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

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

#191

Post by Scoundreller » Sat, Apr 13, 2024, 11:36 PM UTC

Wowfunhappy wrote: post #184

casenmgreen wrote: post #168

Earlier quoted context omitted.

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?

Or maybe more of a "doctor minus" rather than a "nurse plus" system.

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

#192

Post by tejohnso » Sat, Apr 13, 2024, 11:37 PM UTC

> I had worked in a hospital where I was oncall 24/7, 12 days out of 14. I had fortnightly weekends off.

Why would you do this? Some of the most basic labour jobs have better employment terms than this.

> You might ask, why can’t you work less? It’s not as easy as that. If I decide to work less, who is going to cover the hospital?

Yes, I did ask. But covering the hospital isn't your problem, that's a hospital management problem.

> If the hospital aren’t employing other doctors, we can’t allow patients to go uncovered.

It's the hospital that's allowing patients to go uncovered if they don't employ enough doctors for a reasonable workload.

The author goes on to detail just how unreasonable the workload is.

> As a surgeon I spent a year in a hospital where I smiled on the way to work and I am so grateful for my job. I looked forward to long days because I knew what I was doing was significant.

So there are cases where it can be enjoyable, yet ...

> Another year in another hospital, I dreaded going to work. I hated being on call....Same surgeon, different jobs.

I don't see why you'd choose to work at the dreadful job. Isn't surgery a skilled labour job that is in high demand? How can they not demand more control over their working environment?

I'm guessing, but maybe it's possible that they're conditioned to accept increasingly stressful environments from the first day of med school. So that by the time they're surgeons, they're so conditioned that the idea of refusing the unreasonably stressful load is not even fathomable. Maybe there's even a certain amount of egotistical satisfaction that comes from being able to hack it.

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

#193

Post by nradov » Sat, Apr 13, 2024, 11:39 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…

That is not even remotely viable. There is little or no correlation between price and quality in healthcare. There are no reliable ways to accurately measure quality of individual doctors across the full spectrum of services that they deliver. In particular, it doesn't make sense to just look at outcomes because the doctors who take on more difficult cases will always look worse in the metrics regardless of the quality of care that they deliver.

Your example doesn't even make sense. Having a PhD doesn't make software engineers more productive on average. PhD programs train researchers. Research skills have very little correlation with practical software engineering.

What could actually work is to train more physician assistants and nurse practitioners, then have them deliver the bulk of simple primary care services under the supervision of physicians. This is more cost effective and usually works well enough, although there may be some degradation in service quality for edge cases.

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

#194

Post by CydeWeys » Sat, Apr 13, 2024, 11:43 PM UTC

lilsoso wrote: post #146

rr808 wrote: post #125

Earlier quoted context omitted.

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.

Have we though? You got any source on that? There's already a severe shortage of doctors, so what happens if standards are significantly increased?

Having a doctor available to treat you at all is still much better than having your very high standards and then not having a doctor available period.

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

#195

Post by DonnyV » Sat, Apr 13, 2024, 11:44 PM UTC

nradov wrote: post #189

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…

That 17% includes Net cost of health insurance. So that would go down a lot with the profit taken out of it. Also expenditures would go down with price regulation and the system would also generate money from licensed medicines. Also the simplified billing and administration of a single insurance system would save a ton of money. Especially since a lot of the overhead in hospitals is admin. This simplified billing would let doctors have private practices again.

https://www.google.com/search?q=what+make+up+GDP+healthcare+...

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

#196

Post by Scoundreller » Sat, Apr 13, 2024, 11:45 PM UTC

ta_1138 wrote: post #85

kwhitefoot wrote: post #77

Earlier quoted context omitted.

> 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.

Pilot failures are really visible, and kill hundreds atll at once. Bad medical decisions lead to more deaths overall, but it's far less likely the public will hear it, and even if they do, it's one person at a time. Far more people die from car crashes than airplane crashes too: It's not even close. And yet, people who have no business behind a wheel drive, and the penalties for being a poor driver are typically mini…

And the pilot is quite likely to die in any fatal pilot error, so there's an element of self-interest in preventing pilot error.

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

#197

Post by CydeWeys » Sat, Apr 13, 2024, 11:45 PM UTC

game_the0ry wrote: post #176

GavinMcG wrote: post #162

Earlier quoted context omitted.

Have you looked at the research regarding which of those two options leads to better patient outcomes?

Have you? I’d love to hear that answer.

I have. Longer shifts with fewer turn-overs results in better patient outcomes.

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

#198

Post by amluto » Sat, Apr 13, 2024, 11:48 PM UTC

lilsoso wrote: post #146

rr808 wrote: post #125

Earlier quoted context omitted.

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.

I suspect that, after some point, making the qualifications stricter actually drives away many of the best candidates.

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

#199

Post by oldsecondhand » Sat, Apr 13, 2024, 11:51 PM UTC

peschu wrote: post #155

jajko wrote: post #135

Earlier quoted context omitted.

In Switzerland, at least for the french part, most of the doctors are not Swiss anymore. It literally became white collar immigrant job. Wife is one of those and sees the problem very clearly due to speaking about this with both (those few) swiss colleagues and the rest - its simply not attractive career path for locals, too much suffering and risk for relatively little reward. Those bright enough go to law, IT and s…

The picture you are painting is way too dark. And does not give a realistic picture. A lot of what you say is true for doctors in their first 5-10 years into their career, when employed in a hospital. This not true for doctors which reached a certain level like „oberarzt“ and above. This is especially not true for doctors with their own „office“ (business). Yeah people may cry, but normally it is very hard to bring a…

> A lot of what you say is true for doctors in their first 5-10 years into their career, when employed in a hospital.

Then it's just semi-official hazing. It's still something that should be fixed.

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

#200

Post by sensanaty » Sat, Apr 13, 2024, 11:52 PM UTC

tejohnso wrote: post #192

> I had worked in a hospital where I was oncall 24/7, 12 days out of 14. I had fortnightly weekends off. Why would you do this? Some of the most basic labour jobs have better employment terms than this. > You might ask, why can’t you work less? It’s not as easy as that. If I decide to work less, who is going to cover the hospital? Yes, I did ask. But covering the hospital isn't your problem, that's a hospital managem…

I know a few doctors, and you have to keep in mind a lot of them are good people trying to help others as much as they can. They put up with overworking because at the end of the day, they want to be there for their patients as much as they can be, and if it's not them then people would literally not get the chance to see a doctor at all.

You are right, it shouldn't be their problem, and we should work on making sure they're (especially surgeons for christ's sake) well rested and as stress free as you can be in a field like medicine, but what's the alternative for them and their patients right now?