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The darker side of being a doctor (2017)

drericlevi.substack.com

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

#12
(At least some) of the new generation of doctors appears to be better about refusing overwork. AFAICT that's a large component of the doctor shortage here in Canada -- the ratio of doctors to patients is better than ever but if a doctor "only" does 40 hours a week you need more of them.

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

#13
post #9

Earlier quoted context omitted.

The understaffed healthcare system works with overworked doctors on the basis that having a tired and overworked doctor is a lot of the times better than having no doctor at all, because (s)he most likely can end up saving more lives than taking with their tired brain. If your operations have a 90% survivability rate it could still be considered a success despite those 10% they end up killing, because 90% is a lot be…

but the alternative isn't having no doctor at all, but to get more doctors, so the "basic game theory" is about why the limits on more doctors stay in place despite the higher risk of death etc.

> but to get more doctors

Have you found that magic fountain of endless doctors?

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

#14
> I am realising more and more that what brings me greatest distress is the relentless administrative pressure which take away the meaningful clinical engagement I have with my patients. And I wonder if this is what many young doctors are experiencing as well. Medicine used to be a meaningful pursuit. Now it has become a tiresome industry. The joy, purpose and meaning of medicine has been codified, sterilised, protocolised, industrialised and regimented. Doctors are caught in a web of business, no longer a noble vocation. The altruism of young doctors have been replaced by the shackles of efficiency, productivity and key performance indicators.

tl;dr: professional feels like a proletarian.

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

#15
post #9

Earlier quoted context omitted.

but the alternative isn't having no doctor at all, but to get more doctors, so the "basic game theory" is about why the limits on more doctors stay in place despite the higher risk of death etc.

> but to get more doctors Have you found that magic fountain of endless doctors?

Sure, it's very easy! Just do things that prevent burnout (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/) and the job gets more attractive, drawing more students and producing less attrition:

- Valuing work gives meaning (money, appreciation)

- Autonomy gives feeling of control

- Managing burden prevents overwork, exhaustion and fatigue

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

#16

Most of the issues mentioned in the article and the included email are concerning, however they also oddly seem to be common in many places across the globe. The surgeon mentioned was in Australia, I have seen these issues first hand in the Netherlands and am aware of very similar of the first 2 out of 3 issues (caused by overwork/understaffing/over-fatigue etc) in Belgium, Germany, the UK, India and god knows how ma…

The understaffed healthcare system works with overworked doctors on the basis that having a tired and overworked doctor is a lot of the times better than having no doctor at all, because (s)he most likely can end up saving more lives than taking with their tired brain. If your operations have a 90% survivability rate it could still be considered a success despite those 10% they end up killing, because 90% is a lot be…

Sorry, that is bollocks. That is the story most people believe, and makes for a convenient story for those people actually to blame. Funnily, it is also the story most doctors themselves seem to chose to believe in.

First, those are not the only choices. There is also the the option of training and hiring more doctors. 2

Probably, there is also an option of making more efficient use of doctors time, but that one is more complicated.

Most of the work of doctors is not life-saving.

I think, you see a standard problem of pushing shit down or up. Government lowers budget, pushes quotas down, which gets pushed down further until it reaches the bottom rank and file, the doctors.

They have to "do more with less" (Not limited to public sector, see Boeing), and that works for a while, until it doesn't.

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

#17

Most of the issues mentioned in the article and the included email are concerning, however they also oddly seem to be common in many places across the globe. The surgeon mentioned was in Australia, I have seen these issues first hand in the Netherlands and am aware of very similar of the first 2 out of 3 issues (caused by overwork/understaffing/over-fatigue etc) in Belgium, Germany, the UK, India and god knows how ma…

The understaffed healthcare system works with overworked doctors on the basis that having a tired and overworked doctor is a lot of the times better than having no doctor at all, because (s)he most likely can end up saving more lives than taking with their tired brain. If your operations have a 90% survivability rate it could still be considered a success despite those 10% they end up killing, because 90% is a lot be…

What about the meta-game, where doctors get burnt out or suicide, and that increases pressure on the remaining doctors, in a negative feedback loop.

We should impose work limits on doctors, just like pilots.

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

#18

Most of the issues mentioned in the article and the included email are concerning, however they also oddly seem to be common in many places across the globe. The surgeon mentioned was in Australia, I have seen these issues first hand in the Netherlands and am aware of very similar of the first 2 out of 3 issues (caused by overwork/understaffing/over-fatigue etc) in Belgium, Germany, the UK, India and god knows how ma…

> The question is, why is it okay for medical professionals to wear themselves down to the bone (sometimes literally, like in this article), while some other professions take care to avoid it?

I think the answer here is that if you there aren't enough pilots, schedules can be reduced. You can't scale back (in any ethical way, anyway) the demand for healthcare. People will just die at a higher rate and outcomes will worsen.

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

#20

Most of the issues mentioned in the article and the included email are concerning, however they also oddly seem to be common in many places across the globe. The surgeon mentioned was in Australia, I have seen these issues first hand in the Netherlands and am aware of very similar of the first 2 out of 3 issues (caused by overwork/understaffing/over-fatigue etc) in Belgium, Germany, the UK, India and god knows how ma…

I share the same objection about the lack of regulation in the medical profession worldwide.

My best friend from high school became an MD and I witnessed doctors in training being proud of powering through extremely long, back to back shifts with little rest.

Meanwhile, as an engineer I've seen short and strict shift limits on employees operating machinery like trucks and forklifts. Under the obvious principle that insufficient sleep impairs judgement, put lives at risk and creates massive liability.

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