5 ms·

I am a primary care physician, so ear wax is something I deal with every day (or every other day). Medical advice is tailored to meet the needs of everyone, er

by earboi 4y ago

I am a primary care physician, so ear wax is something I deal with every day (or every other day). Medical advice is tailored to meet the needs of everyone, erring on the side of extreme caution. Do I trust myself to insert a q-tip into my ear and not rupture my eardrum? Yes. Do I trust most highly intelligent hacker news readers? Probably. Do I trust the bottom 10% of the general population (in IQ, dexterity, and good judgement)? Hell no. Our medical system is a "no-miss" culture that has extreme life altering penalties for physicians that give medical care that leads to harm. Is rupturing an ear drum a big deal? I'm not so sure, but I bet you can find a plaintiff's attorney hungry enough to sue over it. Don't go to medical school.

philosopher1234 4y ago
Choosing to trust everything you wrote here based on the devotion displayed in your username
nixpulvis 4y ago
IDK why, but I really needed to hear this right now. (I guess it's a good thing I keep my ears clean)
AlbertCory 4y ago
My PCP cleaned out one of my ears recently. I'd trust her more than I'd trust myself. Although I can criticize lawyers for saying this, "out of an abundance of caution" is a totally reasonable thing for a PCP to say. Thanks, Doc.
rawgabbit 4y ago
I noticed there are several medical doctors on Hacker News which is interesting. My son is currently attending college in the USA. His dream is to get accepted into medical school. When you posted "Don't go to medical school.", are you being sarcastic? Or are you serious. Is medical school a dead end in 2022 in the USA?
- bombcar 4y ago
  I would find some doctors you can trust to speak honestly off the record, and talk with them.
- throwntoday 4y ago
  I can't speak to this personally but my brother is a physician and despite scoring well on his exams it took years to get a residency. Pedigree is still an issue, as-is nepotism and age discrimination it seems. There are a limited number of residency slots allotted by the government each year so if you don't get one it's a whole year before you can apply again. It's certainly an archaic system, and the incentive by the medical lobby to expand residency programs is low presumably to protect wages. Even if you do jump through all the hoops, life as a doctor is a grind. Hospitals are businesses and your job is to see as many patients as possible. This is all coming from him and other family members who went through the whole ordeal.
- youniverse 4y ago
  I work with a few Drs and will pass along some common thoughts, doing this quickly on mobile so apologies. In general: If you want a nice balanced life, you should aim to open a private practice. However private practices are a dying breed due to cost for renovating/acquiring an office (150k at the very least for renovating yourself here in LA), shitty payouts by insurance (and getting worse), I saw a pay stub just today for $37 for a specialist visit (cash visit would be around $250 so Drs really hate taking even PPO insurance these days), etc. Few specialties can pull off a private practice such as: Plastic/Aesthetic, ophthalmology (doing LASIK and cataract surgery), and some others but usually these two have it the best. It's even harder if not in a very populous area, but then competition is rife, should be ready to shell out for marketing. The majority of physicians work in groups or hospitals. There is a lot of stress and responsibility if you are a surgeon, you should know that this kind of life is what you want. In the end it depends on his goals, these days and evermoreso going forward physicians are just cogs in the system. You can get away by opening a private practice but there are plenty of challenges there. Getting into a nice residency program is mostly luck and medical school is rough. Not to mention the costs if you aren't well off. If anyone wants to ask anything I'd be happy to answer in a bit more detail when I get time.
Cupertino95014 4y ago
It does seem to be a lousy job nowadays, with the insurance AND government hassling you. On the other hand, you get to help people. Sometimes they're even grateful for it. I imagine that's worth something, even after all the hassles.
ponow 4y ago
> Our medical system is a "no-miss" culture that has extreme life altering penalties for physicians that give medical care that leads to harm. That is the problem. We expect physicians to be faultless, but they're not. If we applied the same standards to everything in life, then life would stagnate, if not grind to a halt. This idea that everyone who passed their exams is equally qualified is a fiction. Let quacks back in and end defamation lawsuits that silence critics and leave it up to reputation and the market, contracts and standard criminal law. A much more dynamic market in medicine is necessary.
- freejazz 4y ago
  Physicians are not at all expected to be faultless. They are expected to not provide advice that runs contrary to the current average assumption in their practice. That's the standard for malpractice.
- wahern 4y ago
  > end defamation lawsuits that silence critics and leave it up to reputation and the market How can anyone rely on reputation in a world where there's no accountability when people systematically and mercilessly destroy someone's reputation? Even most people who oppose copyright and patents still seem to understand that trademarks serve a singularly critical role in permitting a free market to operation. But the existence of trademarks necessarily require the ability to sue those who violate them. The same is true of reputation--reputation has no meaningful substance if the law does not provide a means for people to defend it. Without legally (i.e. community) enforceable accountability, a person's reputation is whatever the most powerful person or group says it is. That's literally a world where might is right; where free market is synonymous to law of the jungle.
- andrewflnr 4y ago
  > If we applied the same standards to everything in life, then life would stagnate Which is exactly why we don't, and essentially no one is advocating for it. But different domains of life need different risk tolerances. Some amount of greater caution, to say the least, is warranted when you're dealing with people's health.
zhengyi13 4y ago
To me, the way you've signed off with "Don't go to medical school" reads vaguely like "Carthago delenda est" - I have no idea if you actually say this all the time, but I wonder if you do.
freejazz 4y ago
The standard for malpractice isn't "advice leading to harm" and is a much higher burden to establish.
m463 4y ago
I would like to ask a non-controversial question... What about ear hair? Is ear hair something that flourishes later in life, or is it something we just don't notice when we're young?
- yourapostasy 4y ago
  If you’re a guy, then it usually flourishes later in life. Also your eyebrows. Most higher-end barber shops these days offer ear and eyebrow waxing to keep them trimmed. Or you can let them grow out and scare old ladies and young children.
dusted 4y ago
That makes a lot of sense.. I use a q-tip at least weekly, I've always produced a lot of wax, and keeping it in check is very important for my well-being (and ability to hear well). I also own an endoscope camera that I use to check my ear canals, very clean ears, no sign of irritation, no visible wax deposits. Tympanic membranes always clean (of course I don't clean them! I guess they stay clean from the fact there's nothing in the canal to get onto them). The "pushing the wax in" idea always seemed ridiculous to me, like, you'd only ever have that much wax if you never cleaned your ears in the first place, and your hearing would surely worsen a lot from it? But yeah, I wouldn't trust my 2 year old with a q-tip and ears either..

by earboi 4y ago

philosopher1234 4y ago

Choosing to trust everything you wrote here based on the devotion displayed in your username

nixpulvis 4y ago

IDK why, but I really needed to hear this right now. (I guess it's a good thing I keep my ears clean)

AlbertCory 4y ago

My PCP cleaned out one of my ears recently. I'd trust her more than I'd trust myself. Although I can criticize lawyers for saying this, "out of an abundance of caution" is a totally reasonable thing for a PCP to say. Thanks, Doc.

rawgabbit 4y ago

I noticed there are several medical doctors on Hacker News which is interesting. My son is currently attending college in the USA. His dream is to get accepted into medical school. When you posted "Don't go to medical school.", are you being sarcastic? Or are you serious. Is medical school a dead end in 2022 in the USA?

bombcar 4y ago
I would find some doctors you can trust to speak honestly off the record, and talk with them.
throwntoday 4y ago
I can't speak to this personally but my brother is a physician and despite scoring well on his exams it took years to get a residency. Pedigree is still an issue, as-is nepotism and age discrimination it seems. There are a limited number of residency slots allotted by the government each year so if you don't get one it's a whole year before you can apply again. It's certainly an archaic system, and the incentive by the medical lobby to expand residency programs is low presumably to protect wages. Even if you do jump through all the hoops, life as a doctor is a grind. Hospitals are businesses and your job is to see as many patients as possible. This is all coming from him and other family members who went through the whole ordeal.
youniverse 4y ago
I work with a few Drs and will pass along some common thoughts, doing this quickly on mobile so apologies. In general: If you want a nice balanced life, you should aim to open a private practice. However private practices are a dying breed due to cost for renovating/acquiring an office (150k at the very least for renovating yourself here in LA), shitty payouts by insurance (and getting worse), I saw a pay stub just today for $37 for a specialist visit (cash visit would be around $250 so Drs really hate taking even PPO insurance these days), etc. Few specialties can pull off a private practice such as: Plastic/Aesthetic, ophthalmology (doing LASIK and cataract surgery), and some others but usually these two have it the best. It's even harder if not in a very populous area, but then competition is rife, should be ready to shell out for marketing. The majority of physicians work in groups or hospitals. There is a lot of stress and responsibility if you are a surgeon, you should know that this kind of life is what you want. In the end it depends on his goals, these days and evermoreso going forward physicians are just cogs in the system. You can get away by opening a private practice but there are plenty of challenges there. Getting into a nice residency program is mostly luck and medical school is rough. Not to mention the costs if you aren't well off. If anyone wants to ask anything I'd be happy to answer in a bit more detail when I get time.

Cupertino95014 4y ago

It does seem to be a lousy job nowadays, with the insurance AND government hassling you. On the other hand, you get to help people. Sometimes they're even grateful for it. I imagine that's worth something, even after all the hassles.

ponow 4y ago

> Our medical system is a "no-miss" culture that has extreme life altering penalties for physicians that give medical care that leads to harm. That is the problem. We expect physicians to be faultless, but they're not. If we applied the same standards to everything in life, then life would stagnate, if not grind to a halt. This idea that everyone who passed their exams is equally qualified is a fiction. Let quacks back in and end defamation lawsuits that silence critics and leave it up to reputation and the market, contracts and standard criminal law. A much more dynamic market in medicine is necessary.

freejazz 4y ago
Physicians are not at all expected to be faultless. They are expected to not provide advice that runs contrary to the current average assumption in their practice. That's the standard for malpractice.
wahern 4y ago
> end defamation lawsuits that silence critics and leave it up to reputation and the market How can anyone rely on reputation in a world where there's no accountability when people systematically and mercilessly destroy someone's reputation? Even most people who oppose copyright and patents still seem to understand that trademarks serve a singularly critical role in permitting a free market to operation. But the existence of trademarks necessarily require the ability to sue those who violate them. The same is true of reputation--reputation has no meaningful substance if the law does not provide a means for people to defend it. Without legally (i.e. community) enforceable accountability, a person's reputation is whatever the most powerful person or group says it is. That's literally a world where might is right; where free market is synonymous to law of the jungle.
andrewflnr 4y ago
> If we applied the same standards to everything in life, then life would stagnate Which is exactly why we don't, and essentially no one is advocating for it. But different domains of life need different risk tolerances. Some amount of greater caution, to say the least, is warranted when you're dealing with people's health.

zhengyi13 4y ago

To me, the way you've signed off with "Don't go to medical school" reads vaguely like "Carthago delenda est" - I have no idea if you actually say this all the time, but I wonder if you do.

freejazz 4y ago

The standard for malpractice isn't "advice leading to harm" and is a much higher burden to establish.

m463 4y ago

I would like to ask a non-controversial question... What about ear hair? Is ear hair something that flourishes later in life, or is it something we just don't notice when we're young?

yourapostasy 4y ago
If you’re a guy, then it usually flourishes later in life. Also your eyebrows. Most higher-end barber shops these days offer ear and eyebrow waxing to keep them trimmed. Or you can let them grow out and scare old ladies and young children.

dusted 4y ago

That makes a lot of sense.. I use a q-tip at least weekly, I've always produced a lot of wax, and keeping it in check is very important for my well-being (and ability to hear well). I also own an endoscope camera that I use to check my ear canals, very clean ears, no sign of irritation, no visible wax deposits. Tympanic membranes always clean (of course I don't clean them! I guess they stay clean from the fact there's nothing in the canal to get onto them). The "pushing the wax in" idea always seemed ridiculous to me, like, you'd only ever have that much wax if you never cleaned your ears in the first place, and your hearing would surely worsen a lot from it? But yeah, I wouldn't trust my 2 year old with a q-tip and ears either..