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The darker side of being a doctor (2017)

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

#21

Post by nradov »

user_7832 wrote: post #2

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…

For inpatient hospital care, research has shown that transitions in care are particularly risky for patients. When one doctor goes off shift and hands off a patient to another doctor, sometimes things fall through the cracks. In theory all of the data needed for a smooth transition should be documented in the patient chart, but in practice this doesn't always get done plus there is some tacit knowledge which clinicians build up by observing a particular patient which can't be put into words.

This risk of iatrogenic harm has been used to justify long hours, particularly for residents in teaching hospitals. I'm not saying that it's necessarily a good idea or that there are no better alternatives, just explaining some of the rationale.

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

#22

Post by grepLeigh »

The three factors mentioned (loss of control, loss of support, loss of meaning) are the pillars of occupational burnout, according to researchers like Christina Maslach.

In many cases, someone experiencing occupational burnout NEEDS extended time away from their work environment to heal. In severe cases, they might not be able to return to work at full capacity for years (or ever). This creates a negative feedback loop for understaffed doctors, nurses, and other healthcare workers.

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

#24

Post by hinkley »

Rinzler89 wrote: post #5
user_7832 wrote: post #2

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…

I think someone also did the math and figured out that having fewer handoffs side a patient led to better outcomes so now there’s pressure to have two doctors per24 hours instead of three or four.

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

#25

Post by malux85 »

Rinzler89 wrote: post #13
eviks wrote: post #9

Earlier 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?

Yeah it’s called correct incentives - I look at the over work, and insane stress levels that doctors suffer and I say “NO THANKS”

I am definitely not the only one

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

#26

Post by yazzku »

IncreasePosts wrote: post #11

I know America strictly limits the number of people who can become doctors every year. Does Australia have a similar system? It seems insane to me to first limit how many there can be, and then overwork the ones you do allow to become doctors.

>I had worked in a hospital where I didn’t get home for days at a time, sleeping overnight in hospital quarters, outpatient clinic benches and in my car. I used to have my sleeping bag, toiletries and change in the boot of my car because I didn’t know if I was going to make it home some nights. Plans change every single day at work because of emergencies. I can’t even be sure what the next hour will bring when I am on call.

This is absolutely insane. Are we reading a town doctor's tale or a war tale?

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

#27

Post by hello_computer »

There was a philosopher who once wrote "all regimes exist under the consent of the governed." This should go double for the medical profession. They have the brains, the education--and in most cases, the money--to object, weather a fight if need be, and comfortably pivot if they lose. If the situation is intolerable, the person to blame is in the mirror. They are competitive people. The bureaucrats and administrators understand this, and use it to pull their strings--make them dance. Click. Click. Click.

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

#28

Post by WalterBright »

Rinzler89 wrote: post #13
eviks wrote: post #9

Earlier 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?

The AMA only allows a fixed number of seats in medical school.

There also can be tiers of medical doctors. Most doctoring work is routine, and can be handled by a more of a medical tech.

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

#29

Post by closewith »

yokaze wrote: post #16
Rinzler89 wrote: post #5

Earlier 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…

Sorry, that is bollocks. That is the story most people believe, and makes for a convenient story for those people actually to blame. Funnily, it is also the story most doctors themselves seem to chose to believe in. First, those are not the only choices. There is also the the option of training and hiring more doctors. 2 Probably, there is also an option of making more efficient use of doctors time, but that one is m…

> Most of the work of doctors is not life-saving.

Yes, but working out which parts are and aren't critical is the $64,000 question.

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

#30

Post by bsdz »

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.parliament.uk/research-briefings/cbp-...
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