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

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

#31

Post by DonnyV » Sat, Apr 13, 2024, 7:48 PM UTC

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 universal, no pay at service, insurance system, everyone taxed at 4% for it.

2) People that have the grades to make it to medical school should get a free ride.

3) Small Private practices should come back with free digital billing with the new health insurance system.

4) Price regulation on all basic medical supplies and medicines. No more $20 tongue depressors

5) All medicines researched at public Universities will not be sold or given to private industry. They will be licensed. That money goes back into supporting this system.

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

#32

Post by postepowanieadm » Sat, Apr 13, 2024, 7:49 PM UTC

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…

It's even worse. In the EU the working week is to be an average of about 48h. ...unless you are an medical professional, then you "may" opt-out and work up to 78h. It's completely legal, and regulated by the law of the EU:)

https://www.europarl.europa.eu/meetdocs/2014_2019/documents/...

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

#33

Post by dirtyhippiefree » Sat, Apr 13, 2024, 7:50 PM UTC

uniqueuid wrote: post #15

Rinzler89 wrote: post #13

Earlier quoted context omitted.

> but to get more doctors Have you found that magic fountain of endless doctors?

Sure, it's very easy! Just do things that prevent burnout ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/ ) and the job gets more attractive, drawing more students and producing less attrition: - Valuing work gives meaning (money, appreciation) - Autonomy gives feeling of control - Managing burden prevents overwork, exhaustion and fatigue

> Sure, it's very easy!

I have issues when someone says a complicated issue can be solved easily…realistic expectations…

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

#34

Post by thundergolfer » Sat, Apr 13, 2024, 7:52 PM UTC

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.

Though significant restrictions on supply do exist, the problem does not seem to be nearly as bad in Australia as in the USA [1]. In Australia there's ~15 medical graduates per 100k vs ~8 in USA.

The doctors in Australia are still definitely overworked though. A decent number of the people I went to school with became doctors in Australia, and though we work roughly the same number of hours (~60-70hrs/week), my work in the software industry is like a stroll in the park.

It was remarkable to hear my male friends who became doctors admitting that they had broken down crying in meetings with their boss because of workplace stress and exhaustion.

1. https://www.ama.com.au/ama-rounds/13-may-2022/articles/more-...

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

#35

Post by Rinzler89 » Sat, Apr 13, 2024, 7:52 PM UTC

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…

>They have to "do more with less" (Not limited to public sector, see Boeing), and that works for a while, until it doesn't.

Yes, which brings us back to the point I made about it being a numbers game. IF you start cutting back pilots sleep and planes' QA to boost profits, you'll reach the "it doesn't work" phase (planes dropping from the air killing everyone) much sooner and at a steeper rate than with overworked doctors where the decline is a lot slower and gradual hence why this issue gets ignored more easily by those in charge, because it's so slow that people keep getting used to this as the new normal.

IF a few Boeings fall from the sky, people might stop flying Boeings, but people won't stop going to the doctor just because some people get killed from malpractice (which is statistically more likely than dying in a plane crash).

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

#36

Post by nradov » Sat, Apr 13, 2024, 7:54 PM UTC

uniqueuid wrote: post #15

Rinzler89 wrote: post #13

Earlier quoted context omitted.

> but to get more doctors Have you found that magic fountain of endless doctors?

Sure, it's very easy! Just do things that prevent burnout ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/ ) and the job gets more attractive, drawing more students and producing less attrition: - Valuing work gives meaning (money, appreciation) - Autonomy gives feeling of control - Managing burden prevents overwork, exhaustion and fatigue

Sounds good, but healthcare already constitutes 17% of US GDP. And with an aging population, spending has been growing faster than the rate of inflation. Most of the funding ultimately comes from governments, self-insured employers, and individual patients. Those groups have no appetite for spending more.

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 program. Congress hasn't significantly increased funding in years.

https://savegme.org/

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

#37

Post by user_7832 » Sat, Apr 13, 2024, 7:54 PM UTC

hinkley wrote: post #24

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…

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.

That's a very good point. I think 12 hour shifts aren't necessarily bad, but even EMTs/firefighters (in some places, afaik) have downtime after their shift. Maybe work one on one off, or maybe 2 on 3 off. I suspect that's still much better than the practice of 24 hour shifts.

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

#38

Post by kvonhorn » Sat, Apr 13, 2024, 7:56 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…

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

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

#39

Post by hello_computer » Sat, Apr 13, 2024, 7:56 PM UTC

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…

Not so sure about that. According to a few studies, medical error is the 3rd leading cause of death, behind heart disease and cancer.

Many operations are elective. In such cases, having a tired surgeon or nurse may be worse than delaying the procedure, or even skipping it.

https://www.bmj.com/content/353/bmj.i2139

https://pubmed.ncbi.nlm.nih.gov/28186008/

https://journals.lww.com/journalpatientsafety/Fulltext/2013/...

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

#40

Post by user_7832 » Sat, Apr 13, 2024, 7:56 PM UTC

dirtyhippiefree wrote: post #33

uniqueuid wrote: post #15

Earlier quoted context omitted.

Sure, it's very easy! Just do things that prevent burnout ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/ ) and the job gets more attractive, drawing more students and producing less attrition: - Valuing work gives meaning (money, appreciation) - Autonomy gives feeling of control - Managing burden prevents overwork, exhaustion and fatigue

> Sure, it's very easy! I have issues when someone says a complicated issue can be solved easily…realistic expectations…

The answers to some problems may be easy to know but difficult to implement, due to political/financial will etc. For eg we know how to reduce emissions, but it's still a challenge. In such cases advocacy and raising awareness can be helpful.