5 ms·

> 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 brea

> 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.
    - zadig 10y ago
      > 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. As someone currently in medical school, I'm going to have to agree w/ the previous comment that often "simple" cases are not so simple. For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract, the physiology of nutrient absorption, pathophysiology of different diseases, important details about infectious causes (i.e. toxins, mech of transmission, etc.), labs, clinical presentation, associated phys/pathophys like neurological, immunological, and hematological features, associated symptoms, common patient histories, drugs and their mechanisms of actions, etc. etc. etc. The sheer volume of knowledge that you need to know and how everything fits together is something I hadn't realized before coming to med school. Plus, you have to learn clinical skills like how to take a patient history, do a physical exam, etc. all of which is only for treatment of diarrhea. Now imagine learning all of this for topics as wide ranging as all the different cancers, heart failure, emphysema, diabetes, all the different congenital defects, etc. You also have to know how to read radiology, how to intubate, draw blood, perform disease-specific tests, maybe learn how to do surgery, etc. Anyway, the point is it takes a lot of skills and concepts for a fully trained doctor to work up simple things.
      - jimmywanger 10y ago
        > For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract... You don't have to understand it. You can say "Hey, usually when you take this pill things get better" or "Just keep him hydrated with a water/salt/sugar mixture, and these things generally take care of themselves." Human life is cheap. There are 7 billion of us. Why are we optimizing for the very few to reduce medical care for the masses?
- Spooky23 10y ago
  Would you prefer to go to a medical office with your kid presenting a serious condition and get a paramedic who doesn't know what to do outside of his protocols?
  - jimmywanger 10y ago
    I'd prefer to go to a medical office without taking out a loan. If the choice is mortaging my house to get an elite doctor to check something out or paying a reasonable fee for somebody who would probably do just as good a job, or escalate it if he was over his head, I'm going for the second every time.
    - Spooky23 10y ago
      They have that now. Go to your local urgent care or CVS doc in a box and you'll get a nurse practitioner who can help you out with routine stuff for low cost.

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.
  - zadig 10y ago
    > 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. As someone currently in medical school, I'm going to have to agree w/ the previous comment that often "simple" cases are not so simple. For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract, the physiology of nutrient absorption, pathophysiology of different diseases, important details about infectious causes (i.e. toxins, mech of transmission, etc.), labs, clinical presentation, associated phys/pathophys like neurological, immunological, and hematological features, associated symptoms, common patient histories, drugs and their mechanisms of actions, etc. etc. etc. The sheer volume of knowledge that you need to know and how everything fits together is something I hadn't realized before coming to med school. Plus, you have to learn clinical skills like how to take a patient history, do a physical exam, etc. all of which is only for treatment of diarrhea. Now imagine learning all of this for topics as wide ranging as all the different cancers, heart failure, emphysema, diabetes, all the different congenital defects, etc. You also have to know how to read radiology, how to intubate, draw blood, perform disease-specific tests, maybe learn how to do surgery, etc. Anyway, the point is it takes a lot of skills and concepts for a fully trained doctor to work up simple things.
    - jimmywanger 10y ago
      > For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract... You don't have to understand it. You can say "Hey, usually when you take this pill things get better" or "Just keep him hydrated with a water/salt/sugar mixture, and these things generally take care of themselves." Human life is cheap. There are 7 billion of us. Why are we optimizing for the very few to reduce medical care for the masses?
Spooky23 10y ago
Would you prefer to go to a medical office with your kid presenting a serious condition and get a paramedic who doesn't know what to do outside of his protocols?
- jimmywanger 10y ago
  I'd prefer to go to a medical office without taking out a loan. If the choice is mortaging my house to get an elite doctor to check something out or paying a reasonable fee for somebody who would probably do just as good a job, or escalate it if he was over his head, I'm going for the second every time.
  - Spooky23 10y ago
    They have that now. Go to your local urgent care or CVS doc in a box and you'll get a nurse practitioner who can help you out with routine stuff for low cost.