5 ms·

Define "finish". For that matter, define "faster". When I was working as a junior doctor, I had colleagues who "saw" 10 patients in the space I saw 3. Wheneve

Define "finish". For that matter, define "faster". When I was working as a junior doctor, I had colleagues who "saw" 10 patients in the space I saw 3. Whenever I was on call at night, I could spot the patients who were "seen" by those colleagues, because it was always the patients who crashed or needed their meds re-writing to remove the allergy risks or needed to have their bloods ordered and taken, or even had to be re-clarked from scratch because the history and exam were utter bullshit, not to mention dangerously so. (I once re-clarked an old lady who was admitted for confusion affecting her ability to communicate and was about to receive all sorts of scans and radiation. When I talked to her, it turned out she had just lost her hearing aid and couldn't hear anything.) Still, it was always the "tenners" who were praised. (PS. I no longer work as a doctor. Fuck that shit.) (PS2. Obviously this isn't unique to medicine. I have the same problems inheriting crappy untested code now, haha.)

veb 5y ago
Ha. Reminds me of my grandmother. She's quite old now but the doctors told us she had dementia. One day Mum was telling me about it and I said, "make sure they understand she's deaf, and will just smile and nod if she doesn't hear properly." Next appt, mum goes with her and lo and behold, she doesn't have dementia, she needs a new hearing aid. (deafness runs in my family, if you're interested: https://medium.com/@veb/my-journey-to-a-cochlear-implant-8cefe5e74344 https://medium.com/@veb/my-journey-to-a-cochlear-implant-8ce... - had to remove part 2 because lawyers...)
- codetrotter 5y ago
  What happened next, and why did lawyers make you remove part 2?
  - Hitton 5y ago
    Pesky lawyers thinking they can really make stuff disappear from interwebz. https://web.archive.org/web/20170112221346/https://medium.com/@veb/my-journey-to-a-cochlear-implant-wtf-happened-38331f661781 https://web.archive.org/web/20170112221346/https://medium.co...
mdp2021 5y ago
> Still, it was always the "tenners" who were praised You figure why "we are rolling down" (loss of quality as a value, "decadence" - loss of purpose (what do those colleagues think they were there for?), loss of good sense, loss of perception). I have already narrated at HN the story of the evaluation in which the subject was criticized for being not as fast in responding as the colleague - who gave wrong answers. I think I have also read in these pages our moderator DanG noting the qualitative difference in general separating prompt posts and meditated posts. It's not that the concept of "reflection" is gone, it is that it has generally declined. Surely, over ten years of "bad school" social networks helped that. Plus, economic and sociopolitical factors promoting the use of cheaper personnel in looser monitoring. Edit: plus, overly-literal-interpreting-people dealing with overly-sloppy compilers of (Key) Performance Indicators...
- lifeisstillgood 5y ago
  I don't think there is something inherently bad about social media. I mean Tv / Radio sped up the time from an event to when people hear about it - and the first time people here is when people shape their perception of the event. Hence if your side of the story is out at the same time as the news of the event, you get a good chance of shaping people's perception of the event. If you wait a week, day or hour, it may be too late. I am not sure it is good bad or other. Maybe it does not matter to you that millions hear one side if the "right" people hear your more considered side. (perhaps we call that lobbying) Speed has meant it's harder to get a considered reaction. But then again, by middle age most things in the world are either things we have seen before so have an instant reaction, or frankly are not worth reacting too.
  - mdp2021 5y ago
    ( Name checks ;) ) > I don't think there is something inherently bad about social media Good that that's your opinion, just I hope you have not understood that is the position of the parent post, which wrote «over ten years of "bad school" social networks helped [the decline ... of the concept of "reflection"]». It meant that people have been encouraged to "fast respond", which boosts the diffusion of low quality. Lack of depth, cheap processing... > the first time people here is when people shape their perception of the event And duly reflection, the point, is there so that the new informational members in the Weltaufbau are well criticized before getting entrenched. Why should have «speed [in the time from an event to when people hear about it] ... meant it's harder to get a considered reaction»? One's reaction to information is not really a function of the distance in time of the event in the information. The problem noted is with those ethological drives against «considered reaction».
deleted 5y ago
[deleted]
danuker 5y ago
> Still, it was always the "tenners" who were praised. I believe the US does not align financial incentives with the quality of care provided. Healthcare in the US is a runaway scam: https://ourworldindata.org/grapher/life-expectancy-vs-health-expenditure?country=USA~FRA~GBR https://ourworldindata.org/grapher/life-expectancy-vs-health...
- lotsofpulp 5y ago
  There has been a massive change in US healthcare from a “fee for service” payment model to a “value based care” payment model over the last 10 years. https://www.cerner.com/perspectives/between-fee-for-service-and-value-based-care https://www.cerner.com/perspectives/between-fee-for-service-... https://www.decorm.com/understanding-fee-for-service-and-value-based-care/ https://www.decorm.com/understanding-fee-for-service-and-val... There are many posts online about doctors and pharmacists about the pros and cons of tying their reimbursement to patient outcomes.
  - dv_dt 5y ago
    That seems to fly in the face of the private health insurance system that many of us are forced to use. I believe there are many more value based healthcare situations now than before but suspect that it’s still a tiny fraction of healthcare delivery in the US.
    - lotsofpulp 5y ago
      25%+ of US residents receive taxpayer funded healthcare, via Medicare, Medicaid, Tricare (military), or other government programs. I think electronic medical records will only accelerate it to non taxpayer funded populations as it will greatly ease the ability to track data even when switching from one managed care organization to another.
lpapez 5y ago
Unrelated question. My girlfriend is an anesthesiologist and she is quite distraught with the fact that she is being payed less than me for working significantly more hours on a job with vastly more responsibility and risk (I work on embedded devices which have 0% chance of causing injury or death). She doesn't want to consider career switch because she already invested 12 years of her life into medicine. I am supportive of course, but to me this is a clear example of a "sunk cost fallacy". How did you get over that?
- lotsofpulp 5y ago
  Based on the 12 years of education, I am guessing you are in the US. Median anesthesiologist income is ~$400k/year. The odds of her earning similar, even per hour, if she switches to programming may cause sticking to being a doctor make more sense.
  - lpapez 5y ago
    Nope, Eastern Europe. We both got pretty good education (even got to study abroad for a few semesters) and it was free for both of us, but her annual pay is around 30k$ while mine is around 35k$ (the median wage is about 15k$). Its really easy to earn more than that if you remotely work for a German or American company, but as a doctor you cant do that unless you move (not an option).
    - lotsofpulp 5y ago
      Oh, my bad. Yes, that changes things quite a bit. I am surprised it takes 12 years in Eastern Europe. I thought it was ~8 years in Europe.
      - lpapez 5y ago
        6 years college minimum. Mandatory one year of general practice and then you can apply for specialist education. Specialization can then take years to begin, but it can also start right away depending how lucky you are and you do it for five years minimum. So that makes it 12 years minimum. After that, most hospitals require you to stay working there for another 5 years otherwise you have to pay for specialization school (about 30k$). After that, you are free to live your life :)
Calamitous 5y ago
> I no longer work as a doctor. I'm curious if you'd be willing to discuss why?
- tpoacher 5y ago
  Honestly, every time I answer this question, it's a bit like when the Joker answer's how he got his smile (i.e. the answer is different every time, hahah). In the end, I think what it boils down to is that I wasn't happy doing it, and I found something else that I felt more passionate about and found a way to do that instead. (while retaining some of the medical context which would set me apart from my peers in the new profession).
stonecharioteer 5y ago
You became a coder after leaving medicine? I'd love to read a blog post about that journey!
- tpoacher 5y ago
  Not a 'coder' coder per se. I'm a biomedical engineering researcher, which so happens to involve writing a lot of code. :)

veb 5y ago

Ha. Reminds me of my grandmother. She's quite old now but the doctors told us she had dementia. One day Mum was telling me about it and I said, "make sure they understand she's deaf, and will just smile and nod if she doesn't hear properly." Next appt, mum goes with her and lo and behold, she doesn't have dementia, she needs a new hearing aid. (deafness runs in my family, if you're interested: https://medium.com/@veb/my-journey-to-a-cochlear-implant-8cefe5e74344 https://medium.com/@veb/my-journey-to-a-cochlear-implant-8ce... - had to remove part 2 because lawyers...)

codetrotter 5y ago
What happened next, and why did lawyers make you remove part 2?
- Hitton 5y ago
  Pesky lawyers thinking they can really make stuff disappear from interwebz. https://web.archive.org/web/20170112221346/https://medium.com/@veb/my-journey-to-a-cochlear-implant-wtf-happened-38331f661781 https://web.archive.org/web/20170112221346/https://medium.co...

mdp2021 5y ago

> Still, it was always the "tenners" who were praised You figure why "we are rolling down" (loss of quality as a value, "decadence" - loss of purpose (what do those colleagues think they were there for?), loss of good sense, loss of perception). I have already narrated at HN the story of the evaluation in which the subject was criticized for being not as fast in responding as the colleague - who gave wrong answers. I think I have also read in these pages our moderator DanG noting the qualitative difference in general separating prompt posts and meditated posts. It's not that the concept of "reflection" is gone, it is that it has generally declined. Surely, over ten years of "bad school" social networks helped that. Plus, economic and sociopolitical factors promoting the use of cheaper personnel in looser monitoring. Edit: plus, overly-literal-interpreting-people dealing with overly-sloppy compilers of (Key) Performance Indicators...

lifeisstillgood 5y ago
I don't think there is something inherently bad about social media. I mean Tv / Radio sped up the time from an event to when people hear about it - and the first time people here is when people shape their perception of the event. Hence if your side of the story is out at the same time as the news of the event, you get a good chance of shaping people's perception of the event. If you wait a week, day or hour, it may be too late. I am not sure it is good bad or other. Maybe it does not matter to you that millions hear one side if the "right" people hear your more considered side. (perhaps we call that lobbying) Speed has meant it's harder to get a considered reaction. But then again, by middle age most things in the world are either things we have seen before so have an instant reaction, or frankly are not worth reacting too.
- mdp2021 5y ago
  ( Name checks ;) ) > I don't think there is something inherently bad about social media Good that that's your opinion, just I hope you have not understood that is the position of the parent post, which wrote «over ten years of "bad school" social networks helped [the decline ... of the concept of "reflection"]». It meant that people have been encouraged to "fast respond", which boosts the diffusion of low quality. Lack of depth, cheap processing... > the first time people here is when people shape their perception of the event And duly reflection, the point, is there so that the new informational members in the Weltaufbau are well criticized before getting entrenched. Why should have «speed [in the time from an event to when people hear about it] ... meant it's harder to get a considered reaction»? One's reaction to information is not really a function of the distance in time of the event in the information. The problem noted is with those ethological drives against «considered reaction».

deleted 5y ago

[deleted]

danuker 5y ago

> Still, it was always the "tenners" who were praised. I believe the US does not align financial incentives with the quality of care provided. Healthcare in the US is a runaway scam: https://ourworldindata.org/grapher/life-expectancy-vs-health-expenditure?country=USA~FRA~GBR https://ourworldindata.org/grapher/life-expectancy-vs-health...

lotsofpulp 5y ago
There has been a massive change in US healthcare from a “fee for service” payment model to a “value based care” payment model over the last 10 years. https://www.cerner.com/perspectives/between-fee-for-service-and-value-based-care https://www.cerner.com/perspectives/between-fee-for-service-... https://www.decorm.com/understanding-fee-for-service-and-value-based-care/ https://www.decorm.com/understanding-fee-for-service-and-val... There are many posts online about doctors and pharmacists about the pros and cons of tying their reimbursement to patient outcomes.
- dv_dt 5y ago
  That seems to fly in the face of the private health insurance system that many of us are forced to use. I believe there are many more value based healthcare situations now than before but suspect that it’s still a tiny fraction of healthcare delivery in the US.
  - lotsofpulp 5y ago
    25%+ of US residents receive taxpayer funded healthcare, via Medicare, Medicaid, Tricare (military), or other government programs. I think electronic medical records will only accelerate it to non taxpayer funded populations as it will greatly ease the ability to track data even when switching from one managed care organization to another.

lpapez 5y ago

Unrelated question. My girlfriend is an anesthesiologist and she is quite distraught with the fact that she is being payed less than me for working significantly more hours on a job with vastly more responsibility and risk (I work on embedded devices which have 0% chance of causing injury or death). She doesn't want to consider career switch because she already invested 12 years of her life into medicine. I am supportive of course, but to me this is a clear example of a "sunk cost fallacy". How did you get over that?

lotsofpulp 5y ago
Based on the 12 years of education, I am guessing you are in the US. Median anesthesiologist income is ~$400k/year. The odds of her earning similar, even per hour, if she switches to programming may cause sticking to being a doctor make more sense.
- lpapez 5y ago
  Nope, Eastern Europe. We both got pretty good education (even got to study abroad for a few semesters) and it was free for both of us, but her annual pay is around 30k$ while mine is around 35k$ (the median wage is about 15k$). Its really easy to earn more than that if you remotely work for a German or American company, but as a doctor you cant do that unless you move (not an option).
  - lotsofpulp 5y ago
    Oh, my bad. Yes, that changes things quite a bit. I am surprised it takes 12 years in Eastern Europe. I thought it was ~8 years in Europe.
    - lpapez 5y ago
      6 years college minimum. Mandatory one year of general practice and then you can apply for specialist education. Specialization can then take years to begin, but it can also start right away depending how lucky you are and you do it for five years minimum. So that makes it 12 years minimum. After that, most hospitals require you to stay working there for another 5 years otherwise you have to pay for specialization school (about 30k$). After that, you are free to live your life :)

Calamitous 5y ago

> I no longer work as a doctor. I'm curious if you'd be willing to discuss why?

tpoacher 5y ago
Honestly, every time I answer this question, it's a bit like when the Joker answer's how he got his smile (i.e. the answer is different every time, hahah). In the end, I think what it boils down to is that I wasn't happy doing it, and I found something else that I felt more passionate about and found a way to do that instead. (while retaining some of the medical context which would set me apart from my peers in the new profession).

stonecharioteer 5y ago

You became a coder after leaving medicine? I'd love to read a blog post about that journey!

tpoacher 5y ago
Not a 'coder' coder per se. I'm a biomedical engineering researcher, which so happens to involve writing a lot of code. :)