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The darker side of being a doctor (2017)

drericlevi.substack.com

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

#481

Post by p1dda »

bobowzki wrote: post #313
p1dda wrote: post #298

Earlier quoted context omitted.

Having worked in software before must have made it easier to change profession? I have not so I think I need formal training, I am a programming hobbyist writing in python and did some SQL for databases for research. I guess I need to have really tough problems to solve, when I succeed, there is almost nothing like it, the feeling of accomplishment.

I had already contributed to some open source projects and had also done some fairly large freelance projects. I'm sure this made me more hireable. I'm not sure I will give up anesthesiology 100%, in the end I'd like to combine and work on "medtech". Currently I work with automotive radar. Feel free to reach out!

Thank you for the response! I also feel this way, I still like some aspects of being a physician. I think it's just the way some of us are built: we thrive on learning new things, we enjoy challenges and we get bored when stuff gets too easy. Automotive radar sounds exciting as well! I will look for open source projects, it might be a great way to get work experience, thanks for the tip!

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

#482

Post by zelphirkalt »

Zenzero wrote: post #476
zelphirkalt wrote: post #473

Earlier quoted context omitted.

I happen to know someone who works in a hospital, in a lab, looking at blood samples. The stories I often have to hear about how little technical knowledge people working in the hospital have, or at least apply to what they are doing on their job are ... not very encouraging, to say the least. So I am not actually as clueless about how hospitals run, as you might assume. It is not all doctors, but also other personel…

Imagine telling a doctor how to be a doctor because they "happen to know someone who works in a hospital". Oh how I would love to have you shadow me on the floor for a week. > If you think the tool is "fisher-price", then why haven't you told the people, who came up with the solution? Because they react just like you did. You perfectly demonstrated why I moved over to the software side. The doctors I work with are si…

Now you make yourself look like a bitter person, since according to you all the software developers in the world will react a certain way and nothing can be done, except you, the holy doctors, showing the devs how to do their job, by becoming developers yourselves!

Meanwhile talking about hubris ...

All the while you could not be bothered to document things and not telling someone who tries to help, where their solution falls down, so that maybe they could improve, but at the same time keeping complaining about "fisher-price". No way they could have any new ideas. You did not have them, so how could they ever have a good idea for improving status quo. How I would have just loved to onboard you onto my engineering team! I am sure you would be great to work with, since sharing information seems to be your strong suit.

It seems very clear to me now, that you did not want things to change as a doctor. Did not want improvement, since nothing these engineer plebs could do would be good enough anyway. And that kind of attitude is exactly what made you part of the problem.

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

#483

Post by p1dda »

jampekka wrote: post #393
p1dda wrote: post #365

Earlier quoted context omitted.

EHR is truly a mess which is why I feel compelled, as a somewhat computer-skilled physician, to try to do something. There is a lot of potential to improve EHR but I think we have to start from scratch with a completely new way of thinking. It will be very costly but current solutions aren't working to help the physician, it just adds to the workload. The business models of EHR's I'm not that familiar with, I will re…

> It sounds like you have experience working with EHR development? Not first hand, but I followed it quite closely when we as activists tried to prevent Finnish healthcare from getting an Epic based system (that turned out to be exactly the disaster we predicted).

Well done! Epic Systems sounds like a nightmare corporation, ruining the lives of health professionals all over the world.

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

#484

Post by myroon5 »

galahad_ wrote: post #474

It's a bit scary how mostly smart people writing here seriously believe doctors are a "cartel" blocking preparing of new doctors. It's scary how you just ignore obvious facts like that the problem is present in any developed country. You really believe there is an international mighty cartel of doctors, what could influence like governments and private universities as well? Even would it be so, who would benefit from…

> influence governments

Healthcare providers spent the most money lobbying the US government for decades:

https://www.opensecrets.org/federal-lobbying/top-spenders?cy...

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

#486

Post by complex1314 »

p1dda wrote: post #371
complex1314 wrote: post #317

Earlier quoted context omitted.

I trained as a doctor, then family practice for a few years, but since the middle of my studies, I realised my main passion was the more technical aspects. I did a bachelor's in electronics engineering while working 50% as a doctor the first two years, and with the last year dedicated only to studying. I realised a bachelor's would not be enough to get the engineering jobs I desired, so I went back to medicine and st…

Wow, that truly sounds like a dream job! I discovered neural networks in 2017 and managed to write a simple app to scan dermatological images to classify them, amazing technology! I have worked for one year at a dementia diagnostic centre as a part of my training to become a specialist in family medicine and there is definitely a lot of interesting work to be done. I have also have an interest in radiology, how are y…

I like it a lot, as I mentioned intellectually rewarding and I feel like most of what I learned at med school is useful. I also quite enjoy the occasional increase in adrenaline when at trauma reception or stroke CT evaluation. Also nice to both be able to work in peace and collaborate with clinicians. And personally I also enjoy keeping up to date on research which is evolving quite rapidly. The negative aspect is mostly what is common to most medical specialities and due to understaffing.

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

#487

Post by thaumasiotes »

seadan83 wrote: post #430
thaumasiotes wrote: post #369

Earlier quoted context omitted.

There are a few factors: 1. Doctors have a lot of political influence because they are popular. This means they can get away with things that other industries mostly can't. 2. State provision of medical care corrupts the system, as I describe sidethread: https://news.ycombinator.com/item?id=40030452 One way to drive "medical costs" down is to ensure that the supply of medical care is low. This also drives prices up.…

> 2. State provision of medical care corrupts the system, as I describe sidethread How is this at play (from the article we are commenting on)? The article does not mention once: "medicare", "medicaid", "regulation", "law", "government" - once. If anything, it's the inverse. You have it bass-ackwards, the private hospital, the for-profit system is driving things like: > I delivered my third child with my own hands be…

Those might be better arguments if this doctor were personally setting the medical school admissions quota, but I'm pretty sure he isn't.

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

#488

Post by DonnyV »

nradov wrote: post #260
DonnyV wrote: post #195

Earlier quoted context omitted.

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 wo…

You're dreaming. Commercial payer organizations have low profit margins, especially since the Affordable Care Act (Obamacare) instituted an 85% minimum medical loss ratio. Some of them already operate as non-profits. Eliminating them wouldn't free up nearly enough funding to make "Medicare for All" work with a mere 4% income tax increase. Do the math.

"low profit margins"

Health insurers raked in more than $41 billion of profits in 2022.

https://penncapital-star.com/uncategorized/americans-suffer-....

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

#489

Post by lazide »

jjackson5324 wrote: post #460
thaumasiotes wrote: post #367

Earlier quoted context omitted.

Obviously, they are a big problem, but they're not the only problem. It is received wisdom among doctors that increasing the number of doctors causes medical costs to go up, and it is generally also the position of the state. The doctors are simply wrong; the state is correct from a pernicious point of view. Because the state is responsible for buying so much of the total supply of medical care, they generally view t…

So you’re saying that increasing the number of doctors will result in more medical services being consumed which means higher costs for the gov? That’s the view of the government?

Think of it like increasing lanes in a highway. [https://en.m.wikipedia.org/wiki/Braess%27s_paradox]

Or induced demand.

That said, likely individual medical outcomes would be better.

Large scale systems tend to produce… odd behaviors.

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

#490

Post by lazide »

seadan83 wrote: post #465
gopher_space wrote: post #464

Earlier quoted context omitted.

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 capitali…

Being a business means they have to optimize for profit (to at least some non trivial degree), or die.

Many hospitals are run by non profit organizations to help reduce this problem. However even they cannot run at a loss overall for long. Bankruptcy doesn’t help anyone actually provide services, after all.

Gov’t has different incentives - but then care is strongly controlled and limited by public policy, for better or worse.

And an organization that is able to optimize to produce more value than they consume (aka is more profitable) can take more risks, expand better, have more capital to invest in training, equipment, etc, be more competitive in who they hire, and have better and more comfortable facilities if they want.

And being a Dr. can be really miserable sometimes, and the training is also really hard and miserable.

Some (surgeons, esp. plastic surgery) optimize for maximum $$ for misery, usually. Others (pediatrics) optimize for maximum ‘feel goods’ for misery, usually. Most others are somewhere in between.

Either way, if they didn’t want/need the money, they’d be going to medicine sans frontiers or working in rural medicine eh?

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