5 ms·

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 dra

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?
    - ejstronge 10y ago
      > You don't have to understand it. I think this is the main point I and the other commenters are trying to explain. You do have to understand it. Imagine someone coming and telling you your software job is better done by overseas contractors - they're less efficient and cheaper so you naturally must be overpaid. Except that ignores the many ways in which your training might make your higher cost worthwhile. > Why are we optimizing for the very few to reduce medical care for the masses? Are you implying there's a concerted effort to deny care? With the proliferation of nurse practitioners and physicians assistants, we're broadening the range of people who can take care of our population. Overseas, groups like Partners in Health are training community members to offer care in order to fill in gaps in health care availability. Sorry to take this to its extreme, but I think you're proposing the idea of the marketplace finding the optimum amount of training for caregivers. As a point of opinion, this kind of system would be far more disadvantageous for society's less powerful than what we have now.

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?
  - ejstronge 10y ago
    > You don't have to understand it. I think this is the main point I and the other commenters are trying to explain. You do have to understand it. Imagine someone coming and telling you your software job is better done by overseas contractors - they're less efficient and cheaper so you naturally must be overpaid. Except that ignores the many ways in which your training might make your higher cost worthwhile. > Why are we optimizing for the very few to reduce medical care for the masses? Are you implying there's a concerted effort to deny care? With the proliferation of nurse practitioners and physicians assistants, we're broadening the range of people who can take care of our population. Overseas, groups like Partners in Health are training community members to offer care in order to fill in gaps in health care availability. Sorry to take this to its extreme, but I think you're proposing the idea of the marketplace finding the optimum amount of training for caregivers. As a point of opinion, this kind of system would be far more disadvantageous for society's less powerful than what we have now.