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The darker side of being a doctor (2017)

drericlevi.substack.com

141–150 of 521 posts

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

#141
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…

idk why doesn't my startup hire twice as many people? wouldn't we get the work done twice as fast and make twice as much money?

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

#142
post #129

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.

Yes but you really don't want to be treated at the end of that 12-hour shift, quality of service drops down significantly, they are significantly more tired at that point. Doctors are just humans like rest of us, and those shifts are often brutal.

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

#143
post #129

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.

I’d rather have three well-rested people and an additional shift change than two burned out, exhausted people. People who are exhausted make mistakes. Maybe it would be better to focus on improving internal communication.

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

#144
post #57

Earlier quoted context omitted.

Supply and demand. If you artificially cap the supply of doctors, then the doctors can ramp up their prices.

Perhaps there's a little of that going on here in the UK. Doctors can certainly command a decent salary especially if they specialise, run private clinics etc. That said, I feel it's probably more complicated than that. Each place costs approx £230k (only £65k paid by student by way of loans). This means increasing supply is a costly endeavour. The government also says that they wish to maintain teaching and learning…

Of course the UK government can avoid the training cost by hiring foreigners. From my personal experience maybe half the NHS doctors are from overseas.

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

#145
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…

idk why doesn't my startup hire twice as many people? wouldn't we get the work done twice as fast and make twice as much money?

With doctors you can parallelize treating different patients pretty easily.

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

#146
post #125
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.

We should enforce rigorous qualifications for doctors. We've relaxed the standards far too much already.

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

#147

The shit we make doctors go through is unnecessarily insane. It takes 300-400k of debt and grueling 7-8 years on top of a bachelors degree, with bunch of uncertainty on where you'll be or whether you ever make it, just to start working. If you ever quit before then, any progress made counts for zero and you have to start all over again in a new field with a ton of debt. Why doesnt an MD or even credits at a medical s…

I agree but the education system is starting to improve. Some schools now offer combined Baccalaureate-MD programs which can reduce the education time by up to 2 years.

https://students-residents.aamc.org/medical-school-admission...

Tennessee now allows some physicians to practice without completing a residency program, largely as a way to attract immigrants to work in underserved communities.

https://www.medscape.com/viewarticle/993693

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

#148

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…

> 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 better than 0%.

> Meanwhile a tired pilot is more binary, it either can have 100% passenger survivability if things go well or 100% fatality if things go tits up, meaning the risk are too high to take chances.

This isn't how the math works. A tired pilot either kills or doesn't kill their passengers on a given flight the same way that a tired doctor either kills or doesn't kill their patient in a given operation. In both cases it's 100% survive or 0% survive.

Pilots aside, we also have laws about keeping truck drivers from driving too many hours, and accidents involving drowsy truck drivers are unlikely to have fatality counts measured in the hundreds.

The difference between doctors and pilots/truckers isn't in the amount of risk involved, it's that surgeries are expected to have a non-zero fatality rate. A doctor can do their job perfectly and still lose a patient, so it's harder to prove that the fatality rate would be lower if we gave surgeons more rest. When a truck driver falls asleep at the wheel and kills someone it's obvious because they did something provably illegal or unsafe right before the crash. When a surgeon fails it's a lot harder to prove it was preventable.

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

#149
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…

Training places are already rammed to the gills, there aren't enough places to put substantially more students. Junior doctors already have to compete to get training slots even vaguely where they live and if they miss that they simply have to physically move to a different city. Medical training isn't as simple as just adding a lecture theatre and a few classrooms, or even a whole university building faculty of lecturers and admin. You also need a hospital (and GP surgeries etc) to be attached as well as enough senior staff to train them when they are there. That training is very intensive on trainer:trainee ratios and the senior staff are also in critically short supply as the ones who were trained up when there was training capacity (which, to be fair, was a time when it was far cheaper to train a medical student), are retiring by the thousands and many newer junior doctors quit or emigrate as a result of their experiences up to that point.

Hospitals cost absurdly large amounts of money, especially in the UK where there are consultancies and layers of subcontracting for everything. So the infrastructure costs of adding even a few hundred student places is astronomical.

Due to strategic underinvestment (or ideological sabotage, or governance incompetence, depending on outlook) there is now a self-reinforcing problem: not enough hospitals and staff to train doctors to beef up existing hospital staffing or work in hypothetical new hospitals even if a money firehose was turned on.

Rather than having a tall glass of concrete and doing the hard thing, which will still take decades to manifest, what the government is currently doing is a rerun of Healthcare Assistants where more care is delegated to much cheaper-to-train staff. Plus quite a bit of noise about "AI" bring used to allow them to sweat the asset of the staff they do have by, for example having one radiologist verifying AI findings rather than a pair-based system.

Which will all work "kinda ok" and let them punt the problems at least into the next government's domain when they lose the next election and can spend 5 years screaming from the Opposition benches about the mess. But you cannot do it forever (or the hail-Mary works, there's an AI revolution and you can actually run a hospital with an app, 2 agency nurses, a few smart plugs and an AWS instance).

Of course "doing the hard thing" would be easy to say if it was just the NHS, but there's the same structural degradation in everything. So you also need to spend billions on education. That's the same general problem - shortage of facilities and not enough existing staff to train new staff and the ones you do train quit. Schools are currently one something like a near-500-year replacement rate (50 per year, 24000 total) and that's without considering population growth or even the hundreds of schools that need rebuilding because they're made of RAAC. Then roads need billions to repair the accumulating damage. The railways need huge investment and staffing. Energy is the same - virtually no supply of domestic nuclear design engineers mean they get absolutely rinsed on even squinting in the direction of a drawing of reactor (though Hinkley Point C cost spiral is currently EDF's problem, not the taxpayer and green energy is actually a rare success story). Defence is similar (e.g. ships being retired because they need the staff elsewhere). At least some water networks are collapsing into a multi-billion hole after private dividend extraction. So that money firehose has a lot of work to do, even if they would turn it on. Which is ideological poison apparently.

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

#150
post #132

One 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 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?

My impression (as an outsider with a partner in the medical field) is that the prime function of the "medical industry" is to generate reams and reams of documentation about "care provided" to an insanely granular level. Functionally, this information is mostly bullshit that is irrelevant to providing medical care, but it serves a very important purpose for the medical administrative class so that they can bill the patient for each bandage applied or Ibuprofen administered.

AI MedTech companies mostly seem primed to increase this firehose of bullshit. Whether or not that will take the pressure off front-line medical personnel who are currently tasked with generating it remains to be seen, but you'd be hard pressed to convince me.

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