Doctors Tell All - And It's Bad

[Pointedstick]

What a sad article.

It reminds me of a thread I started, interestingly enough, almost exactly one year ago: http://gyroscopicinvesting.com/forum/ot ... idealists/

If you buy into Meyers-Briggs typology and Keirsey's modifications to it, then doctors would tend to be Idealists, often of the "Healer" sub-type (INFP).

Doctors would seem to be examples of Idealists who are doing fine financially (unlike many other Idealists) but who nonetheless feel like it's all wrong, because while they wanted to be nurturing people, healing them, and helping them grow, and what they instead find themselves doing is something utterly alien to them--servicing a big impersonal system designed by the Rationals to squeeze every penny of profit out of a fundamentally failing market. They are not systems thinkers or maintainers; systems feel cold and inhuman, devoid of the compassion they feel like they should be able to express.

However, I don't think money and medical services are fundamentally incompatible--but they certainly are when combined in the system we have today. Doctors who move to a cash-only model seem to be much happier than those still being slowly strangled by the insurance industry. You don't need single-payer to make doctors happier.

I might also muse that doctors are more frustrated taking care of a sickening population. There is always a kernel of truth (my new favorite phrase, apparently) in mean epithets like "Hispanic Hysterical Syndrome" and "beached whale." It has to be depressing to see so many obese people whose weight problem is clearly their own fault, or deal with large numbers of semi-informed, unreasonable, aggressive patients. When people can't be bothered to care of themselves, how fair is it to demand compassion (and low prices!) from someone they demand do it for them?

[WiseOne]

I'll read this later when I have some time - TennPaGa, thanks SO much for posting this.

It's a bit of a joke about medical care being "evidence-based".  We are constantly socked in the face to do two things:  1) maximize income and 2) somehow make people happy (aka "the customer is always right").  And get used to the idea that you're treated like scum by the army of administrators sitting over you.  And everyone else you're dealing with is unionized, so they get to dump on you too.

Ironically I'm plugging through yet another online training course, which I file in the email under "nastygrams", which of course requires a forum break partway through. 

Also this is why I'm staying in academia even at low pay:  much, much better quality of life on the research side.  You couldn't pay me enough to be a doctor full time.

[Benko]

Because it's all about making money.  IMO, this is the cultural change that has corroded the U.S. more than anything else.

Why do you feel that greedy doctors have done more to corrode the US culture than:

1.  A culture of lies from the presidents down (" I did not sleep with that woman", "if you like your policy, you can keep your policy"

2.  The reversal of the trend toward personal responsibility/independence toward blaming others and being deependend on others.

etc.

[Benko]

Because it's all about making money.  IMO, this is the cultural change that has corroded the U.S. more than anything else.

Why do you feel that greedy doctors have done more to corrode the US culture than:

1.  A culture of lies from the presidents down (" I did not sleep with that woman", "if you like your policy, you can keep your policy"

2.  The reversal of the trend toward personal responsibility/independence toward blaming others and being deependend on others.

etc.

I was speaking more broadly than just the medical profession.

My own belief is that culture is shaped more by everyday relationships between people.  But the message that corporate America sends is that people don't matter.  Only money.  This is alluded to in the part that I excerpted:

Today’s physicians, he tells us, see themselves not as the “pillars of any community”? but as “technicians on an assembly line,”? or “pawn(s) in a money-making game for hospital administrators.”?

And I think this dispair extends to other fields.

Of course, this is just my own belief, and I realize I've not fleshed it out very well.

I totally understand.  I'm a doc, but where I work I'm a 3rd class citizen behind administrators, etc.  Mostly I don't care except when the administrators interfere with patient care and I then I intervene (or try to).

Whatever message corporate america "sends", people are raised by parents and schools which have way more influence.  Look at what their influence did below (video at link).  If you cannot even tell the difference between lying and not, voter fraud and not you have a much bigger problem than anything caused by corporate america.   

'“That is not even like lying or something, if someone throws out a ballot, like if you want to fill it out you should do it.”? 
http://www.nationalreview.com/article/3 ... -john-fund

[Pointedstick]

But are people actually raised by parents these days?

We outsource parenting to daycare centers because the culture sends the message that we should be slaving for an employer.  And we have to slave away for said employer because if we don't, we won't be able to afford to send our kids to the best daycare center and the best schools and the best universities.  Because if we don't do that, then there is no place for our kids because people the culture tells us that people don't matter.

To me, this seems so weird. For many, working to afford childcare is a net negative, not even counting the effects of outsourcing your parental responsibilities.

And the whole culture of pushing kids into ever better schools so they're better prepared for the next pre-determined stage of life is... I dunno, it just seems kind of crazy to me. All that pressure is really hurting kids, I think, and turning them into neurotic, uptight adults who don't actually enjoy that which they're forced to accomplish and don't learn real self-esteem because all of their accomplishments feel like they were engineered by somebody else.

[Tyler]

We outsource parenting to daycare centers because the culture sends the message that we should be slaving for an employer.  And we have to slave away for said employer because if we don't, we won't be able to afford to send our kids to the best daycare center and the best schools and the best universities. 

Right there with ya.  The "system" today is full of circular logic that ultimately sacrifices a bit of humanity on the altar of cashflow and productivity.

[Pointedstick]

We haven't yet decided whether to homeschool or not. While it seems like homeschooling, especially from the start, could give a kid a better academic experience, I do worry that it could encourage introversion and difficulty relating to peers, especially with my wife and I who already tend toward hermit-ism. I was in a public school until the fifth grade when it was destroyed by the forces of political correctness, and I recall that it yielded a good social and interpersonal education, but the academics weren't terrible either. Maybe it's different today what with NCLB and other ridiculously bad ideas.

[Libertarian666]

We haven't yet decided whether to homeschool or not. While it seems like homeschooling, especially from the start, could give a kid a better academic experience, I do worry that it could encourage introversion and difficulty relating to peers, especially with my wife and I who already tend toward hermit-ism. I was in a public school until the fifth grade when it was destroyed by the forces of political correctness, and I recall that it yielded a good social and interpersonal education, but the academics weren't terrible either. Maybe it's different today what with NCLB and other ridiculously bad ideas.

I have been VERY impressed with the homeschooled children I have met. They were very mature and had excellent interpersonal skills as well.

Not data, of course, but a data point...

[Pointedstick]

My personal experience has been that homeschooled children make fantastic adults but awkward children, and that the difficulties and rejection they may face during childhood (and especially teenagehood ugh) may bleed into adulthood. I dated a girl in high school who was homeschooled through middle school and super awkward, but now she's a totally awesome successful adult.

I guess it depends on the homeschooling parents. Puts a lot of pressure on YOU!

[stuper1]

We homeschooled our son through 8th grade.  He just started at a public high school this year, and he seems to be fitting in well.  Believe me I wondered how it would be for him, but it's a smaller charter school, so not quite as intimidating as the mega high schools.

Our daughter is in 5th grade and still homeschooled.

My recommendation is to keep them home as long as you can.  You will be a much better influence on your kids than any school situation.  I feel so sorry for kids who are just a little bit different and get teased and bullied incessantly.  What a miserable thing to have to face every day, especially when you're not old enough to know how stupid it all is.  Maybe your kid won't be the one who is different.  Maybe he'll be the one doing the bullying.  Either way, he'd be better off at home.

Try to get your kids involved with other kids when you can, but don't stress over it.  Just make sure that you spend time with your kids rather than ignoring them most of the time, as many parents do these days.  Family is much more important than friends.  How many friends from your elementary school days do you still have contact with?

[pp4me3]

I work in software development and many of the complaints I'm hearing from doctors are identical to the ones me and my colleagues bitch about every day. So goddamn much paperwork and bureaucracy to get anything done. Constantly made to feel like a very small cog in a very inefficient wheel no matter how much experience and expertise you have.

Seems to be an aspect of modern life that goes beyond the medical profession.

Fortunately I only have a few more years and I'm out.

[Tyler]

Seems to be an aspect of modern life that goes beyond the medical profession.

Agreed.  Engineering in general suffers from many of the same problems. 

At a high level, modern middle management, regardless of industry, exists for two reasons:

1) to maximize profits by running the producers at the highest sustainable levels of stress (by either piling on more work or pulling in deadlines). 

2) to minimize mistakes resulting from said stress levels by attempting to standardize every process and separate thinking from doing.

As Matthew B Crawford (http://matthewbcrawford.com/) might say, the modern trend of separating thinking from doing -- perpetuated by educational, corporate, and political institutions alike -- sucks all the meaning, joy, and quality out of work.  And without the meaning, the stress is even less manageable for most people.

[clacy]

I've worked with hundreds of physicians and surgeons in a previous life in medical device sales and consulting.  I would say the vast majority of them would put the burden of our government (medicare/medicaid) and trial lawyers right up there with insurance carriers as the biggest problem with medicine.

When you combine

Megacorps (insurance and most hospital groups) + government bureaucrats + trial lawyers + people who are quick to blame doctors when there is the slightest error or problem....

You have the makings of a system that virtually no one is happy with, but often times for different reasons.

[FarmerD]

I've worked with hundreds of physicians and surgeons in a previous life in medical device sales and consulting.  I would say the vast majority of them would put the burden of our government (medicare/medicaid) and trail lawyers right up there with insurance carriers as the biggest problem with medicine.

When you combine

Megacorps (insurance and most hospital groups) + government bureaucrats + trail lawyers + people who are quick to blame doctors when there is the slightest error or problem....

You have the makings of a system that virtually no one is happy with, but often times for different reasons.

I have known many physicians who joined the Air Force simply to minimize the extraneous problems you mention even though it costs them in salary. 

[WiseOne]

OK, read the article.  It's a rather limited viewpoint that boils down to "please be my psychologist as well as doctor".  Some doctors can do that, others can't and that's just life.  Similarly, hospitals are not spas and never will be.  They're for treating people too sick to stay home, not the "worried well."

The badness that can result from doctors having to rush through appointments is a valid point.  When you spend more time with patients you pick up simple things you might have missed in a flying 30 second interview.  Like just yesterday...encountered a patient who was crushing extended-release pills, and then complaining that they made him sleepy.  Problem solved quite easily and for essentially zero cost (switched to cheaper non-timed-release version).

That particular problem is caused by the current care system rewarding procedures while devaluing office visits - a problem that long predates the Obama era.  The increased paperwork burden and pressure to bring in more and yet more $$ exacerbates it further but isn't the primary cause.

It would help if people didn't equate surgery with medical care.  Whenever you see medical shows on TV it's always the operating room that's featured, even when the subject in question is an infectious disease where the OR has no place in care.  I thought it was funny, but it most certainly contributes to the devaluation of medical (non-surgical) care.

[pp4me3]

Could this be a good sign for the cost of healthcare?

Every day low prices?

http://www.marketwatch.com/story/wal-ma ... =afterbell

And I guess the question I should ask is who do you think would be more likely to actually deliver on the promise of affordable care - Walmart or the USG?

But I'm guessing the USG will find a way to shut this down if it goes too far?

[WiseOne]

That is awesome...I can see people getting high deductible plans and then paying cash for the occasional office visit.  Totally sensible!

They have managed to avoid some of the traditional expenses like getting preauthorizations for tests and answering patient calls after hours.  Still, if they had to go the EHR/PQRI/CMS billing route since they do take traditional Medicare, that still has to be a pretty slim profit margin.  It sounds like they figure they'll make money not from the clinic, but from the fact that people have to walk through their store to get there, and probably will get medications from the pharmacy.  Incidentally, they use NPs not MDs.  I have zero problem with NPs for primary care.  There's nothing that goes on in a PMD's office that a good NP can't handle.

The USG might not shut this down but the AMA is trying to (not them specifically but all the store-associated clinics).  They're arguing conflict of interest since they will sell patients any drugs prescribed through their pharmacy.

Just one more reason why I refuse to join the AMA :-)

[Mountaineer]

I've worked with hundreds of physicians and surgeons in a previous life in medical device sales and consulting.  I would say the vast majority of them would put the burden of our government (medicare/medicaid) and trial lawyers right up there with insurance carriers as the biggest problem with medicine.

When you combine

Megacorps (insurance and most hospital groups) + government bureaucrats + trial lawyers + people who are quick to blame doctors when there is the slightest error or problem....

You have the makings of a system that virtually no one is happy with, but often times for different reasons.

Oh the irony of this thread and the Ebola thread comments in juxtaposition. 

... Mountaineer