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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)

#501

Post by matheusmoreira »

Anthony-G wrote: post #438
matheusmoreira wrote: post #403

Earlier quoted context omitted.

> Something I've never quite understood is why, in the UK, we cap the number of medical students per year. To keep salaries high. I'm brazilian. In recent years, brazilian medical schools have been "democratized", so to speak. The number of medical schools has exploded and acceptance of doctors from neighboring south american countries has been facilitated. About 50 thousand new doctors enter the market every year. R…

Thanks for contributing that point. It’s good to have one data point for what happens when there are no restrictions. I’m from Ireland and have the same experience as most of the rest of the commentators on this thread, i.e., we have a chronic shortage of doctors – and nurses – in our health system. This has been the case for as long as I’ve been alive but it’s got much worse in the last decade or so. It’s interestin…

> we have a chronic shortage of doctors – and nurses – in our health system

Just imagine how bad it's going to be once the "you're set for life if you go to medical school" meme dies. It's still very much alive here in Brazil but people are already being forcibly woken up to face reality before they've even graduated. Won't be long before the new generation of students realizes that medical school is a bad choice.

The bitter truth is nobody is really going to put the "care" in health care if they're not getting paid ridiculous sums of money for it. Would you really want to slave your life away in some hospital for shitty pay? I mean that literally, medical residency is analogous to indentured servitude. Would you want to spend the best decade of your youth studying and training and working 14 hours a day only to end up poor? I've seen doctors actually kill themselves over lesser failures than that.

Very few people are that selfless and altruistic, even those who affect such a demeanor in public are likely secretly hoping it will come back to them in some way in the future. They will be bitterly disappointed when it doesn't. Even fewer are rich enough that they can sustain such caring activities out of love. Those who try discover that they are just individuals, that they don't scale, they don't form a health care system. They don't make much difference in the grand scheme of things.

Today I saw an interesting post from an older doctor. He just straight up quit medicine. Took his money, bought a bunch of trucks and now he's managing a logistics company and making several times as much money as he used to while caring for people. This is an older doctor who reaped the profits of the golden age, he had the capital to create his business. New doctors arrive at the market with 100kUSD+ debt only to find that they get paid about 10 dollars a consult if they're lucky. The only winners here are the owners of the medical schools.

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

#502

Post by hipjiveguy »

jimmar wrote: post #279

A brain surgeon saved my sister's life. In the days after her recovery, my dad ran into her surgeon eating in the hospital cafeteria at 11pm. My dad asked him when his shift ended and the surgeon just looked at him and said, "I live at the hospital." There was just so much work he had to do. Rewarding work, but grueling.

That was very funny - I laughed out loud :D

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

#503

Post by int_19h »

thaumasiotes wrote: post #487
seadan83 wrote: post #430

Earlier quoted context omitted.

> 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.

Not personally, no, but in many countries the professional organizations representing doctors do lobby for exactly that.

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

#504

Post by Zenzero »

yoyonamite wrote: post #498
Zenzero wrote: post #420

Earlier quoted context omitted.

> The problems are aversion to technology in places, unwillingness to adopt new (human) protocol/processes, entrenched proprietary technology, that does not adhere to standardized formats. It is not. This is a classic example of assuming the problem exists within the realm of your current understanding. The stereotype of people in medical roles not wanting/liking/understanding technology is wrong. What we don't like…

If you don't mind me asking: Do you see a solution, technical or otherwise, to this problem? My guess is there are limits to knowledge transfer that's difficult, if not impossible, to overcome.

You are correct that the problem is an information bandwidth issue.

The number of variables that must be considered for any given case are extensive and multi-layered. I don't have the time to get much in depth on this but off the top of my head: - There can be errors in our lab tests - The errors are test-dependent in degree and significance - Less than ideal handling or sampling affects different analytes differently - Errors in one analyte can affect others - The absence of deviations from normal in some tests can itself be an abnormal finding - Sometimes abnormal findings can be due to error or genuine in an unknowable way - The confidence of what constitutes "normal limits" is dependent on the underlying epidemiology of what is being tested for - There is no realistic way to have a unified data model for everything we assess - Much of what is interpeted/assessed gets reported as paragraphs of text - Missing data can either be untested or unavailable and it is not always clear which it is - What is communicated to you may be dishonest (such as drug seeking behavior) - As much as we have tried to standardize fundamentally subjective assessments (such as murmurs) they are still subjective - The MO is to push providers to the limit of what is safe in terms of number of cases and aggregate complexity - Putting humans in the loop of anything opens up to emotional/social factors that can influence interpretations/trust in various factors

I could go on, but the point is that as a result of all of this, the most efficient route by far is passing information directly from one caregiver to the next since they are often operating on a platform of context (much from their training) that is difficult to replicate in software.

The solution in my mind is lifting providers off of the low level data and activities. If we can close the loops on automating decisions in a generally agreed upon and reliable manner, it removes the need to discuss or think on the information fed into that system. Clearly that is a big task, but the realistic path forward in my mind. Harping on matters of process at the same level of detail is a waste of time and effort.

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

#505

Post by int_19h »

obscurette wrote: post #331
georgeburdell wrote: post #209

Earlier quoted context omitted.

Potentially controversial opinion, but perhaps it is exactly the immigrants who are enabling the dysfunction to continue? I imagine tougher decisions would have been made to balance doctor quality of life with patient outcomes without immigrants taking whatever abuse the current system throws at them.

While somewhat rudely expressed, but in principle I'd agree. There are people who call it modern day imperialism – it's the draining high performant brains from other countries what allows western societies to keep doing a lot of things.

As an immigrant myself, I've heard this take a lot. I despise it because it treats us as a resource that you can allocate here or there as needed to solve problems, ignoring the person themselves and their needs and wants. What if the "high performant brain" does not want to sacrifice their own well-being for the sake of "improving their country"?

If "anti-imperialist" Westerners truly care so much about brain drain negatively affecting other countries, they should go live in those countries themselves and provide their services there for the sake of greater good. But very few actually do so, and even fewer are willing to do it on any kind of non-temporary basis.

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

#506

Post by int_19h »

georgeburdell wrote: post #236
cqqxo4zV46cp wrote: post #210

Earlier quoted context omitted.

Ah, yes. Literal victim blaming.

They voluntarily immigrated to the country to take highly skilled jobs and are free to leave at any time. They are not victims; they are willing participants in an exploitative system.

You're kinda ignoring the part where the exploitative system is global, and those people are coming from places that are on the more exploited end of it. The reason why they come to take those jobs is because of the quality of life that comes with that, that is impossible to achieve in their home country. And the reason for the latter is largely because their countries have historically been exploited by the one they're now coming to, and in many cases, are still being economically exploited in various ways (including directly sponsoring local political corruption by foreign businesses). If you don't want them to come to your country to chase a better life, raise the living standard in their country.

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

#507

Post by int_19h »

lesam wrote: post #456
refurb wrote: post #228

Earlier quoted context omitted.

Not if you're in the universal system where the government sets the payments. I do know that limiting the number of doctors is one of many mechanisms to limit healthcare spending. A doctor can only see so many patients in one day.

I’m in Canada. If there were enough doctors that doctor unemployment was 2%+, like a normal job, doctors here would get paid less. Also doctors might not burn themselves out working crazy hours. Instead, we have a dire shortage of doctors and people in government employed full time trying to recruit the limited supply. Doctors can’t move to the next hospital for more pay, but they can move to the next province, or to…

Doesn't Canada (or maybe individual provinces) also have artificially imposed limits on how many new doctors there can be each year?

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

#508

Post by int_19h »

matheusmoreira wrote: post #403
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…

> Something I've never quite understood is why, in the UK, we cap the number of medical students per year. To keep salaries high. I'm brazilian. In recent years, brazilian medical schools have been "democratized", so to speak. The number of medical schools has exploded and acceptance of doctors from neighboring south american countries has been facilitated. About 50 thousand new doctors enter the market every year. R…

This just goes to show yet again that healthcare and markets are largely incompatible if you want to have good outcomes and ethical treatment of people.

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

#509

Post by 2143 »

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…

When I was studying in the US, my roommate was studying to become a "physician assistant" — a concept I think is brilliant. I don't think there's anything similar in my own country.

But I was wondering if more physician assistants would help the doctors. Maybe they could take care of the paperwork and all those things as well.

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

#510

Post by m463 »

nojvek wrote: post #368

> I went into medicine knowing that I will have to sacrifice much for the sake of my patients. What I am realising is that today in modern medicine, a doctor is just one of the many commodities in this complex industry. It’s no longer about the patient. It’s about the business of hospitals. Patient satisfaction officers, Theatre Utilisation officers, Patient Flow Coordinators. These are all business roles. I have to…

You remind me of an old article I read:

https://philip.greenspun.com/flying/unions-and-airlines

probably not a 1:1 comparison to health care, but the conclusion was:

> a sustainable long-term structure would be a pilot-owned airline

I kind of wonder if there could be a way for doctors to start a hospital and run it top-down from first principles.

Kind of like good engineering companies that were started and run by engineers.

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