The darker side of being a doctor (2017) • Hacker News Board

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

#121

Post by The_Blade » Sat, Apr 13, 2024, 8:55 PM UTC

derbOac wrote: post #61

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…

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…

I would also add the famous Bert Cooper line, "I never heard the word client in there." He mentions patients, but they are all wrapped up in a woe-is-me section I work so hard and yet I haven't been diagnosed with a mental illness.

He sounds like the kind of person that brags about being mentally sound but is secretly addicted to benzos. Always advocate for yourself!

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

#122

Post by james-redwood » Sat, Apr 13, 2024, 8:56 PM UTC

hello_computer wrote: post #39

Rinzler89 wrote: post #5

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…

Not so sure about that. According to a few studies, medical error is the 3rd leading cause of death, behind heart disease and cancer. Many operations are elective. In such cases, having a tired surgeon or nurse may be worse than delaying the procedure, or even skipping it. https://www.bmj.com/content/353/bmj.i2139 https://pubmed.ncbi.nlm.nih.gov/28186008/ https://journals.lww.com/journalpatientsafety/Fulltext/2013/..…

This has been extensively debunked. Read the original methods of the BMJ article that you linked. They took every single minor error, like prescribing medicine 15 minutes late, and if the patient died, even of an aggressive cancer that they had already, it would be counted in the 'medical error that caused the death' statistic.

https://www.nytimes.com/2016/08/16/upshot/death-by-medical-e...

https://www.medscape.com/viewarticle/863788?scode=msp&st=fpf...

https://sciencebasedmedicine.org/medical-errors-2020/

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

#123

Post by arp242 » Sat, Apr 13, 2024, 8:58 PM UTC

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…

Your own link contains your answer:

> Expanding the cap on medical and dental school places is complicated by the cost of training, current university and clinical placement capacity, and the current number of clinically qualified academic staff who design and deliver courses.

Furthermore, the NHS actually needs the funds to hire staff.

The core problem is that people are getting older with more complex health care requirements, that more and more conditions become treatable, that healthcare is often expensive, and that no one wants to pay for it.

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

#124

Post by dogmatism » Sat, Apr 13, 2024, 9:03 PM UTC

eclectic29 wrote: post #78

Thanks for sharing. This is so disheartening. The other day I was debating with my friends how a doctors life is so cool that they don’t have to go though grueling coding interviews every single time they want to change jobs, don’t have to prove themselves every single quarter, don’t have to be answerable to anyone or write performance reviews or be subjected to arbitrary rubrics. Boy, I was so wrong. Every processio…

US PCP doctors do take calls. It's less common for them to go to the hospital to admit their own patients anymore since the rise of "hospitalists" but they still take outpatient calls and calls from the ER.

Also, PCPs are subject to the most metrics/rubrics of any, and all the crap paperwork that any specialist can foist off onto them, they do. Shit rolls downhill, and PCP's are at the bottom

They may stop seeing patients at 5, but they sure as shit aren't done at 5. Most are logging back in even later doing all the "paperwork" they didn't have time to do during the day. Even has a nickname: "pajama time"

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

#125

Post by rr808 » Sat, Apr 13, 2024, 9:04 PM UTC

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…

An associated problem is that bright people from rural or poor areas who are really passionate about being a doctor dont get the right grades to get in. Middle class kids in cities get in because its a good career but dont really like it that much and definitely dont want to work outside their city. My brother worked as a doctor until his thirties then quit, such a waste of training.

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

#126

Post by neilv » Sat, Apr 13, 2024, 9:05 PM UTC

Especially since the Covid vaccine return to some normalcy for many of us, always in the back of my mind whenever dealing with healthcare providers, is that they're probably the ones that both survived and stuck through that catastrophe.

And, some places, I get the impression they have fewer staff now, and greater financial challenges.

> If I decide to work less, who is going to cover the hospital? If the hospital aren’t employing other doctors, we can’t allow patients to go uncovered. I accept the fact that I have a duty of care to be on call.

The hospital also has a duty of care.

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

#127

Post by treprinum » Sat, Apr 13, 2024, 9:06 PM UTC

Enforcing duration of medical actions must be some of the most idiotic things a healthcare MBA/MPH could come up with. Forcing a surgeon to finish surgery exactly within allocated time is putting lives at risk. The factory model should never be applied to fields like these.

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

#128

Post by [deleted] » Sat, Apr 13, 2024, 9:06 PM UTC

triceratops wrote: post #108

nradov wrote: post #46

Earlier quoted context omitted.

False. The AMA has no regulatory or accreditation authority over medical schools. Schools can admit as many students as they want. The bottleneck right now in producing more US physicians is lack of Medicare funding for residency slots (graduate medical education). Every year some students graduate from accredited medical schools with an MD but are unable to practice because they don't get matched to a residency prog…

> The bottleneck right now in producing more US physicians is lack of Medicare funding for residency slots... Congress hasn't significantly increased funding in years. Much routine care can be delivered by Physician Assistants or Nurse Practitioners working under a Physician's supervision We should all accept a lower standard of care because hospitals can't find more funding to train doctors? What are all the $20 asp…

[deleted]

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

#129

Post by rr808 » Sat, Apr 13, 2024, 9:07 PM UTC

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?

Some wards with really sick people benefit from having longer shifts as you see the person progress and have fewer shift changes. Ie with 2 people doing 12 hr shifts is better than 3 people doing 8 hours shifts as the doctors and nurses see how a patient is doing and dont have to communicate to next shift. Something like ER where people come and go all day wouldn't benefit from this however.

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

#130

Post by mlyle » Sat, Apr 13, 2024, 9:07 PM UTC

lazyasciiart wrote: post #102

mlyle wrote: post #76

Earlier quoted context omitted.

> 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 c.f. "...everything is rushed, and mistakes are bound to occur." "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." "I was burned out and I c…

> which does not have artificial restrictions on the supply of doctors to the same extent Yes it does. One of the really interesting questions is actually why the same problems have been created in so many otherwise-different systems. Edit: a post giving details on the Australian medical training constraints https://www.aph.gov.au/About_Parliament/Parliamentary_depart...

> > to the same extent

Your source says that the government sets (indirectly) a limit on the number of places at most public universities, but there are private, full-fee universities that are not so limited.

Internship slots, in turn, are set by disparate government agencies. They've climbed, but probably not climbed enough.

Compare to the US, where congress basically directly controls the number of residency slots and has failed to increase them really at all to keep up with increasing population and increasing need for medical services.