Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The darker side of being a doctor (2017)

drericlevi.substack.com

Post reply on HN
Print view View original

81–90 of 521 posts

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

#81

Post by Gunax »

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.

While it's true that there is a limit (really there is a limit to every university study), there is also a limit to the number of people who are qualified and interested.

For instance, there are only about 20k people who score > 510 on the MCAT per year (the average matriculant has about a 512). And remember that includes US & Canada.

While I know there are a lot of people rejected from medical school each year, some probably should not be accepted to medical school. I think we could probably increase the number of seats by about 20%.

The American and Canadian medical schools place a high bar on accepting students, so nearly everyone who is accepted graduates. It's uncommon for medical students to perform poorly.

But this isn't true everywhere. Some places prefer to admit many students and let them sink-or-swim.

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

#82

Post by beau_g »

nradov wrote: post #46
WalterBright wrote: post #28

Earlier quoted context omitted.

The AMA only allows a fixed number of seats in medical school. There also can be tiers of medical doctors. Most doctoring work is routine, and can be handled by a more of a medical tech.

False. The AMA has no regulatory or accreditation authority over medical schools. Schools can admit as many students as they want. 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 prog…

Why do residency programs require subsidies, are resident doctors each a large net financial loss to a hospital? I can't think of many other career paths where someone out of school is so underprepared for the job that the business could not employ them without someone else footing the bill, doesn't seem like a reasonable system that will sustain itself in the long term. I suppose pilots are a bit like this but they typically take the financial risk on themselves to some degree or get the taxpayer funded training via the military.

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

#83

Post by genewitch »

kingkawn wrote: post #51

The profession as a whole is profoundly hostile to any serious considerations of mental health, and it’s going to take many more suicides before even the smallest steps are taken toward obvious quality of life improvements.

humanity as a whole is profoundly hostile to any serious considerations of mental health. Dr. Drew once agreed with a rant by cohost adam carolla along the lines of (this is a whisper transcription. blame me for mistranscriptions, idc)

"It just doesn't make any sense to me. What's so bizarre in our culture, if you'd broken your leg when you were a kid and you needed a few years of physical therapy, you'd get it. You'd be running on it, and by the way, people would be applauding your great commitment that you go out and work out every day on your leg, and you make sure that you're going to overcome that problem, and you're going to get back up on skis again and whatever. The same thing is true with our brain, and somehow because it's our brain, no, no, no. Sorry. We'll have none of that. What would [...] tell you to do? Oh, he'd say just decide to change. You just gotta decide to change. You gotta get up, you gotta dust yourself off, you gotta take a long look in the mirror, and you gotta decide to change. I can't change for you, and all the people wishing you'd change around you aren't gonna make you change. There's only one person that can change your life, and that person's name is [...]. You want to lose weight, you're gonna have to burn more calories, and you're gonna... "

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

#84

Post by Turing_Machine »

impossiblefork wrote: post #74
yokaze wrote: post #16

Earlier quoted context omitted.

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…

I think having more physicians is the core thing. The US stands out in having so few physicians per capita (per 1000 it's 3.6 in the US, here in Sweden it's 7.1, in Germany 4.5, Spain in 4.6). This has been discussed before here before, and I don't think it was controversial that a sensible solution was to simply have more physicians. I think one major thing that the US is doing wrong with that which is not so well k…

This was in Australia (4.1).

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

#85

Post by ta_1138 »

kwhitefoot wrote: post #77
derbOac wrote: post #61

Earlier quoted context omitted.

The answer is implied, right there in the first paragraph: "... I’ve never been diagnosed with a mental illness." At least in the US, there's a kind of masochistic pride in the physician community, that everything he described in his essay is laudable, noble, to be emulated. Nowhere does he acknowledge the risks to his patients or whether the costs are worth it in the end, or if a different system might be better. An…

> At least in the US, there's a kind of masochistic pride in the physician community, But the question is why does the rest of society insist that pilots be properly rested but not doctors? I'm sure a lot of pilots would also work crazy amounts of overtime if allowed.

Pilot failures are really visible, and kill hundreds atll at once. Bad medical decisions lead to more deaths overall, but it's far less likely the public will hear it, and even if they do, it's one person at a time.

Far more people die from car crashes than airplane crashes too: It's not even close. And yet, people who have no business behind a wheel drive, and the penalties for being a poor driver are typically minimal. Same difference.

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

#86

Post by Turing_Machine »

closewith wrote: post #29
yokaze wrote: post #16

Earlier quoted context omitted.

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…

> Most of the work of doctors is not life-saving. Yes, but working out which parts are and aren't critical is the $64,000 question.

Indeed. Is that weird mole just a weird mole, or is it skin cancer?

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

#87

Post by MichaelZuo »

nradov wrote: post #46
WalterBright wrote: post #28

Earlier quoted context omitted.

The AMA only allows a fixed number of seats in medical school. There also can be tiers of medical doctors. Most doctoring work is routine, and can be handled by a more of a medical tech.

False. The AMA has no regulatory or accreditation authority over medical schools. Schools can admit as many students as they want. 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 prog…

Do residency slots mandate public funding?

Aren't they doing actual useful work same as regular doctors? (albiet with a higher error rate)

So they could be funded through via charging for services rendered.

Of course their effective pay may be close to zero, after malpractice insurance, but it will still attract some number of med school grads who can't get in otherwise.

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

#88

Post by game_the0ry »

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?

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

#89

Post by kwhitefoot »

novok wrote: post #58
nradov wrote: post #36

Earlier quoted context omitted.

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 (graduat…

The entire medicare residency slot system seems a bit self inflicted, why hasn't an alternative system popped up? Also this is a global problem, not just the USA. You look at videos of student doctors in the UK for example and there are similar abusive schedules. https://www.youtube.com/watch?v=KE1XwEMGm0I

Read Adam Kay's "This is going to hurt" [1]. It was made into a miniseries. I read the book and it was so horrifying that I couldn't face watching the dramatisation.

It doesn't seem to be such a big problem here in Norway where things like working time directives are taken much more seriously.

[1] https://en.wikipedia.org/wiki/This_Is_Going_to_Hurt

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

#90

Post by kwhitefoot »

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.

Did they really study how doctors and other staff work in enough countries?
Post reply on HN