GDP.

Re: Why doctors are sick of their profession

#100

Post by esfandia » Sat, Aug 30, 2014, 10:20 PM UTC

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'd take a crowd sourced db of health info over a doctor's personal knowledge any day of the week.

I think it's a great idea, and so I went looking for a StackExchange forum for it. It turns out there is one that is in the staging phase:

http://area51.stackexchange.com/proposals/66048/health

Obviously caveat emptor, YMMV etc. would apply to such a forum, and the other issue is that a patient posting there doesn't have access to all the diagnosis tools that doctors do.