5 ms·

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.
- Aeolun 8y ago
  It’s a pretty sad thing we have to describe such a soul destroying environment as par for the course for a job though.

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.
Aeolun 8y ago
It’s a pretty sad thing we have to describe such a soul destroying environment as par for the course for a job though.