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.
The darker side of being a doctor (2017)
131–140 of 521 posts
Re: The darker side of being a doctor (2017)
#132I also agree that running hospitals like a private business is at odds with the essence of healthcare. However, this trend might be more indicative of a broader societal shift rather than a phenomenon unique to this sector.
Re: The darker side of being a doctor (2017)
#133Earlier quoted context omitted.
> 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…
I'm in New Zealand: not a heap better than you describe. Here GPs are overworked and getting an appointment is difficult. The health system has waitlists to control access to a limited number of procedures performed in each specialty. You need to be healthy enough to pass the access requirements and for acute surgery you need to live long enough to get to the front of the queue.
Re: The darker side of being a doctor (2017)
#134Something 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 r…
Re: The darker side of being a doctor (2017)
#135Something 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.
Those bright enough go to law, IT and similar.
Speaking for my wife, she had to wade through absolutely brutal first 10 years for absolutely no good reason (she ain't no neurosurgeon, just internal medicine GP with FMH), no personal life at all at the prime of her life. 50 work week in contract (when average here is 42), reality with all required bureaucracy goes to 60-70, for everybody, consistently, unpaid (illegal here but who cares, state owns the hospital), often much more and catching up with tons of bureaucracy/billing at home.
Add night shifts, which most of us elsewhere have no experience with, that mess you up for many further days. You are a fraction of yourself, mentally and physically, for easily a week, more if you had to go through say 4-5 in a row.
These are the conditions that we put repeatedly people who have full control over life and death and health of their patients, often without further supervision, hoping they somehow magically never ever make a mistake, and when they do, folks immediately cry a murder and families sue to hell with massive dollar signs in their eyes.
You complain about that, or that you spend whole weekend being on call 48h unable to do anything really for literally 20 USD altogether (price of a canteen lunch here), including when you have to come and work 10-hour shift? You are put under pressure, shushed for being a pussy if you complain, told to toughen up since previous generations had it even tougher, and they somehow got through. Nobody mentions how horrible parents those absent folks were, how burned out they often were, quietly weeping or drinking themselves into oblivion. Well yes, those that didn't just quit, didn't go insane, didn't commit suicide, sure they got through. And now enjoy seeing young going through a bit milder version of the same. Of course there are insane amounts of money involved, but its always between insurance and hospital, doctors get less than capable IT folks for much less work. I am IT guy and consider this utterly fucked up wrong.
A good friend of ours sued the hospital (biggest public in Switzerland) for breaking basic Swiss law consistently like that, he was first but quickly gathered tons of other doctors. IIRC hospital finally caved in, a bit, but he is gone from it for good to private sector. Twice the pay, half the crap.
I could go on and on like this, a lot of doctor friends in our circles. It ain't some dream job, (at least a bit well-placed) IT job is a blessing in comparison.
/rant
Re: The darker side of being a doctor (2017)
#136The profession as a whole is profoundly hostile to any serious considerations of mental health, and it’s going to take many more suicides before even the smallest steps are taken toward obvious quality of life improvements.
humanity as a whole is profoundly hostile to any serious considerations of mental health. Dr. Drew once agreed with a rant by cohost adam carolla along the lines of (this is a whisper transcription. blame me for mistranscriptions, idc) "It just doesn't make any sense to me. What's so bizarre in our culture, if you'd broken your leg when you were a kid and you needed a few years of physical therapy, you'd get it. You'…
Re: The darker side of being a doctor (2017)
#137Earlier quoted context omitted.
> hospitals are so overloaded How do you suggest we limit the demand for healthcare?
In the US, anyone can walk into the emergency room for treatment, but people who don’t have insurance are very unlikely to participate in preventative care. The way to decrease demand For complicated and expensive interventions to preventable problems is to increase access to preventative care.
In New Zealand "poor" might be a synonym for uninsured? However my peer group is middle aged professionals (not poor) with as variety of healthcare issues. Only a very few would preventative care help. Prevention would help many of my friends. A friend with a cancer scare that keeps smoking. A friend with gout that doesn't change habits. Multiple friends with issues from drugs that continue to take drugs. All my friends and me that are unfit and eat poor diets. I've given up drinking recently but I'm most definitely an outlier.
Prevention is often the cure.
Assuming you mean prevention when you say preventative care?
Re: The darker side of being a doctor (2017)
#138Earlier 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?
Re: The darker side of being a doctor (2017)
#139One point I resonated with is the high administrative overhead of being a doctor. I can imagine the stress of using an outdated EMR system when the time you have for each patient is so limited. I see lots of AI companies are trying to transform the MedTech industry, but I'm unsure how much of their products useful / are actually adopted by the hospitals. Maybe some experts in that space can enlighten me on that? I al…
I am really hopeful that systems like this will take off – the reality of being a junior doctor in the UK is that most of your time will be used on quite tedious admin tasks (documenting every patient interaction, filling forms, booking clinics etc.) using very & slow outdated computer systems. I don't think anyone expects this when they apply to medical school, and it can be quite demoralising when you start your first job.
Re: The darker side of being a doctor (2017)
#140Earlier 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/..…
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