Why doctors are sick of their profession • Hacker News Board

Re: Why doctors are sick of their profession

#111

Post by vacri » Sat, Aug 30, 2014, 11:27 PM UTC

wtbob wrote: post #93

johan_larson wrote: post #90

Earlier quoted context omitted.

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…

When were doctors ever 'lower-middle class' in any western society?

Re: Why doctors are sick of their profession

#112

Post by jrapdx3 » Sat, Aug 30, 2014, 11:27 PM UTC

pinkyand wrote: post #106

jrapdx3 wrote: post #65

Earlier quoted context omitted.

Of course, talking about the US health care "system" is hazardous given the enormous diversity of systems within it. 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 res…

Yes i agree, sometimes "production" goes too far. In some of those complex case it's even wiser to allocate much more time in advance from doctors and nurses, to prevent future complications - which are much more costly. But i wonder: On what sources do you rely when it comes to managing complex cases ? is it only known hard coded medical data in books and databases ? or also some intuition ? And if it's intuition ,…

The ancient wisdom is the practice of medicine is as much art as science. There is "evidence" supporting many practices. As in every complex endeavor, evidence is not static, but evolving constantly.

Evidence is necessary but by itself insufficient. We must use our own power of observation combined with what we know and what we've learned to decide what to do.

So your question is indeed profound, cuts to the core of the issues. Intuition is one way to phrase it. I once heard a colleague say we're not paid because of what we know, but for the judgement we exercise about advice or treatment to offer.

Each human is indeed unique. Even identical twins are in fact not exactly the same. Rules have limits when no two cases are precisely the same, it always comes down to that very intuition you are intuitively aware of.

After all, we frequently wish to have a second opinion. I do often enough too. I like the saying, get 5 experts in a room, and you're likely to get at least 6 opinions on any subject.

Who said decisions should be easy? I sweat over each and every one.

Re: Why doctors are sick of their profession

#113

Post by dobbsbob » Sat, Aug 30, 2014, 11:27 PM UTC

toasted wrote: post #38

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…

Problem with social health care is of course each successive government tries to purposely run it into the ground in my country so they can point to it's failures and claim we must adopt a US style private insurance method.

Another problem is creeping fees. Most clinics, hospitals ect all nickle and dime you for fees here which add up even though they aren't supposed to. Some regional health authorities here charge a flat monthly tax, which if you can't pay or are in arrears you're screwed and have to pay cash to these clinics. Because there is a standardized rate you're going to pay $135 just to talk to a doctor for 5 minutes because there's no low income clinics, all rates are the same.

Source: my young, foolish self who had to pay this out numerous times to clinics for being behind on taxes.

It's good that this works where you live but you need to be hyper vigilant on who is elected to govern your health authority, which is a huge downside of any kind of socialization of medicine. Governments are fleeting, the next one could purposely sabotage it to satisfy insurance lobbyists or be so incompetent they accidentally let it all go to hell.

Re: Why doctors are sick of their profession

#114

Post by vacri » Sat, Aug 30, 2014, 11:43 PM UTC

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?

It shouldn't be terrifying at all. GPs are not specialists. And even specialists don't know everything. I used to work as a neuro tech and I remember a patient came in announcing that he had some particular syndrome (I can't recall the name). I stayed quiet about it, never having heard it, but needed to get a neurologist in for the test anyway. In comes the specialist, one whose skill I greatly respected, and the patient proudly announces the syndrome. The neurologist had no qualms about directly asking what that was. The thing is, if your syndrome only has five people in the country that are affected by it, it's not reasonable to expect every doctor (even specialist) to know what it is off the top of their head. There are hundreds of thousands of maladies that can affect the human body. Many of them go by multiple names.

To top this all off, a GP is a General Practitioner. Their main role is to filter out the sniffles and the rashes, and keep an eye out for the more serious stuff, which gets passed on to an appropriate specialist. In the GP's case, going to Wikipedia gives a good, quick baseline on what the disease is. A GP shouldn't be prescribing drugs from WP, but if you say you've got McGrady's Syndrome, the GP looks it up quickly on WP (which is a very quick, concise resource), and finds out it's a liver problem of a certain type, the GP now has a base to work with. Liver problems mean X, Y, or Z in general, start looking at those avenues of inquiry.

The other thing is that while it should not be a canonical reference, when it comes to scientific topics, WP is very well written, concise, and quick to access. If you've ever used medical software, you'd know the high variety of quality there is - some is just plain awful when it comes to looking things up. And textbooks by their very nature go out of date.

Re: Why doctors are sick of their profession

#115

Post by seanstickle » Sat, Aug 30, 2014, 11:43 PM UTC

jkestner wrote: post #53

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 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).

Not to be too pedantic, but the profession is "physician assistant", not "physician's assistant." They typically have master's degrees (and all will be required to have master's degrees by 2020), can practice medicine in most specialities (including surgery, pediatrics, etc.), and can prescribe medicine in all 50 states.

Note: I work for the Physician Assistant Education Association.

Re: Why doctors are sick of their profession

#116

Post by [deleted] » Sat, Aug 30, 2014, 11:46 PM UTC

dmfdmf wrote: post #104

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…

The doctors lost the argument decades ago when they agreed that people had a right to medical services. It was self-imposed slavery (because they agreed) and now we are just discussing the details (e.g. Obamacare, medicare, etc.) and the govt programs that steal from people to pay for medical services are just windows dressing to make it look civilized and moral. The good news is that your rights are inalienable, you…

[deleted]

Re: Why doctors are sick of their profession

#117

Post by cmdrfred » Sat, Aug 30, 2014, 11:46 PM UTC

dmfdmf wrote: post #104

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…

The doctors lost the argument decades ago when they agreed that people had a right to medical services. It was self-imposed slavery (because they agreed) and now we are just discussing the details (e.g. Obamacare, medicare, etc.) and the govt programs that steal from people to pay for medical services are just windows dressing to make it look civilized and moral. The good news is that your rights are inalienable, you…

I manage IT for ten dental offices, Hippa isn't that hard (full disk encryption isn't even mandatory). You must not be very good at what you do, and its probably why you are so angry.

Re: Why doctors are sick of their profession

#118

Post by tim333 » Sat, Aug 30, 2014, 11:48 PM UTC

dmfdmf wrote: post #104

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…

The doctors lost the argument decades ago when they agreed that people had a right to medical services. It was self-imposed slavery (because they agreed) and now we are just discussing the details (e.g. Obamacare, medicare, etc.) and the govt programs that steal from people to pay for medical services are just windows dressing to make it look civilized and moral. The good news is that your rights are inalienable, you…

>when they agreed that people had a right to medical services ... It was self-imposed slavery...

We've had rights to medical services in most of the developed world outside the US for decades. Doctors have high salaries and reasonable conditions for the most part. Funny version of slavery.

Re: Why doctors are sick of their profession

#119

Post by cloverich » Sat, Aug 30, 2014, 11:56 PM UTC

jseliger wrote: post #25

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've read this before, and feel obligated to state I couldn't disagree more. And this is coming from someone who quit the profession (physician).

Be a nurse or PA because you have shadowed one, and enjoy the work. Their job is different than a Physicians, and personality (etc.) plays a part in which you'll enjoy. Additionally, the available specializations in medicine are something thats simply not available outside the profession. Don't settle for one or the other, choose the one that suits you.

Re: Why doctors are sick of their profession

#120

Post by jasonisalive » Sat, Aug 30, 2014, 11:57 PM UTC

vacri wrote: post #111

wtbob wrote: post #93

Earlier quoted context omitted.

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…

When were doctors ever 'lower-middle class' in any western society?

Any time right up until the 1950s I would say. I don't know what you'd call the status of mid-19th century doctors in Britain, for example, but they definitely weren't upper class.