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You can absolutely become a doctor for the love of taking care of people that are sick and help them overcome a bad situation. Many of my friends displayed a ca

You can absolutely become a doctor for the love of taking care of people that are sick and help them overcome a bad situation. Many of my friends displayed a caring side very early on (middle school).

arkades 8y ago
> become a doctor for the love of taking care of people that are sick and help them overcome a bad situation That’s the fantasy. And, hey, when it pops up, awesome - it’s a very energizing moment. However, most medicine has absolutely nothing to do with that day to day. The day to day is subject to Pareto’s Law. A surgeon may occasionally get to “take care of the sick,” but 80% of the time they get to do a five minute chart review of an obvious gallbladder passed along from the ED, a cookie cutter GB removal, and an uneventful recovery that involves a daily stomach poke and the same handful of questions they ask every other post-op pt on the floor. Medicine is a technical profession.
- kamaal 8y ago
  One likely won't get that good at surgery unless they practiced a lot. And if they had no interest towards that profession they likely won't be putting in crazy hours in their prime early career time becoming a surgeon. You can't even become good at flipping burgers without being interested in doing it.
  - vonmoltke 8y ago
    "Interest" is not "love" or "passion". Anyone using the latter terms as synonyms for the former is seriously diluting their meaning.
- luckydata 8y ago
  You're talking about the bad ones, the ones I hate to see. The friends I'm talking about are all excellent professionals. Passion matters.
  - lovich 8y ago
    You can't be passionate about boring work 24/7 and most jobs are boring work. Even if they aren't when you start, once you've done something 1000 times it becomes rote. Why do you think there's stories of burnout from places like google where people join up to do great work, but get stuck doing CRUD apps to support the business? The only people I see claiming everyone needs to be passionate all the time are business owners and management who then channel that passion into unpaid overtime
  - arkades 8y ago
    No, I'm talking about 99% of docs 99% of the time. It's a job. It's a great job sometimes, but it's paperwork most of the time. For every hour we spend rounding in the morning - when we're given at best 2/3 of the time we need to actually do the bare minimum, and half the time we need to really talk to people - we spend another 1-2 hours (minimum) in a windowless room doing a pile of paperwork notating the hell out of the morning's visits. I won't mention the X additional hours doing bullshit like wrangling with insurance companies and home healthcare and calling the nurse to very-politely-because-we're-all-a-team-here find out why my STAT EKG on last night's chest pain didn't get a fucking EKG. No one is passionate about paperwork in windowless rooms and workplace political wrangling. No one. But that's what it is most of the time, because it's a job. A real world job, with TPS reports (heh) and never enough printer paper to go around. But, hey, if you want to buy the hype, go for it.
    - mjevans 8y ago
      Would being a doctor be better in a system where there was /only/ a choice of either single payer or bring your own all-cash payment? (No 'insurance' at all.)
      - arkades 8y ago
        I don't know, to be honest. I know a lot of docs blame insurance for this, but I've worked in health policy and insurance - the problems are bigger than that. A lot of the documentation is an attempt to create "quality standards". I like that in theory, and it's independent of what kind of payment mechanism is used, but ... docs will have a riot if we're held accountable for final outcomes ("This guy has had 30 docs in 20 years, smokes like a chimney despite my repeatedly trying to get him to stop, and I'm getting my wallet drained because he had a heart attack?"). Alternatively, process measures ("Did you put everyone with high cholesterol on a statin?") kill autonomy, require documentation, destroy nuance (there's a good reason I don't want this patient on a statin) and also calcify medicine (advances in medical knowledge occur faster than Medicare updates its performance metrics). Unfortunately, "quality care" is also a PR move to cut costs. Create enough metrics over enough things docs have no control over, and a documentation slip-up becomes a good reason to ding us our reimbursement. This documentation is also a way to cut government and insurance budgets: they want the information for their programs, but don't want to pay for anyone to convert unstructured medical notes into structured data. Therefore, it becomes an unfunded mandate plopped onto physician's heads. That's not going to go away, unless all insurance - public and private - go away. All-cash payment removes documentation because there's no one to be accountable to. There's no central party trying to track your outcomes. But... I like the idea of tracking performance. I like the idea of encouraging quality care. I wouldn't mind if we could divorce quality metrics from centralized payors, and put the cost burden of data entry onto the party using and benefiting from that data rather than physicians. Some of the paperwork headache won't go away regardless. Primary Care docs spend most of their time doing bullshit paperwork tasks. As often comes up on HN, an employer won't let you bring your own chair to work - unless you get a doctor's note. Family med guys write stupid notes every single day, and it occupies a significant percentage of their workday. It's disheartening, and it's not going anywhere. Another big thing that's happened is social work. Every issue that society doesn't want to deal with rolls down to healthcare: the homeless, the mentally ill, the uninsured, eventually land in an emergency room. That means we're the central clearing house for social services. Psychiatry - especially ER psychiatry - spend probably as much of their time (or more) networking with social work and the state trying to secure Medicaid and housing for patients than they do addressing their mental health needs. It's work that needs doing, but man is it heartbreaking to train to be a physician just to spend your day trying to arrange housing. Lastly, even a single payer system has incentives to deny services. That's still a cost borne by the system. Accordingly, docs will still find themselves fighting paperwork battles with the insurer to justify a course of treatment - they'll just be doing it against a single bureaucracy instead of several.
- carpo 8y ago
  Im confused. All those small day to day technical things you described are opportunities to help and care about sick people. On the otherside of the chart is someone in pain. Its maybe not House, but it will make a huge difference in their life. If I was hiring a doctor, I'd want the person that understood that.
  - arkades 8y ago
    Picture a lab. It's a Nobel laureate's lab. They work on biochemistry. They work on producing drugs that might one day cure cancer. Everyone that works there gets to say, "all the small, day to day, technical things I do ... are opportunities to help advance the fight against cancer!" And it's plausible! They're rockstars! The primary investigator, he still has to chair like six goddamned committees because that's the institutional politics of his job. But it lets him do his job, so it gives him a chance to cure cancer! Surely that somehow makes all those committees less tiresome and boring. Every time someone spends half an hour arguing the merits of switching what brand of coffee pod they want in the faculty lounge (read: closet), he can think to himself, I'm doing this to cure cancer! Certainly that makes all the boredom just zip and go away. His senior PhD student? When he's up at three AM writing a last-second response to a peer review of his latest publication of a boring and predictable iteration of their last study (but needed, to juice his pub count and help him land a job FIGHTING CANCER!)... when that response makes it abundantly clear the reviewer didn't bother reading his damn paper and just wants the student to revise it to cite the reviewer's last paper (to juice their pub count)... well, that student can rub the grit out of his eyes, pour himself another cup of discount-brand pod-coffee, and say, this is awesome! I'm helping to fight cancer! When the janitor comes in in the morning, and gets pissed because the water has turned blacker than the faculty's discount coffee but the nearest closet with a hose is on the other side of the goddamn building, well... hey, that's okay. Because he's keeping this lab clean, which helps the lab workers do their jobs, which means he's helping FIGHT CANCER! None of that is un-true. All of that helps people get out of bed in the morning. But just because your job, big picture, has a noble end doesn't mean the every-day misery of every-day work is somehow magically awesome. If I was hiring a doctor, I'd want the person to understand that. Because if they didn't, they'd be a goddamn train wreck once they found out that hours of paperwork hoop-jumping isn't any more exciting just because it's medically related. I don't mean to go ad-hominem here, but honestly: are you a college student or something? If you've held down a job, you should fully understand that the "mission" of the job is separate from the day-to-day tedium of ... work. Work is work.
- samontar 8y ago
  My parents are surgeons and considering all the stories they’d tell me growing up about the conditions they treat and the surgeries they perform I’ve got to say it always sounded like what you describe as the fantasy. They still enjoy it in their 60s. Boredom has never been an enemy they’ve faced. And I’ve thought about it and over the last decade of programming I get it. Boredom hasn’t been an enemy I’ve met. And I look around at my friends and nor is it an enemy they know. I think the cynicism just misses the joy most people get from performing their craft right.
  - arkades 8y ago
    Of course they don't discuss the boring routine. When I get home, I talk about the highlight of the day/week, too - no one talks about the ubiquitous routine. But it's a job, not an episode of ER - most of it is the ubiquitous routine of jobs everywhere.
    - samontar 8y ago
      Yeah, but that routine isn’t really boring, is it? My job is arguably less exciting and I don’t find it boring.

arkades 8y ago

> become a doctor for the love of taking care of people that are sick and help them overcome a bad situation That’s the fantasy. And, hey, when it pops up, awesome - it’s a very energizing moment. However, most medicine has absolutely nothing to do with that day to day. The day to day is subject to Pareto’s Law. A surgeon may occasionally get to “take care of the sick,” but 80% of the time they get to do a five minute chart review of an obvious gallbladder passed along from the ED, a cookie cutter GB removal, and an uneventful recovery that involves a daily stomach poke and the same handful of questions they ask every other post-op pt on the floor. Medicine is a technical profession.

kamaal 8y ago
One likely won't get that good at surgery unless they practiced a lot. And if they had no interest towards that profession they likely won't be putting in crazy hours in their prime early career time becoming a surgeon. You can't even become good at flipping burgers without being interested in doing it.
- vonmoltke 8y ago
  "Interest" is not "love" or "passion". Anyone using the latter terms as synonyms for the former is seriously diluting their meaning.
luckydata 8y ago
You're talking about the bad ones, the ones I hate to see. The friends I'm talking about are all excellent professionals. Passion matters.
- lovich 8y ago
  You can't be passionate about boring work 24/7 and most jobs are boring work. Even if they aren't when you start, once you've done something 1000 times it becomes rote. Why do you think there's stories of burnout from places like google where people join up to do great work, but get stuck doing CRUD apps to support the business? The only people I see claiming everyone needs to be passionate all the time are business owners and management who then channel that passion into unpaid overtime
- arkades 8y ago
  No, I'm talking about 99% of docs 99% of the time. It's a job. It's a great job sometimes, but it's paperwork most of the time. For every hour we spend rounding in the morning - when we're given at best 2/3 of the time we need to actually do the bare minimum, and half the time we need to really talk to people - we spend another 1-2 hours (minimum) in a windowless room doing a pile of paperwork notating the hell out of the morning's visits. I won't mention the X additional hours doing bullshit like wrangling with insurance companies and home healthcare and calling the nurse to very-politely-because-we're-all-a-team-here find out why my STAT EKG on last night's chest pain didn't get a fucking EKG. No one is passionate about paperwork in windowless rooms and workplace political wrangling. No one. But that's what it is most of the time, because it's a job. A real world job, with TPS reports (heh) and never enough printer paper to go around. But, hey, if you want to buy the hype, go for it.
  - mjevans 8y ago
    Would being a doctor be better in a system where there was /only/ a choice of either single payer or bring your own all-cash payment? (No 'insurance' at all.)
    - arkades 8y ago
      I don't know, to be honest. I know a lot of docs blame insurance for this, but I've worked in health policy and insurance - the problems are bigger than that. A lot of the documentation is an attempt to create "quality standards". I like that in theory, and it's independent of what kind of payment mechanism is used, but ... docs will have a riot if we're held accountable for final outcomes ("This guy has had 30 docs in 20 years, smokes like a chimney despite my repeatedly trying to get him to stop, and I'm getting my wallet drained because he had a heart attack?"). Alternatively, process measures ("Did you put everyone with high cholesterol on a statin?") kill autonomy, require documentation, destroy nuance (there's a good reason I don't want this patient on a statin) and also calcify medicine (advances in medical knowledge occur faster than Medicare updates its performance metrics). Unfortunately, "quality care" is also a PR move to cut costs. Create enough metrics over enough things docs have no control over, and a documentation slip-up becomes a good reason to ding us our reimbursement. This documentation is also a way to cut government and insurance budgets: they want the information for their programs, but don't want to pay for anyone to convert unstructured medical notes into structured data. Therefore, it becomes an unfunded mandate plopped onto physician's heads. That's not going to go away, unless all insurance - public and private - go away. All-cash payment removes documentation because there's no one to be accountable to. There's no central party trying to track your outcomes. But... I like the idea of tracking performance. I like the idea of encouraging quality care. I wouldn't mind if we could divorce quality metrics from centralized payors, and put the cost burden of data entry onto the party using and benefiting from that data rather than physicians. Some of the paperwork headache won't go away regardless. Primary Care docs spend most of their time doing bullshit paperwork tasks. As often comes up on HN, an employer won't let you bring your own chair to work - unless you get a doctor's note. Family med guys write stupid notes every single day, and it occupies a significant percentage of their workday. It's disheartening, and it's not going anywhere. Another big thing that's happened is social work. Every issue that society doesn't want to deal with rolls down to healthcare: the homeless, the mentally ill, the uninsured, eventually land in an emergency room. That means we're the central clearing house for social services. Psychiatry - especially ER psychiatry - spend probably as much of their time (or more) networking with social work and the state trying to secure Medicaid and housing for patients than they do addressing their mental health needs. It's work that needs doing, but man is it heartbreaking to train to be a physician just to spend your day trying to arrange housing. Lastly, even a single payer system has incentives to deny services. That's still a cost borne by the system. Accordingly, docs will still find themselves fighting paperwork battles with the insurer to justify a course of treatment - they'll just be doing it against a single bureaucracy instead of several.
carpo 8y ago
Im confused. All those small day to day technical things you described are opportunities to help and care about sick people. On the otherside of the chart is someone in pain. Its maybe not House, but it will make a huge difference in their life. If I was hiring a doctor, I'd want the person that understood that.
- arkades 8y ago
  Picture a lab. It's a Nobel laureate's lab. They work on biochemistry. They work on producing drugs that might one day cure cancer. Everyone that works there gets to say, "all the small, day to day, technical things I do ... are opportunities to help advance the fight against cancer!" And it's plausible! They're rockstars! The primary investigator, he still has to chair like six goddamned committees because that's the institutional politics of his job. But it lets him do his job, so it gives him a chance to cure cancer! Surely that somehow makes all those committees less tiresome and boring. Every time someone spends half an hour arguing the merits of switching what brand of coffee pod they want in the faculty lounge (read: closet), he can think to himself, I'm doing this to cure cancer! Certainly that makes all the boredom just zip and go away. His senior PhD student? When he's up at three AM writing a last-second response to a peer review of his latest publication of a boring and predictable iteration of their last study (but needed, to juice his pub count and help him land a job FIGHTING CANCER!)... when that response makes it abundantly clear the reviewer didn't bother reading his damn paper and just wants the student to revise it to cite the reviewer's last paper (to juice their pub count)... well, that student can rub the grit out of his eyes, pour himself another cup of discount-brand pod-coffee, and say, this is awesome! I'm helping to fight cancer! When the janitor comes in in the morning, and gets pissed because the water has turned blacker than the faculty's discount coffee but the nearest closet with a hose is on the other side of the goddamn building, well... hey, that's okay. Because he's keeping this lab clean, which helps the lab workers do their jobs, which means he's helping FIGHT CANCER! None of that is un-true. All of that helps people get out of bed in the morning. But just because your job, big picture, has a noble end doesn't mean the every-day misery of every-day work is somehow magically awesome. If I was hiring a doctor, I'd want the person to understand that. Because if they didn't, they'd be a goddamn train wreck once they found out that hours of paperwork hoop-jumping isn't any more exciting just because it's medically related. I don't mean to go ad-hominem here, but honestly: are you a college student or something? If you've held down a job, you should fully understand that the "mission" of the job is separate from the day-to-day tedium of ... work. Work is work.
samontar 8y ago
My parents are surgeons and considering all the stories they’d tell me growing up about the conditions they treat and the surgeries they perform I’ve got to say it always sounded like what you describe as the fantasy. They still enjoy it in their 60s. Boredom has never been an enemy they’ve faced. And I’ve thought about it and over the last decade of programming I get it. Boredom hasn’t been an enemy I’ve met. And I look around at my friends and nor is it an enemy they know. I think the cynicism just misses the joy most people get from performing their craft right.
- arkades 8y ago
  Of course they don't discuss the boring routine. When I get home, I talk about the highlight of the day/week, too - no one talks about the ubiquitous routine. But it's a job, not an episode of ER - most of it is the ubiquitous routine of jobs everywhere.
  - samontar 8y ago
    Yeah, but that routine isn’t really boring, is it? My job is arguably less exciting and I don’t find it boring.