Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The darker side of being a doctor (2017)

drericlevi.substack.com

Post reply on HN
Print view View original

111–120 of 521 posts

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

#111

Post by robocat »

Gunax wrote: post #81
IncreasePosts wrote: post #11

I know America strictly limits the number of people who can become doctors every year. Does Australia have a similar system? It seems insane to me to first limit how many there can be, and then overwork the ones you do allow to become doctors.

While it's true that there is a limit (really there is a limit to every university study), there is also a limit to the number of people who are qualified and interested. For instance, there are only about 20k people who score > 510 on the MCAT per year (the average matriculant has about a 512). And remember that includes US & Canada. While I know there are a lot of people rejected from medical school each year, some…

> there are only about 20k people who score > 510 on the MCAT per year

The article clearly shows the skills necessary to work as a doctor are a lot wider than academic ability.

One pleasure/pain of being a software developer is that there is less gatekeeping.

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

#112

Post by dmead »

paxys wrote: post #73
bsdz wrote: post #30

Something I've never quite understood is why, in the UK, we cap the number of medical students per year. I've known very bright people who aspired to be doctors but had their applications turned down only to go on to do phds and become scientists instead. I'd rather have twice as many doctors who work sensible hours rather than the status quo burn out. Looks like there are calls to change this. https://commonslibrary…

Because doctors' associations and regulatory bodies (like AAMC in the US) lobby to keep it that way to keep the value of their profession up.

And then make young residents work themselves to death.

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

#113

Post by spxneo »

People think doctors are some super human that they can heal themselves but they are people just like you and me. It's despicable that they along with veterans are being treated with ambivalence.

The most recent example of contempt towards doctors described in the article I've seen comes from South Koreans who enjoy a generous, affordable, high quality healthcare that exceeds those in North America complaining doctors make "too much" and that there isn't enough doctors.

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

#114

Post by dzink »

bsdz wrote: post #30

Something I've never quite understood is why, in the UK, we cap the number of medical students per year. I've known very bright people who aspired to be doctors but had their applications turned down only to go on to do phds and become scientists instead. I'd rather have twice as many doctors who work sensible hours rather than the status quo burn out. Looks like there are calls to change this. https://commonslibrary…

The training of each doctor takes a lot of resources, especially specific numbers of cases necessary for each of the specialists who do surgery of any kind. If a surgeon does not do a procedure on a regular basis they lose skill in it and the less practice a doctor has had in a field, the worse their outcomes. So if you get 10 whipples in a year in an area and you have too many surgeons or hospitals taking less than 1 per year, without one getting more than a number of cases a year, all of them will be bad and your mortality will be high.

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

#115

Post by opinion-is-bad »

game_the0ry wrote: post #88

I don't understand why doctors that are entering the field need to be over-staffed and over-worked. I have a cousin who is an Er surgeon and she needs works 3 days a week, but that certainly was not the case when she was starting out. The work culture of the medical profession looks horribly inefficient. What benefit do you get from buying out young doctors?

Poor incentives for the existing members of the system that hold power to implement change. They already cap the number of med students to control salaries, perhaps burning out young doctors fulfills the same purpose, while also (temporarily) covering for the lack of doctors available because of the artificial limit?

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

#116

Post by dogmatism »

bsdz wrote: post #30

Something I've never quite understood is why, in the UK, we cap the number of medical students per year. I've known very bright people who aspired to be doctors but had their applications turned down only to go on to do phds and become scientists instead. I'd rather have twice as many doctors who work sensible hours rather than the status quo burn out. Looks like there are calls to change this. https://commonslibrary…

NHS is in a process of replacing doctors with physician assistants

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

#117

Post by rors »

user_7832 wrote: post #2

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…

My partner is a surgeon in the UK. She's planning on leaving the profession at the end of the year. We talk a lot about what is wrong with the medical profession.

One issue is the type of person attracted to the profession. They're incredibly academically talented, not driven by money, and desire status and recognition. Surgeons are the most extreme cases of this personality type, as they're harder jobs to get and have a lot of pressure. These people are the types who get their head done, roll up their sleeves, and get on with things. They're not used to asking for help or additional resources. They're the sort of people who care for others! Medicine self-selects for martyrs.

In addition, you have so many hoops to jump through (training, specialisations, etc) with significant time investment that can be lost in moments by pissing off training directors or other senior doctors. My partner ends up working more than her contracted hours because her bosses expect her to, although they would never explicitly enforce stricter rules. If she works her contracted hours she can kiss a consultant job (UK equivalent of attending) goodbye as her bosses won't provide a reference for the role.

Because the stakes in medicine are literally life and death, meaning that it is heavily regulated. There are horror stories around the GMC, the UK regulator, and doctors are terrified of being investigated. They adopt a legalistic mentality where they only treat if they're sure that they won't get prosecuted. It's very different from aviation with its no blame culture.

Finally, another factor that is making medicine so tough is that it is a success story! People live longer, and pathologies that were once fatal can be managed with ever more complex treatments. As demographics lean to older populations, then the demand keeps increasing.

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

#118

Post by impossiblefork »

Turing_Machine wrote: post #84
impossiblefork wrote: post #74

Earlier quoted context omitted.

I think having more physicians is the core thing. The US stands out in having so few physicians per capita (per 1000 it's 3.6 in the US, here in Sweden it's 7.1, in Germany 4.5, Spain in 4.6). This has been discussed before here before, and I don't think it was controversial that a sensible solution was to simply have more physicians. I think one major thing that the US is doing wrong with that which is not so well k…

This was in Australia (4.1).

Ah, thank you.

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

#119

Post by ptsneves »

kwhitefoot wrote: post #77
derbOac wrote: post #61

Earlier quoted context omitted.

The answer is implied, right there in the first paragraph: "... I’ve never been diagnosed with a mental illness." At least in the US, there's a kind of masochistic pride in the physician community, that everything he described in his essay is laudable, noble, to be emulated. Nowhere does he acknowledge the risks to his patients or whether the costs are worth it in the end, or if a different system might be better. An…

> At least in the US, there's a kind of masochistic pride in the physician community, But the question is why does the rest of society insist that pilots be properly rested but not doctors? I'm sure a lot of pilots would also work crazy amounts of overtime if allowed.

Not only pilots. Truck driver resting time is heavily regulated to the point the need to record start and end or they will be fined at best. Their employers will also be on the hook if drivers are non compliant.

A truck driver! But doctors? No… they are Uberhuman and can make life or death decisions after 24 hours on call and awake. Ridiculous. It is a topic that angers me a lot.

This happens in Portugal as well as Poland, it indeed feel universal. I think the reason is that doctors are kind of like gods: in the hour of your biggest need it is them that can help, therefore they are highly respected and have huge influence over a wide cross section of society. Everybody will eventually need a doctor in their life.

Another pet outrage topic related to doctors is the amount of time they need for training. They train almost 12 years after high school before they are qualified. What a wasteful training. They learn lots of generalities to the specialize in the end. With a 10 or 12 year higher education you are speaking about phd or post docs for a profession that requires 1 for every 1000 citizens. Imagine that ratio of phds and post docs. Is being a GP really requiring such training? I don’t think so and agree with above posts that their duties should be broken down, opened and delegated.

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

#120

Post by switch007 »

robocat wrote: post #101
nradov wrote: post #67

Earlier quoted context omitted.

Artificially limiting the supply of doctors is one way of rationing healthcare and holding down costs. Healthcare in the UK is largely funded through the NHS. Voters are already financially struggling and don't want to pay higher taxes. In some cases, even emergency patients are waiting hours in ambulances because hospitals are so overloaded. https://www.bbc.com/news/uk-england-cornwall-68171254

> hospitals are so overloaded How do you suggest we limit the demand for healthcare?

In the UK they severely limit access to any diagnostics, and your GP just gives you antibiotics and/or anti depressants.

At the hospital, they just classify your symptoms as “not critical”, refuse to admit you and kick you back to your GP, who then refuses to refer you for any investigations, I imagine because there is a gun to their head over targets etc

If your levels are high, you’re told oh it’s not severe. If it’s severe, you’re told oh it’s not critical etc

We have a system where everyone just gaslights you that you’re in fact not sick because you aren’t 3 seconds from death

Post reply on HN