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The darker side of being a doctor

111 points Danhale93 1 hour ago 74 comments

ferrule 1 hour ago | parent

Friends in medicine often mention the constant emotional drain from dealing with suffering and death. Takes a serious toll.

osmukka 53 minutes ago | parent

Healthcare is the last industry that should be privatized. It should be for the public good rather than for the profit of few.

panick21_ 40 minutes ago | parent

By that logic all food production and distribution should not be privatized because is should be for the public good rather then the profit of the few.

There are are arguments to be made about private or public but that logic makes no sense.

Some system that have many private aspects outperform other public systems and the other way around. And even in a public system many people will profit as many of the companies that are your suppliers are still for profit.

lotsofpulp 52 minutes ago | parent

>You might ask, why can’t you work less? It’s not as easy as that. If I decide to work less, who is going to cover the hospital? If the hospital aren’t employing other doctors, we can’t allow patients to go uncovered. I accept the fact that I have a duty of care to be on call.

Yes, you can allow patients to go uncovered. This hero mentality is what leads the bosses to not properly staff and the politicians to not properly fund in the first place.

It is not an individual’s responsibility to correct a societal failure by hurting themselves.

Ensorceled 46 minutes ago | parent

We saw this during the COVID crisis: declare nurses and doctors "heroes" and then it's ok that they burn out, get PTSD or die due to lack of PPE because "that's just what heroes do"

khalic 51 minutes ago | parent

I remember some friends working in intensive care during the pandemic, I'll never forget their facial expressions after these 24hr shifts... I really wish someone would come up with a better way to do this

throw39304938 27 minutes ago | parent

There is no better way to do this. Perhaps all doctors should be on suicide watch and under psychiatric supervision.

bryanlarsen 25 minutes ago | parent

And that's the main reason why lock downs extended so far later than they should have. Our hospitals run at 120% during normal times; during abnormal times they're stretched to the breaking point. Our small local hospital had two nurse suicides during the pandemic. Not early in the pandemic, but well after vaccines were available.

khalic 18 minutes ago | parent

I'm sorry to hear that... this thing really took away a lot of good people...

throw39304938 10 minutes ago | parent

Covid kills people even today! We should have a lockdows every winter!

Those nurses saved many people! It was worth it!

simonw 50 minutes ago | parent

Wow.

> I had worked in a hospital network that covered 4 campuses and drove 500kms a week when covering these sites. I had worked in a hospital where I didn’t get home for days at a time, sleeping overnight in hospital quarters, outpatient clinic benches and in my car.

As a patient, I'd like the person performing surgery on me to be well-rested!

It gets worse:

> I used to be able to arrange the operating list because I know that some operations take longer than others. But now, the bookings office determine that that all my tonsillectomies take 14 minutes because that’s the average time recorded on the computer. The moment I scrub in, the timer starts. The moment I unscrub timer stops. Click. Click. Click. Because the theatre bookings does not take into account the interpreter time, pre-med period or transfer to ICU, the list is running late. The nurse in charge is breathing down my neck to finish on time.

And yet somehow that 14 minute tonsillectomy gets billed at ~$10,000.

This seems to me like a system that has been hyperoptimized in a way that grinds down the participants.

askonomm 37 minutes ago | parent

Sounds like just about every other system in modern capitalism.

joenot443 29 minutes ago | parent

Really? This funny limbo seems pretty specific to American healthcare, which is a fairly unique and admittedly fascinating study in the intersection of politics and capitalism.

You don't perceive that system to be different from grocery stores, auto manufacturing, Nvidia, or lemonade stands? They're all very different in my mind, I'm surprised you see them as identical.

estearum 50 minutes ago | parent

(speaking from US): The reality is we need more doctors. A lot more.

There's no solution other than training a lot, lot, lot, lot more doctors.

Their salaries need to be lower, training needs to be cheaper and faster, and we need a lot more of them.

ossicones 44 minutes ago | parent

The American Medical Association would sooner let the whole thing burn than allow that to happen

askari01 36 minutes ago | parent

sooner or later whole world(west) is going to hire more doc at lower(not as high as it is right now) salary from East(asia). they might lower the barrier to entry. same would happen in medicine the causes are inflation, economic conditions and poor health system.

joenot443 33 minutes ago | parent

This is the bottleneck, right?

I hear people say "we need more doctors" all the time. It would seem to me, the people deciding how many new doctors we train per year, are doctors. Their pay is proportionate to their scarcity, if we had 5x as many doctors, existing doctors would make far less.

Imagine if existing software engineers got to decide how many juniors entered our profession each year. I think things would look very, very different.

sebastiansm7 27 minutes ago | parent

Now that senior engineers can utilize an LLM as his junior, the job market its deciding that don't need too many juniors.

khalic 43 minutes ago | parent

I'm not sure about the salaries. Vocation-motivated people are already doing it. The rest needs a good reason to put their entire life, quite literally, into one single purpose. It's one of those professions that requires a complete dedication of free time, youth, health, mind, etc.

pajamasam 26 minutes ago | parent

If there are more doctors, it would require less of each one's time though.

khalic 17 minutes ago | parent

Yes it would, but the sacrifices start at the university already, that part is incompressible I'm afraid

groestl 9 minutes ago | parent

And there's certain constraints related to patient's safety which have an impact (i.e. less handovers, longer shifts)

kolla 7 minutes ago | parent

It does not require more than your standard 8-17. Know tons of doctors that work the same hours as I do and spend their free time the way I do.

seb1204 41 minutes ago | parent

Would you say that people also need to be more responsible to be healthy themselves? Reducing pressure on the system and freeing capacity. E.g. healthy lifestyle to reduce diabetes.

panick21_ 31 minutes ago | parent

Of course people need to take some responsibility, but reality is most people live in a society and do as the society does. You can minimally change people with some financial intensives but the effect of that is pretty limited and its hard to implement.

You have to create a healthy system, that takes social engineering and government cooperating on a general plan. And in the US such a thing is basically not possible, even if they wanted to do it.

Ideally your transportation, agricultural, educational policies should all work together to produce healthy population. But this simply isn't the case.

But it will not 'reduce pressure' in a practical way, because such changes purely private or public take decades to work themselves threw the population.

Forgeties79 10 minutes ago | parent

Well let’s start with insurance actually acknowledging preventative care as a worthwhile investment. We have a system that incentivizes waiting until emergency care is necessary and that comes with massive cons.

I can’t even get basic foot stuff covered, they won’t care until my feet and knees land me under “disability,” so people like me - but unlike me they can’t afford to spend hundreds more a year on special inserts and shoes - just keep doing what they’re doing until they’re hurt.

People go to the grocery store and marketing teams are trying to sell them “vitamin water” which is neither of those things, so they have to do tons of research and pay constant attention to literally every food they buy. Then when they get hurt they can’t afford to go to a doctor and the insurance that is sucking up huge amount amounts of their annual pay doesn’t pay for it either.

Meanwhile we have a US administration that is telling everybody, a population that is incredibly predisposed to heart disease already, to go eat more red meat. Also, they have spent a decade telling people that vaccines are shady and maybe they shouldn’t get them. How much damage have we done to preventative care with that one?

I could go on and on, I’m barely covering the breadth and depth of this problem. We can’t just call it “personal responsibility” or whatever

rolisz 40 minutes ago | parent

Are you sure you can find that many more doctors? That they'll be any good?

Speaking from Romania: here medicine is prestigious. So many parents push their kids towards medicine. There's a glut of newly minted doctors every year, but rumour has it that the quality drops every year. Sure, they pass the exams and residency and what not, but... They're just not into medicine as much.

Do you want to get treated by such a person?

This year I had to go to a neurologist. I went to one locally, they dismissed me in 5 minutes, told me to take some vitamins basically. Went to another one in a much bigger city, they talked to me for an hour, ordered a ton of tests.

Would it help if we get a lot more of the first kind of doctors?

postalcoder 31 minutes ago | parent

We do have qualified people to do the work of doctors, and they're called nurses. But arbitrary lines are drawn between what they can do and what doctors can do, just to maintain the existing salary structure.

TeMPOraL 29 minutes ago | parent

Hate to be cynical, but going by the stories a doctor in my personal circles tells me, "talked to me for an hour, ordered a ton of tests" could be more about billing the national healthcare fund for many tests, that may not be most useful, but carry best margins for the facility.

In my country, there's a big feud between cardiologists and radiologists right now, big enough to be a regular topic in national media. Inside sources tell me it has nothing to do with quality of care, and is entirely about the march of technology allowing radiologists to perform some diagnostics that previously required cardiological procedures, and those procedures happened to be the major funding source for the cardiology departments.

adrianN 29 minutes ago | parent

I'd like not to have to wait for three months to see a doctor to prescribe me the routine treatment for my routine illness, so yes, more mediocre doctors would be good for me. It would also unburden the doctors who are "really into medicine" so that they could spend their time on more difficult cases.

lolakutty 29 minutes ago | parent

Yea, that is what is going to happen.

Earlier you just need to find a doctor and they were probably good. Now you have to take your luck with many till you find a good one (if you are still alive by then)..

I don't know why people think that they can mass produce competence..

expedition32 25 minutes ago | parent

Ah yes and when doctors give everyone expensive tests because the patients are a bunch of drama queens who think they know better because they have a doctorate in Google the costs go up.

cbg0 20 minutes ago | parent

This is another one of those "kids these days" thing based on nothing but vibes. https://www.science.org/doi/10.1126/sciadv.aav5916

I'll give you some N=1 sample on older doctors since I'm also from Romania: a lot of these older doctors haven't opened a book in a very long time and are still using older practices instead of providing their patients with the latest and most effective treatments available because they're too lazy and/or prestigious to go and learn new things. Would you say that they "into medicine"?

> Would it help if we get a lot more of the first kind of doctors?

It would certainly help hypochondriacs a lot. Ordering "a ton of tests" needs to have some basis behind it, and doing it just to make the patient "feel seen" is not a great way to do your profession. People being dismissed quickly also happens in the US quite a lot, sometimes with disastrous results though it's not incredibly common, it's typically labeled under "diagnostic error" https://qualitysafety.bmj.com/content/23/9/727.long

account42 10 minutes ago | parent

> Would it help if we get a lot more of the first kind of doctors?

Hard to tell when you don't let us know which of those doctors ended up solving the issues that made you seek a doctor.

Dismissive doctors are bad but so are those that waste your time and risk complications from unnecessary invasive tests.

simianwords 39 minutes ago | parent

> Their salaries need to be lower, training needs to be cheaper and faster, and we need a lot more of them.

We need to reduce the requirements to be a doctor. I think general ability is way way way more important than the specialisation. I don't think the speciality that doctors spend money and time on add that much value..

azan_ 37 minutes ago | parent

> I think general ability is way way way more important than the specialisation. I don't think the speciality that doctors spend money and time on add that much value..

And why do you think that? I'm a doctor and I disagree completely - the medicine nowadays is so advanced, that it's impossible to keep up with advances without specialising yourself in narrow area.

simianwords 36 minutes ago | parent

That's interesting because it is exactly for the reason you give "impossible to keep up" that I think general ability is crucial.

7952 38 minutes ago | parent

I don't think Dr salaries are even that high a percent of healthcare spending. Although, maybe better work life balance, lower salary escalation and less debt would help everyone.

balderdash 35 minutes ago | parent

Agree - one sensible start would be to at least hybridize the European model where students are a whole lot closer to getting there medical degree as an undergraduate.

mococa 32 minutes ago | parent

In brazil, we imported doctors from Cuba

lolakutty 26 minutes ago | parent

> The reality is we need more doctors. A lot more.

No, the reality is we should be more healthy, so we need less doctors.

killingtime74 14 minutes ago | parent

While you're at it why not no crime so there's no police. Nothing dangerous so no firemen. Nobody throws anything away, so no need for factories. Peace on earth, so no soldiers.

zsoltkacsandi 23 minutes ago | parent

> The reality is we need more doctors. A lot more.

I think building a better prevention layer is more important.

Don't get me wrong, I agree that we need more doctors (and nurses, and physios, and dietetists, and ...), but it is much easier to scale a good prevention system than the number of workers in healthcare.

gww 20 minutes ago | parent

I think one issue is that the admissions for medicine are getting harder and harder. In many places you practically need a 4.0.GPA, volunteer work, great mcat scores, research experience, sometimes a post grad degree like an MSc and PhD etc. This selects for highly competitive and intense personalities that are not always suited for every medicine specialty. Most of them don't want to go into family medicine and pediatrics because it's more work, less money, less prestige etc. The friends I had who wanted to go into family medicine couldn't because of the admission requirements. Their only alternative was to have family money to pay for medical school in places like Ireland.

Edit: I should have mentioned that pediatrics and family medicine represent a large proportion of available residency spots each year and are rarely full.

Forgeties79 17 minutes ago | parent

General practitioners make something like 150k on average in the US. Specialists tend to make a lot more (upwards of double) and also tend to skew perceptions of doctors’ pay.

You could argue specialists should make less but considering how long it takes to become a doctor, how much work it takes to get there, how long you’re putting off real earning potential, school debt, etc., I do not consider 150k overpaid.

From a more practical angle, I don’t know how you could possibly find more doctors by lowering their earning potential.

Palomides 11 minutes ago | parent

there is another solution that will be (and is) actually happening: diffusion of doctor responsibilities to other less regulated/trained workers

sucks but that's incentives for ya

torben-friis 5 minutes ago | parent

The author: "Doctors are caught in a web of business, no longer a noble vocation. The altruism of young doctors have been replaced by the shackles of efficiency, productivity and key performance indicators."

The answer: here's some key performance indicator we can improve.

Sigh.

baxtr 3 minutes ago | parent

If you want more doctors you need to find out what’s holding people back to become doctors.

I have no idea what this might be.

hutattedonmyarm 49 minutes ago | parent

In the same vein: there’s the fantastic book

This is Going to Hurt: Secret Diaries of a Junior Doctor by Adam Kay

n4r9 38 minutes ago | parent

Adapted into a TV series with Ben Whishaw and Ambika Mod:

https://en.wikipedia.org/wiki/This_Is_Going_to_Hurt_(TV_seri...

asdefghyk 47 minutes ago | parent

It seems there needs to be more doctors to help reduce the insane workload. Must be lots burn out suffered ? by Drs?

panick21_ 27 minutes ago | parent

Not enough doctors in the pipeline. The government gave doctor associations control over the pipeline and basically even encouraged reduction, because it increases wages. They don't want to many doctors. Lawyers do the same potentially even better.

I'm sure burnouts happen but the fundamental problem is the pipeline.

carver2941 47 minutes ago | parent

Makes you wonder if they face similar on-call burnout but with actual life-or-death stakes. Way more intense than a buggy deploy.

ransom1538 46 minutes ago | parent

"I have lost control of my days. I had worked in a hospital where I was oncall 24/7, 12 days out of 14. I had fortnightly weekends off."

Medicine is ran by a bunch of creepy boards. "ACGME Review Committee for Dermatology." For example gets together and votes on how many Dermatologist we get, fun fact it doesn't go up much.

$They were so kind to add 400 more Dermatologist$ in the past decade to the student pipeline.$ What could the rea$son be?

What I would do if you are a doctor and don't hate humans - ask these boards to let more people in (hopefully Americans, but Americans have an uphill climb getting accepted with the flood of fraud applications from around the world).

reverius42 41 minutes ago | parent

> hopefully Americans

Why? Do you think Americans make better doctors?

underdeserver 40 minutes ago | parent

It's ridiculous. We need more doctors.

panick21_ 39 minutes ago | parent

How the US does scheduling is kind of insane. Doctors like pilots (and truck drivers in Europe) should have clear rules about how long they work with rest periods and so on. Giving people 24h shifts is nonsensical and insane.

1970-01-01 38 minutes ago | parent

This very much points to the administrative side causing the damage. The overall toolset is broken and nobody is fixing.

exdoctormachina 35 minutes ago | parent

I had a patient who tried and failed to use the legal system to extort me. Extremely frivolous.

I'm in the process of leaving the profession.

I don't feel guilty for the patients who will be left behind, they voted for this.

brrrrrm 15 minutes ago | parent

I would guess “us vs them” mentalities are not good for productive societies

kiln_ash 31 minutes ago | parent

Friends in residency describe it as a grind that breaks people, not just physically but emotionally too. The toll is immense.

ratmice 29 minutes ago | parent

Feels like a hundred years later we're still cursed by the cocaine addiction of Dr. William Stewart Halsted

robertcope 26 minutes ago | parent

I feel like a very similar article could be written by a teacher.

logicallee 24 minutes ago | parent

I'm not suicidal and have never been suicidal or thought about suicide. I'm happy and in a good mood every day. If someone is thinking about suicide please reach out to me: rviragh@gmail.com I'll listen to your issues and concerns and we will find a better solution for you.

nsnsnsnsjsj 18 minutes ago | parent

That is beautiful to offer but they should also call a crisis line, emergency number or talk to mental health professional.

cbg0 17 minutes ago | parent

Don't reach out to random strangers on the Internet. Instead, reach out to the official support hotlines in your own country and talk to someone with training:

https://en.wikipedia.org/wiki/List_of_suicide_crisis_lines

throw39304938 21 minutes ago | parent

I wish doctors would stop whining. They have great opportunity to save human lives! That is the best reward possible!

kunley 16 minutes ago | parent

Same corporate-greedy shit as everywhere but harder, because it's dealing with suffering and death.

jcft2 5 minutes ago | parent

Are these problems consistent all over the world, or are they particularly severe in certain countries? I assume there are many studies of this already so it would be good to understand whether this is a problem that has a solution.