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Your hypothesis seems to be that things would improve if doctors were less protected. If you achieve putting that into practice you will see your already damage
by rscho 8y ago
Your hypothesis seems to be that things would improve if doctors were less protected. If you achieve putting that into practice you will see your already damaged healthcare system literally crumble to ruins.
You have to realize that whether you like it or not docs are the last line of defense. They are the ones putting in the hours to keep the ship afloat, which is why you have to pay them well.
You are right in saying there are dishonest people in medicine, but if you want change then target the industry and their lobbyists. It will be much better for you and everyone else, and will bring some of the changes you seek.
- Ericson2314 8y agoI'm not even arguing a massive conspiracy, to be clear. Not all doctors are Tom Price. I don't know how it works with the ADA, but my guess is the stuff is mainly tradition, and economics informs tradition unconsciously. And yes the institutions that most want to pay doctors left are totally untrustworthy with that money. So I am not advocating letting them do that. I guess I'd like: 1. Government health care. Nobody can rationalize the value of their life on their death bed; markets make no sense for health. 2. After that (which fixes the deepest problems), switch to an apprentice style program where everyone starts as a nurse, and then some go back to school to learn more. The way society valorizes doctors above all (including, implicitly, nurses) (this "last line of defense stuff", etc, etc) strikes me as ungrounded and, frankly, classist or sexist in many instances. There are other well-meaning individuals, and focusing on the individual level, whether patient or care-giver, is not the right approach to systemic problems.
- rscho 8y agoWhat I meant to say is that in the current structure it's like that and unfortunately very real. It can be changed, but probably at both a high cost and a profound cultural change. Your current social contract as a doc is 1. Do the job that is traditionally yours. 2. Handle all the impromptu alone because no one else will do it. The second part is the problem, and is largely due to ressource constraints. What's clear is that the system is already in pretty bad shape, so I'm just saying that the frontline workers are not a suitable target for pressure. BTW your view regarding the nurse to doctor transition would have been ok 50 years ago. Nowadays, nurses are hyperspecialized in their own niches. If you meant to say "you should know how to make a bed before doing heart surgery", I heartily agree that it would do great good to everyone if docs were to experience what life is lower down the care ladder.
- Ericson2314 8y agoThanks for replying this far after the life of the thread. I was aware that nurses are far more trained today. But is their training that orthogonal to the doctors? I was thinking doctors starting with nurses in tandem with nurses allowed to operate more machines, do more radiology, etc.
- rscho 8y agoWell, yes you can do that for some theoretical knowledge, but it wouldn't be very practical on the job because indeed, they are not the same jobs at all. The role of nurses is to handle the expected as efficiently as possible. The job of docs is to handle anything unexpected. That is why a wide education is necessary. You may also be surprised by the fact that specialist nurses are well paid and would often never want to "upgrade" to being a doc, precisely be cause of the additional constraints. Finally, the ego of specialist nurses rivals that of docs, and they are even stronger unionized. I don't think it's really possible to keep the same quality of care for cheaper by changing education because armies of residents and fellows are effectively doing slave labor and you'd have trouble finding cheaper and more efficient than a highly-trained slave. In my opinion, well applied technology is the only long term solution.