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

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

#181

Post by seabombs » Sat, Apr 13, 2024, 11:02 PM UTC

There's been a critical spotlight on Australia's medical industry lately. Like gouging the medicare system or skirting regulations to profiteer off the insane demand for semiglutide weight loss drugs like Ozempic (couple of links below).

If you were a young, idealistic doctor (or an experienced idealistic doctor) I could imagine feeling incredibly disheartened when you see this kind of thing going on around you.

For the regulators I think the challenge they have is how to minimise the damage of the "bad" medical professionals (or weed them out of the system entirely) while not crushing the spirit of the good ones. I certainly don't know the answer.

https://www.abc.net.au/news/2024-04-08/price-of-pain-doctors...

https://www.abc.net.au/news/2024-04-01/cowboy-pharmacist-beh...

Also not that it really changes anything but the linked article says it was written in 2024, though Dr Bryant's death was in 2017: https://www.brisbanetimes.com.au/national/queensland/i-didnt...

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

#182

Post by JackeJR » Sat, Apr 13, 2024, 11:04 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…

one reason is to make sure that the best and brightest are distributed amongst different industries.

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

#183

Post by raincole » Sat, Apr 13, 2024, 11:05 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…

In many countries they have a cap of the number of medical students. You might want to check what is happening in Korea rn.

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

#184

Post by Wowfunhappy » Sat, Apr 13, 2024, 11:08 PM UTC

casenmgreen wrote: post #168

lilsoso wrote: post #146

Earlier quoted context omitted.

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

We do not need all doctors to be uber doctors. We need a range of doctors, who range in price according to quality . That way for simple stuff, which anyone can get right, we go to a cheap, reasonable doctor. A similar example would be if we only had uber software engineers. Each one had to have a PhD. There were no cheap and okay developers who could do say web-sites but not write a programming language from scratch…

I think you're possibly describing nurse practitioners?

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

#185

Post by psychlops » Sat, Apr 13, 2024, 11:10 PM UTC

If they didn't artificially restrict the supply of doctors the demand would be met.

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

#186

Post by psychlops » Sat, Apr 13, 2024, 11:11 PM UTC

H8crilA wrote: post #173

worik wrote: post #171

Doctors meet better unions in that country Senior doctors in New Zealan have one of the most powerful unions in the country Junior doctors are catching up It is still a punishing career, but not like that.

In many countries doctors' unions actually encourage this sort of stuff, by restricting the number of spots in medical degrees. Making sure there are as few juniors as possible, making their life more miserable than it needs to be - this sort of stuff.

The goal of a union is to put a fence around the employers and drive wages up. Mission accomplished.

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

#187

Post by robbiep » Sat, Apr 13, 2024, 11:18 PM UTC

seabombs wrote: post #181

There's been a critical spotlight on Australia's medical industry lately. Like gouging the medicare system or skirting regulations to profiteer off the insane demand for semiglutide weight loss drugs like Ozempic (couple of links below). If you were a young, idealistic doctor (or an experienced idealistic doctor) I could imagine feeling incredibly disheartened when you see this kind of thing going on around you. For…

The first things you talk about have nothing to do with the second things you talk about, but I can see how they can be lumped together.

The truth is the medical sector in Australia is always under intense scrutiny, and rightly so.

Currently the biggest systemic threat to our healthcare system (in my opinion) is underpayment/underinvestment in general practice which is having a critical effect on new trainees entering GP.

Dr Levi is a well known Melbourne ENT surgeon who has been extensively involved in doctor wellbeing initiatives, including starting Socks for Docs day. It looks like he just discovered substack and has started writing - I am sure I have seen this exact essay from him previously, which is where we get the discordance of him talking about the 2017 death as though it happened last week.

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

#188

Post by Zenzero » Sat, Apr 13, 2024, 11:26 PM UTC

dimal wrote: post #143

rr808 wrote: post #129

Earlier quoted context omitted.

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.

Rounding is a major source of mistakes. It is very common that cases rounded through multiple people develop major gaps in information. This is not as simple of a problem as you think it is.

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

#189

Post by nradov » Sat, Apr 13, 2024, 11:33 PM UTC

DonnyV wrote: post #31

This is what happens when everything is financialized. There is no reason that we should be running doctors into the ground. Health professionals are a necessity in a functioning society. I know in the US Government seems to have no problem throwing money at corporations and providing endless tax breaks. But god forbid we proved a functioning health system. For the US this needs to happen. 1) Medicare For All - a uni…

I don't think you've done the math on that. Healthcare constitutes 17% of US GDP. A huge chunk of that is paid by self-insured employers. An additional 4% income tax wouldn't be sufficient to fund a "Medicare for All" program. Any further increases in income taxes would be highly regressive for low-income people. And the baseline Medicare program doesn't even cover a lot of stuff that is typically included in private medical insurance such as prescription drugs (need at Part D supplement for that).

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

#190

Post by nradov » Sat, Apr 13, 2024, 11:34 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…

Where would you suggest that teaching hospitals find more funding? Most of them are non-profits, or operate as part of state or local government agencies. They have no ability to negotiate higher rates with Medicare/Medicaid and only limited ability to negotiate higher rates with private payers (typically set as a multiplier to the Medicare rate). Voters generally haven't been willing to raise taxes. There is probably some waste that could be trimmed but it's tough to figure out where to cut without impacting patient care quality. Much of the administrative overhead is forced upon them by unfunded government mandates around reporting, quality, security, credentialing, and interoperability.

Private donors are always welcome. If you have a few million to spare then you can personally fund a residency program expansion at your favorite teaching hospital.

I won't attempt to defend ridiculous charges for certain basic medical services. Hospital accounting is a funny business, and almost entirely artificial. The teaching hospitals tend to deliver a lot of charity care (including writing off a lot of bad medical debt) and some Medicare/Medicaid reimbursements don't even cover their costs. So, they attempt to close the gaps by jacking up other prices as high as they can.

You should accept a lower standard of care because as a society we have limited resources and can't afford to waste them. If you have a boo boo then a NP can clean the wound and apply a bandage. That's what happened to me when I crashed my bike last year and it was fine. Physician time should be reserved for more complex cases.