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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)

#461

Post by rtaylorgarlock »

shufflerofrocks wrote: post #415
game_the0ry wrote: post #88

I don't understand why doctors that are entering the field need to be over-staffed and over-worked. I have a cousin who is an Er surgeon and she needs works 3 days a week, but that certainly was not the case when she was starting out. The work culture of the medical profession looks horribly inefficient. What benefit do you get from buying out young doctors?

One thing is that the rigid terrific schedule of the modern-day residency program was designed by a cocaine addict who made the structure to fuel and hide his addiction, so all doctors start out with a skewed sense of normal working hours. ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828946/ ) Another thing is the toxic culture perpetuated for allowing medicos to stroke their egos - toxic cultures about overtime a…

Further worthy to note the culture inside surgery departments and residency programs, which seems to feed on exactly this sort of toxicity to measure the worthiness of applicants / residents / graduates. Young surgeon hopefuls should seriously consider the residency process before committing to the field; one of my wife's former co-residents, now early in surgery residency, is surprised by her own fertility challenges, for example. Anyone 'in the business' knows cases like this, and it's a good thing that suicides are national conversation.

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

#462

Post by [deleted] »

pc86 wrote: post #426
shkkmo wrote: post #406

Earlier quoted context omitted.

> I think you’re giving way too much credit to medical associations to rig the game in their favor. They exert enough influence over all fifty states and the various private institutions to systemically deny training to qualified candidates? The underlying fact that the AMA is directly responsible for the doctor shortage in the USA is historically accurate. 20 years ago the AMA believes we were heading towards a doct…

I am wildly in favor of expanding the number of medical schools, expanding med school class sizes, expanding residency slots and funding per resident. None of this means I want decisions now made by someone who does 4 years of college, 4 years of med school, 3-7 years of residency and potentially fellowship on top of that to instead be made by a nurse "under the supervision" of a doctor. If you're a doctor of one spe…

[deleted]

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

#463

Post by rtaylorgarlock »

billfruit wrote: post #302
throwaway20222 wrote: post #286

One of my friends I grew up with was “that kid;” smartest in the community, funny, played a mean guitar. Everyone loved him. Top of class. Harvard. Harvard med. Top placement for residency. Something happened during that time and he killed himself. It was absolutely unexpected from all of his friends. Shocking to say the least. Apparently it turned out to be stress from work, his hours, his fear of failing. Who will…

Can't medical doctors have duty time limits like aircrews. Wouldn't that alleviate some of the overwork.

My wife's a doc, in residency, and also Swiss, so I find myself referencing this study [1] on residency hours in Swiss residency programs over years. Bottom line: there are limitations on hours/wk and consecutive shifts, but enforcement of that is a joke + nonexistant, especially among residents (note resident's interest in maintaining their resident status and remaining 'bureaucratically blessed'). [2] See the Albuquerque neurosurgery resident walkout for an interesting business case of the real value of surgeon residents and what might motivate them to cause a big kerfuffle in hopes of bringing about changes. [3] I'm mostly acquainted with attending physicians who don't mind the 60hr weeks when they don't have a choice, and residents who pick up the rest of the work that attendings financially benefit from. Surgery attendings seem to be a special sort of animal. It's just not as simple as limiting hours, unfortunately -_-

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464122/ [2]: https://psnet.ahrq.gov/issue/public-opinion-resident-physici... [3]: https://thesheriffofsodium.com/2022/02/04/how-much-are-resid...

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

#464

Post by gopher_space »

seadan83 wrote: post #437
bravura wrote: post #366

Earlier quoted context omitted.

The post you replied to scoped their statement to „coveted“ applications. No one actually believes scarcity drives demand in all cases.

The grammar of the sentence, as written, would really indicate otherwise. Written in the post: "Scarcity drives demand." (exact quote) The sub-text is that doctors are slightly corrupt and wish to be payed more, and therefore are incetivized to reduce the total number of doctors. After reading the travails of what this doctor is going through, that seems like a very callous take, insulting even.

It’d be callous and insulting if it was a reasoned position.

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

#465

Post by seadan83 »

gopher_space wrote: post #464
seadan83 wrote: post #437

Earlier quoted context omitted.

The grammar of the sentence, as written, would really indicate otherwise. Written in the post: "Scarcity drives demand." (exact quote) The sub-text is that doctors are slightly corrupt and wish to be payed more, and therefore are incetivized to reduce the total number of doctors. After reading the travails of what this doctor is going through, that seems like a very callous take, insulting even.

It’d be callous and insulting if it was a reasoned position.

IDK if needs to be reasoned or not. I'm imagining someone making these comments to the author's face after having been read the article. The 'callous' part comes from disregarding everything in the article to go on some great tangent about the AMA and artificial scarcity of doctors.

What's more, it seems that this article has triggered a reflexive anti-union stance, when it's more a hallmark of a place where capitalism does not work well. Why doesn't that hospital have more doctors? Surely, they could have found someone additional if they wanted. The hospital did not have to schedule every surgery as if they all required the average procedure time. The hospital could invest in better IT infrastructure and have software that was not a drag to use. Surely the hospital could have someone help the doctor not make 70+ calls over the course of a shift in addition to everything else they do. This blog post is not about a general scarcity of doctors; there's lots that could be done by the hospital investing in its staff and outcomes without hiring a single additional doctor.

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

#466

Post by mcmoor »

GuB-42 wrote: post #355
mcmoor wrote: post #254

Earlier quoted context omitted.

I don't know, lower skilled doctors can be quite a pseudo science amplifier at worst. Sometimes it does feel like that no doctor is better lower skilled one, especially when self treatment (or more accurately, remote treatment) is getting better nowadays.

The problem is worse when there is a lack of actual doctors. It people can't see a doctor, or can't get decent care because doctors are overworked, they will go to the "pseudo doctors". "pseudo doctors" are usually much less regulated, because they don't really practice medicine, can't make prescriptions, are not covered by healthcare subsidies, etc... but they are available, and actually caring, because there is no…

Sounds like we need something between nurse and doctor. Or is actual nurse already suffice for this?

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

#467

Post by CatWChainsaw »

personomas wrote: post #308
stevenhuang wrote: post #306

Earlier quoted context omitted.

What a weird way to frame the problem. Why not increase the supply of doctors instead of reducing demand, whatever that means?

> Why not increase the supply of doctors instead of reducing demand, whatever that means? Because that's not sustainable. We can't throw unlimited human resources at health care. We have other issues and societal problems to focus on. We can only create so many doctors, because its expensive to lock down a smart and ambitious mind for so many years. Opening up healthcare for free for old people is like opening up an…

Oooh, how about we do "Obamacare death panels" instead? I mean, that's basically what would happen if Medicare ceased to exist, anyway!

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

#468

Post by erik_seaberg »

mcmoor wrote: post #466
GuB-42 wrote: post #355

Earlier quoted context omitted.

The problem is worse when there is a lack of actual doctors. It people can't see a doctor, or can't get decent care because doctors are overworked, they will go to the "pseudo doctors". "pseudo doctors" are usually much less regulated, because they don't really practice medicine, can't make prescriptions, are not covered by healthcare subsidies, etc... but they are available, and actually caring, because there is no…

Sounds like we need something between nurse and doctor. Or is actual nurse already suffice for this?

https://en.wikipedia.org/wiki/Nurse_practitioner is a title I've seen.

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

#469

Post by CydeWeys »

to1y wrote: post #282
CydeWeys wrote: post #197

Earlier quoted context omitted.

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

That's strange as you would expect quality to suffer in every single respect when forced to work inhumane conditions. I would find a different mechanic if I thought the one I was considering was miserable from being overworked. Was there an explanation for why outcomes improved? Perhaps it is necessary to look into who conducts these studies as I imagine someone up the ladder profits greatly from having 1 doctor do t…

Quality does suffer as the hours drag on, but quality suffers more when you hand off a case (which can be quite complex) to someone else. The tired but experienced-with-this-case doctor still does a better job than the rested doctor who is brand new to the patient's case.

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

#470

Post by hello_computer »

james-redwood wrote: post #122
hello_computer wrote: post #39

Earlier quoted context omitted.

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/..…

This has been extensively debunked. Read the original methods of the BMJ article that you linked. They took every single minor error, like prescribing medicine 15 minutes late, and if the patient died, even of an aggressive cancer that they had already, it would be counted in the 'medical error that caused the death' statistic. https://www.nytimes.com/2016/08/16/upshot/death-by-medical-e... https://www.medscape.com/v…

Of course practicing doctors and nurses are going to swear up and down that it isn't true. They are the perpetrators. Ask any person who has had to spend time in a hospital recently, and watch your "de-bunked" turn back into a "re-bunked." These jokers can't even keep the charts straight. It is fast-food-tier service for a life-and-death commodity.
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