221–230 of 1001 posts
The survey sample was 200 RNs in the USA.
Standard error in this case, assuming the 200 are randomly sampled is: sqrt((p*(1-p)/n) sqrt((0.9*0.1)/200) = 0.021 So 95% confidence interval for this ~ 0.86 - 0.94 Does that radically change the message of this article?
While it's anecdote, every single peer in bedside medical care I know without exception has either left the field, or has immediate plans to as soon as student loan debt is repaid. The few older medical professionals in my family are simply sticking out the last few years until they can retire early. This was generally the case prior to pandemic due to how poor the work environment has become, but the pandemic seems…
I’m pretty sure both of these will implode under the bureaucratic weight at some point — the financial and social costs of the excessive administrators is not justified by their (often minimal or negative) value added.
Earlier quoted context omitted.
Patient satisfaction surveys are the legible feedback mechanism showing that something is deeply broken, but not the source of the problem itself. It's clear from your comment that the source of the problem is the increasingly sharp divide between what the credentialed medical professionals believe and what lay people believe. The satisfaction survey is simply uncovering that fact. It would be vastly worse if patient…
Patients have always been entitled to make decisions about their bodies. You can decline procedures, and treatment, and you can get second, third, fourth, fifth opinions. Satisfaction surveys do nothing to increase that autonomy. The dystopian world you speak of is a straw man. The problems stems from people believing they are consumers of healthcare, on equal footing with the practitioner they are seeing. They're no…
I was with you up until this point. Part of the problem is that this cannot be true in all cases, unless either (a) your condition is commonplace (b) the doctor specializes in your condition.
Yes, doctors know more than you in almost every way about bodies about medicine, about drugs. However, people with relatively uncommon conditions have been enabled (largely by the internet) to create communities of fellow condition-sufferers, and the collections of anecdata that result represent a resource that generalist doctors do not have access to. The good specialists, in some cases, will take occasional dips in to augment their own knowledge and expertise.
Case in point: my daughter has had two major hip surgeries. While there is no way anyone in their right minds would have chosen someone who had not performed these surgeries previously (preferably, many times), and while it was completely clear that the surgeons really really really knew what they were doing, it was also the case that various online communities made up of people who have been through this procedure were able to provide lots of information that the surgeons could/would not. This was particularly true of the recovery process, where there were a number of common oddities that most people who have the procedure experience, and they're really not a problem. They are scary however, and the actual medical professionals really had nothing useful to say about them.
There's another issue with the blanket "doc knows best" rule. If you've had a GP for many years, or a specialist helping you with a condition for many years, then it's probably a great rule of thumb. On the other hand, if you've moved, or for any other reason switched doctors, and you're the kind of person who does pay attention to their body, there's a reasonable chance that you're going to know things about yourself/your body that the new doc(s) will likely not be aware of. They can (and will) learn, of course, and there's no reason to be aggressive or patronizing about it. But for example, you may understand the way you typically recover from antibiotic treatments, or the consequences of lack of sleep, or your tendency to always pull a lower back muscle given certain movements, etc. etc. in ways that your (newish) doctor may not yet be wise to.
While it's anecdote, every single peer in bedside medical care I know without exception has either left the field, or has immediate plans to as soon as student loan debt is repaid. The few older medical professionals in my family are simply sticking out the last few years until they can retire early. This was generally the case prior to pandemic due to how poor the work environment has become, but the pandemic seems…
Insurance companies. Everything is controlled by insurance companies. You can’t do anything unless it’s exactly how insurance wants and only for what insurance will pay. It limits everything, including how every profession can be compensated simply because you can’t easily hire somebody for more than what insurance will pay for their services. You can, but the funds have to come from somewhere.
Earlier quoted context omitted.
Insurance companies. Everything is controlled by insurance companies. You can’t do anything unless it’s exactly how insurance wants and only for what insurance will pay. It limits everything, including how every profession can be compensated simply because you can’t easily hire somebody for more than what insurance will pay for their services. You can, but the funds have to come from somewhere.
Insurance is the only industry where they agree to pay for something (in this case, "medical care"), but then after service has been rendered can decide to pay less, or not pay at all, or stop paying that provider altogether, etc. This combined with hospitals being run by non-physicians*, and people thinking being able to Google and read WebMD qualifies them to argue with their doctor about treatment plans**, healthc…
It's really jarring to read an otherwise reasonable comment that drops a whopper like this. Nothing exists outside of cost considerations. The NSA has cost considerations. The Space Shuttle had cost considerations (obviously, not great ones!). The design of nuclear submarines involves cost considerations, however unsettling that may seem. You're telling me that my broken hand needs to be judged outside of cost considerations? Give me a break.
The problem is that there is a lack of "trustworthy" parties to evaluate cost expectations in medicine. The patient often doesn't understand their condition or its treatments, the doctor has a clear perverse incentive to inflate costs, and the insurance company may actually be better off if the patient dies. At least that's the conventional picture. Leftist pundits often complain that the American economy is based on "greed", but a more precise criticism is that there has recently been a trend away from expecting benevolence and for-its-own-sake honesty from anyone under any circumstances, or equivalently an increasing cynicism about human motivations. It remains to be seen whether a medical system can function when nobody expects to trust anyone.
Earlier quoted context omitted.
Standard error in this case, assuming the 200 are randomly sampled is: sqrt((p*(1-p)/n) sqrt((0.9*0.1)/200) = 0.021 So 95% confidence interval for this ~ 0.86 - 0.94 Does that radically change the message of this article?
lol.. what kind of calculation is this? n is 1 in this case, the survey was not repeated 200 times from which you derived 90% as the mean number of nurses quitting.
You are incorrect that "n is 1" since, by that logic one survey talking to 100,000 nurses would be the same as one talking to 3.
If you would like an alternate, more Bayesian formulation we can use the Beta distribution which is parameterized by alpha (numbers of 'yes') and beta (number of 'no').
This approach is a bit more intuitive than the Frequentist method since it answers the question "what do we believe to be the expected rate of nurses answering 'yes'"
In this case alpha=180 and beta=20, we'll include uniform prior of alpha_prior = 1, and beta_prior = 1
For Betas the posterior is defined quite nicely as:
Beta(alpha_posterior, beta_posterior) = Beta(alpha_likelihood + alpha_prior, beta_likelihood + beta_prior)
In general for Beta distributions we can compute the expectation as:
E[Beta(alpha,beta)] = alpha/(alpha + beta)
In this case: 181/202 = ~0.9
And the variance of a Beta distributed random variable is:
Var[Beta(alpha, beta)] = (alpha*beta)/((alpha+beta)^2 * (alpha + beta + 1))
Which for our case is:
0.00046
and the standard deviation of this is just it's square root:
0.021
Which gives us the same answer as we get with the normal approximation.
Earlier quoted context omitted.
Insurance companies. Everything is controlled by insurance companies. You can’t do anything unless it’s exactly how insurance wants and only for what insurance will pay. It limits everything, including how every profession can be compensated simply because you can’t easily hire somebody for more than what insurance will pay for their services. You can, but the funds have to come from somewhere.
Insurance is the only industry where they agree to pay for something (in this case, "medical care"), but then after service has been rendered can decide to pay less, or not pay at all, or stop paying that provider altogether, etc. This combined with hospitals being run by non-physicians*, and people thinking being able to Google and read WebMD qualifies them to argue with their doctor about treatment plans**, healthc…
A common attitude which may cause:
Health care is extremely costly in the United States. Although the rate of growth in spending has attenuated in recent years, per capita spending on health care is estimated to be 50 to 200 percent greater in the United States than in other economically developed countries. Despite leading the world in costs, however, the United States ranks twenty-sixth in the world for life expectancy and ranks poorly on other indicators of quality.
https://journalofethics.ama-assn.org/article/complex-relatio...
Earlier quoted context omitted.
Insurance is the only industry where they agree to pay for something (in this case, "medical care"), but then after service has been rendered can decide to pay less, or not pay at all, or stop paying that provider altogether, etc. This combined with hospitals being run by non-physicians*, and people thinking being able to Google and read WebMD qualifies them to argue with their doctor about treatment plans**, healthc…
As a quick counter-point to *, there is another sub-problem with healthcare/doctors in the US, where often patients with chronic illnesses or not-easily-testable conditions have to fight hard for doctors to take them seriously. The why of this varies a lot from what I've seen, but includes: - an attitude of "most patients are just trying to wring medications out of you" - an ego-hit of "if I didn't make the diagnosis…
I told my doctor I had already been diagnosed with ADHD because I had a strong suspicion I had it and wanted to see for myself if the medication helped (it helped massively). I think medicine should be accessible for patients who need it but I don't know how to avoid large amounts of patients then taking medications for the wrong thing, which would probably happen if it was a free-for-all. It kinda comes down to the question of having the personal freedom to hurt yourself doing something stupid, which is a balance (a little of that freedom is good, too much probably bad). All-in-all I lean toward the current system of using on experts to make the final decision. Still, I would be really pissed if a doctor prevented me from getting stimulants for something I believe I need, so I am not 100% satisfied with the current system either.