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> The forced marches through the wards at 2am in the morning prepare the budding doctor for the real world where he can be called upon as say, the sole doctor

> The forced marches through the wards at 2am in the morning prepare the budding doctor for the real world where he can be called upon as say, the sole doctor for miles in a rural area to attend to a mass casualty event. When has that happened to you, or anybody you've known? > There are many different diseases that present alike and even subgroups of the same diseases that have different management regimes. Sure, how frequent is that? My point is that we're training doctors like they have to be Navy Seals, equipped and prepared for every situation, whereas in real life, a grunt with 3 months paramedic training would be up for the task.

ejstronge 10y ago
I'm not sure how you can prove what you're saying. It sounds a lot like someone seeing an app/website and thinking, "I could do that in no time." The scope of what a paramedic does and what a doctor does are totally different. The way medical care is organized capitalizes on each person's training: paramedics stabilize and transport patients; nurses carry out treatment plans; and doctors create treatment plans. It sounds like you're saying, just because we don't always need to use an efficient algorithm all the time, we should never be trained to use efficient algorithms. This could make sense in the context of the next Rails app, but, when your life is at stake, the extra training matters. > When has that happened to you, or anybody you've known? In the state I grew up in, there were only three pediatric psychiatrists for multiple millions of citizens. If a doctor's training confers the ability to affect hundreds of children's lives, I definitely want them to be as knowledgeable of their area of practice as possible.
Lordarminius 10y ago
> When has that happened to you, or anybody you've known? Are you kidding me? I practiced medicine until 8 months ago when I burned out and had to take a break. One of the cases I recall having on an offshore medical center, involved 4 victims who had suffered burns(in one case over 80% of his body surface area), on a night when I had 2 other patients on admission. It easily took my team of four 5 hours to stabilize the patients and have them evacuated by helicopter. In 2014, the oil company we subcontracted for had an incident where over 90 people suffered acute food poisoning from eating dinner at the staff canteen. This was a bacillus cereus infection with vomitting and stooling. Dont attempt to imagine that number of sick patients. There were only 2 doctors and five nurses initially to manage the incident. I could tell you war stories all day so could many other doctors.
- jimmywanger 10y ago
  In these incidents, how many times did you have to reach on your advanced medical training instead of the basic ones to treat burn wounds and fix food poisoning? How was any aspect of your job improved by your years of medical school, your years of residency? Would you rather have more less trained doctors, or fewer elite doctors in those circumstances?
  - Lordarminius 10y ago
    Its difficult to explain to lay people (and I in all honesty do not mean to be condescending) but even in the "simplest" of cases a doctor is called upon to draw on advanced skills and concepts he may not even remember he has. People fail out of the profession at various levels. A classmate of mine fled in the second year during her first dissection of a cadavar, never to return, some make it to residncy then quit. Certainly we should be vigilant and catch students before they become suicidal. But really, the practice of medicine requires a certain temperament. Some people are built for it and others are not. > Would you rather have more less trained doctors, or fewer elite doctors in those circumstances?* Unfortunately there is no middle ground. A doctor is either capable or he/she is not. We simply cant train them halfway. There are countries that have carried out the experiment you propose and attempt to train doctors to 'adequate' levels. The results are not good.
    - jimmywanger 10y ago
      > but even in the "simplest" of cases a doctor is called upon to draw on advanced skills and concepts he may not even remember he has. But how often does that occur? And is it worth the economic cost of not having doctors available, or doctors overworked? Individual human life is cheap. >A doctor is either capable or he/she is not. We simply cant train them halfway. There are countries that have carried out the experiment you propose and attempt to train doctors to 'adequate' levels. Do you have a source? I'd be quite interested in reading it. And the phrase "either <x> is capable or either he/she is not" can be applied to any other profession.
      - 10y ago

ejstronge 10y ago

I'm not sure how you can prove what you're saying. It sounds a lot like someone seeing an app/website and thinking, "I could do that in no time." The scope of what a paramedic does and what a doctor does are totally different. The way medical care is organized capitalizes on each person's training: paramedics stabilize and transport patients; nurses carry out treatment plans; and doctors create treatment plans. It sounds like you're saying, just because we don't always need to use an efficient algorithm all the time, we should never be trained to use efficient algorithms. This could make sense in the context of the next Rails app, but, when your life is at stake, the extra training matters. > When has that happened to you, or anybody you've known? In the state I grew up in, there were only three pediatric psychiatrists for multiple millions of citizens. If a doctor's training confers the ability to affect hundreds of children's lives, I definitely want them to be as knowledgeable of their area of practice as possible.

Lordarminius 10y ago

> When has that happened to you, or anybody you've known? Are you kidding me? I practiced medicine until 8 months ago when I burned out and had to take a break. One of the cases I recall having on an offshore medical center, involved 4 victims who had suffered burns(in one case over 80% of his body surface area), on a night when I had 2 other patients on admission. It easily took my team of four 5 hours to stabilize the patients and have them evacuated by helicopter. In 2014, the oil company we subcontracted for had an incident where over 90 people suffered acute food poisoning from eating dinner at the staff canteen. This was a bacillus cereus infection with vomitting and stooling. Dont attempt to imagine that number of sick patients. There were only 2 doctors and five nurses initially to manage the incident. I could tell you war stories all day so could many other doctors.

jimmywanger 10y ago
In these incidents, how many times did you have to reach on your advanced medical training instead of the basic ones to treat burn wounds and fix food poisoning? How was any aspect of your job improved by your years of medical school, your years of residency? Would you rather have more less trained doctors, or fewer elite doctors in those circumstances?
- Lordarminius 10y ago
  Its difficult to explain to lay people (and I in all honesty do not mean to be condescending) but even in the "simplest" of cases a doctor is called upon to draw on advanced skills and concepts he may not even remember he has. People fail out of the profession at various levels. A classmate of mine fled in the second year during her first dissection of a cadavar, never to return, some make it to residncy then quit. Certainly we should be vigilant and catch students before they become suicidal. But really, the practice of medicine requires a certain temperament. Some people are built for it and others are not. > Would you rather have more less trained doctors, or fewer elite doctors in those circumstances?* Unfortunately there is no middle ground. A doctor is either capable or he/she is not. We simply cant train them halfway. There are countries that have carried out the experiment you propose and attempt to train doctors to 'adequate' levels. The results are not good.
  - jimmywanger 10y ago
    > but even in the "simplest" of cases a doctor is called upon to draw on advanced skills and concepts he may not even remember he has. But how often does that occur? And is it worth the economic cost of not having doctors available, or doctors overworked? Individual human life is cheap. >A doctor is either capable or he/she is not. We simply cant train them halfway. There are countries that have carried out the experiment you propose and attempt to train doctors to 'adequate' levels. Do you have a source? I'd be quite interested in reading it. And the phrase "either <x> is capable or either he/she is not" can be applied to any other profession.
    - 10y ago