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Medical school can be brutal, and it’s making many of us suicidal

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Re: Medical school can be brutal, and it’s making many of us suicidal

#141

Post by tnecniv »

cylinder wrote: post #28
LeifCarrotson wrote: post #26

Earlier quoted context omitted.

Where did you do your internship, and what were you asked to do there? How many hours did you work and study while in school? Were you expected to work much longer hours as a junior employee to "work your way up the ranks? I think these are the sorts of elements of a hazing culture that GP is discussing. Not necessarily fraternity-prank style hazing.

Yes, this is the type of hazing I am referring to. Call it "institutionalized hazing" rather than fraternity style hazing. The bar exam for lawyers is one good example of hazing. Most law grads who apply themselves will pass, it's just a form of hazing for new entrants. Other countries with common law have just as good, if not better, bars and they do not have postgraduate law degrees and bar exams to become admitted…

If you call the bar hazing, then isn't pretty much any exam you've ever taken hazing?

Re: Medical school can be brutal, and it’s making many of us suicidal

#142

Post by jimmywanger »

zadig wrote: post #137
jimmywanger wrote: post #128

Earlier quoted context omitted.

> but even in the "simplest" of cases a doctor is called upon to draw on advanced skills and concepts he may not even remember he has. But how often does that occur? And is it worth the economic cost of not having doctors available, or doctors overworked? Individual human life is cheap. >A doctor is either capable or he/she is not. We simply cant train them halfway. There are countries that have carried out the exper…

> But how often does that occur? And is it worth the economic cost of not having doctors available, or doctors overworked? Individual human life is cheap. As someone currently in medical school, I'm going to have to agree w/ the previous comment that often "simple" cases are not so simple. For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract, the physiology of nutrient…

> For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract...

You don't have to understand it. You can say "Hey, usually when you take this pill things get better" or "Just keep him hydrated with a water/salt/sugar mixture, and these things generally take care of themselves."

Human life is cheap. There are 7 billion of us. Why are we optimizing for the very few to reduce medical care for the masses?

Re: Medical school can be brutal, and it’s making many of us suicidal

#143

Post by ejstronge »

jimmywanger wrote: post #142
zadig wrote: post #137

Earlier quoted context omitted.

> But how often does that occur? And is it worth the economic cost of not having doctors available, or doctors overworked? Individual human life is cheap. As someone currently in medical school, I'm going to have to agree w/ the previous comment that often "simple" cases are not so simple. For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract, the physiology of nutrient…

> For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract... You don't have to understand it. You can say "Hey, usually when you take this pill things get better" or "Just keep him hydrated with a water/salt/sugar mixture, and these things generally take care of themselves." Human life is cheap. There are 7 billion of us. Why are we optimizing for the very few to reduce me…

> You don't have to understand it.

I think this is the main point I and the other commenters are trying to explain. You do have to understand it. Imagine someone coming and telling you your software job is better done by overseas contractors - they're less efficient and cheaper so you naturally must be overpaid.

Except that ignores the many ways in which your training might make your higher cost worthwhile.

> Why are we optimizing for the very few to reduce medical care for the masses?

Are you implying there's a concerted effort to deny care? With the proliferation of nurse practitioners and physicians assistants, we're broadening the range of people who can take care of our population. Overseas, groups like Partners in Health are training community members to offer care in order to fill in gaps in health care availability.

Sorry to take this to its extreme, but I think you're proposing the idea of the marketplace finding the optimum amount of training for caregivers. As a point of opinion, this kind of system would be far more disadvantageous for society's less powerful than what we have now.

Re: Medical school can be brutal, and it’s making many of us suicidal

#144

Post by mixmastamyk »

stephencanon wrote: post #140
mixmastamyk wrote: post #122

Earlier quoted context omitted.

To what end? It's well known the body has Unless they get paid by the hour, I see no reason to continue to participate in such a system. Still, it should not be allowed when lives are at stake.

There's no other path to becoming a doctor in the US. You can choose to go into a specialty with more relaxed hours, but you need to go through residency no matter what. If you want to be a doctor, you put up with it, like the generations before you. A sufficient number of residents organizing could do something about it, but (a) no one has time to organize when they're working 90 hour weeks and (b) there's a signifi…

You can only learn so much per day. It sounds like you are making excuses to ignore basic human rights (recognized post-industrial revolution) such as ~40 hour weeks in favor of indentured servitude. Appeals to "outcomes" do not supersede workers rights.

Sorry, I don't buy it.

Re: Medical school can be brutal, and it’s making many of us suicidal

#145

Post by mixmastamyk »

module0000 wrote: post #135
mixmastamyk wrote: post #122

Earlier quoted context omitted.

To what end? It's well known the body has Unless they get paid by the hour, I see no reason to continue to participate in such a system. Still, it should not be allowed when lives are at stake.

Well, look at it from the patients point of view... if there isn't a doctor to available, because they took some time off after a 20+ day stint...where does that leave you(the patient)? It's a tough job, but they signed up for it, and the pay is very good by comparison to other jobs that have similarly long hours. For some contrast though, before everyone cries out "save the med students, they have it harder than any…

Doctors could work shifts just like everyone else at the hospital.

Just because a worse job might exist is not a justification to continue---logic and all that.

Re: Medical school can be brutal, and it’s making many of us suicidal

#146

Post by kahrkunne »

mixmastamyk wrote: post #144
stephencanon wrote: post #140

Earlier quoted context omitted.

There's no other path to becoming a doctor in the US. You can choose to go into a specialty with more relaxed hours, but you need to go through residency no matter what. If you want to be a doctor, you put up with it, like the generations before you. A sufficient number of residents organizing could do something about it, but (a) no one has time to organize when they're working 90 hour weeks and (b) there's a signifi…

You can only learn so much per day. It sounds like you are making excuses to ignore basic human rights (recognized post-industrial revolution) such as ~40 hour weeks in favor of indentured servitude. Appeals to "outcomes" do not supersede workers rights. Sorry, I don't buy it.

Human lives supersede workers rights. If you don't like it don't go to medical school.

Re: Medical school can be brutal, and it’s making many of us suicidal

#147

Post by johan_larson »

winter_blue wrote: post #136
deelowe wrote: post #84

Earlier quoted context omitted.

As a father whose young son had a compound fracture recently and had to wait in the ER for 3 hours to get it patched up by a grumpy, rushed, and tired ortho, this is horrifying. Something really needs to be done about current crony capitalistic US medical industry.

The solution might just be to expand or establish more medical schools, and graduate more doctors. If there were twice as many doctors, the existing doctors probably wouldn't need to work 80 hours a week, and could likely cut down to 40 hours. The other problem might be that doctors are paid extremely well in the U.S. compared to the rest of the world, and even compared to other rich first-world countries.

The problem is residency, not the medical schools. The medical schools actually turn out slightly more graduates than find places in residency programs. And without completing a residency, you aren't allowed to practice medicine.

Proposals to expand residency run into the problem that it costs the government money. Residencies are funded at the federal level; teaching hospitals get a certain amount of money per resident to compensate for the effort required to train them. And the number of residencies funded per year has (I think?) been maintained at a pretty constant level compared for a long time, with so many new doctors per year per million people.

One option, I suppose, would be to allow self-funded residencies. Why should only the government's money be good enough? But that would probably be an option only for wealthy students, or those who are willing to go even further into debt.

Another option would be to replace residencies with something more like conventional apprenticeship. Is there any reason a new doctor has to learn the practical details of her trade at a hospital, rather than working under the supervision of an experienced doctor in private practice?

Of course, nothing like this is likely to happen. The whole medical industry is extensively regulated; those regulatory barriers are wide moats that ensure fat incomes and profits, which in turn create strong interest in keeping things as they are. Barring utter crisis, nothing is going to change.

Re: Medical school can be brutal, and it’s making many of us suicidal

#148

Post by dagw »

kahrkunne wrote: post #146
mixmastamyk wrote: post #144

Earlier quoted context omitted.

You can only learn so much per day. It sounds like you are making excuses to ignore basic human rights (recognized post-industrial revolution) such as ~40 hour weeks in favor of indentured servitude. Appeals to "outcomes" do not supersede workers rights. Sorry, I don't buy it.

Human lives supersede workers rights. If you don't like it don't go to medical school.

That's a bullshit argument. If hospitals really cared about human lives, they would keep a staff level that ensured that patients would be seen by doctors that where rested and focused. People die because doctors and nurses who've been on their feet for the past 20 hours are unfocused make stupid mistakes and hospitals simply don't care because dealing with the occasional accidental death is cheaper than hiring more doctors, and we as a society let them get away with it.

Re: Medical school can be brutal, and it’s making many of us suicidal

#149

Post by bryanlarsen »

dagw wrote: post #148
kahrkunne wrote: post #146

Earlier quoted context omitted.

Human lives supersede workers rights. If you don't like it don't go to medical school.

That's a bullshit argument. If hospitals really cared about human lives, they would keep a staff level that ensured that patients would be seen by doctors that where rested and focused. People die because doctors and nurses who've been on their feet for the past 20 hours are unfocused make stupid mistakes and hospitals simply don't care because dealing with the occasional accidental death is cheaper than hiring more…

As the OP noted, people die at a higher rate when you switch to shorter shifts because information loss during shift change causes more mistakes than tired physicians.

In many hospitals doctors are paid hourly, so shorter shifts wouldn't cost the hospital money.

Re: Medical school can be brutal, and it’s making many of us suicidal

#150

Post by thechao »

jmde wrote: post #114
M_Grey wrote: post #111

Earlier quoted context omitted.

The solution is automation.

... and/or deregulation (reregulation?) to open up competition. Often if not usually, the same task could be just as skillfully by done, or even more skillfully or appropriately done, by someone with a different educational route, with or without training beyond what is now typical (e.g., NPs, nurse anesthetists, PAs, optometrists, psychologists, pharmacists, RNs, you name it). PAs provide an instructive example, but…

Bar none, the happiest group of graduate students I ever worked with (at a hospital, or not) were the PAs. The education is focused, fulfilling, demanding without being exhausting. The pay is great (I know a number of guys who did a path of: high school flunkout -> GED -> nurse -> PA). Furthermore (at least 15 years ago), they don't have to deal with the vast majority of the insurance BS... they basically get to help & heal.
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