8 ms·

Most of the issues mentioned in the article and the included email are concerning, however they also oddly seem to be common in many places across the globe. Th

Most of the issues mentioned in the article and the included email are concerning, however they also oddly seem to be common in many places across the globe. The surgeon mentioned was in Australia, I have seen these issues first hand in the Netherlands and am aware of very similar of the first 2 out of 3 issues (caused by overwork/understaffing/over-fatigue etc) in Belgium, Germany, the UK, India and god knows how many other places. However, fields like aviation have strict workload limits. You cannot be on call/duty for too long because fatigue kills. Issues like alarm fatigue are studied by agencies, and folks at Boeing/Airbus then implement the findings. The question is, why is it okay for medical professionals to wear themselves down to the bone (sometimes literally, like in this article), while some other professions take care to avoid it? (Edit/PS: I added a fairly detailed self-reply below on what I think are some of the common arguments (like on the number/availability of doctors) and why they don't really fly, pun not intended.)

user_7832 3y ago
(My musings/thinking-aloud): One partial hypothesis/answer is that there are far fewer pilots/cabin crew than there are doctors/medical staff, and hence it's easier to treat pilots properly. But fewer people makes it harder to let someone off if they haven't slept well so I don't really buy that. Another is that the medical profession is much more "flexible"/fluid in its needs, unlike flights scheduled in a regular manner. However, that doesn't mean it's not possible to give doctors an 8 hour workday, and substitute/bring more doctors for other shifts. In fact, this is exactly what happens in many 24-hour manufacturing plants/operations. Foxconn doesn't let a sleep deprived employee make an iPhone, but it's okay to let a sleep deprived doctor perform life-saving/potentially deadly operations? Another possibility is that "it would cost more" to have 3 docs instead of 1. Which might be supported by anecdotal evidence on how expensive things (including salaries) are in the medical field. However (especially if you're only familiar with the US healthcare system), this doesn't explain how doctors in say India are overworked. The "real" reason, I think behind all this? The first part is it's because it's "easy" to compress and push an 8 hour shift to a 24 hour shift, fatigue be damned. The costs are "hidden", it's likely even with fatigue a 99% successful operation is still 95 or 90% successful. Everyone can rationalize it and go about with their day. "Oh, unfortunately people don't always make it". Not, "there was a 20% chance they wouldn't have made it but an 80% chance it was because the doctor was fatigued." When an aircraft crashes, 300 people may die instantly. This gets front page coverage on a newspaper. However, a few deaths "here" and "there" don't really show up, even if they tally up to thousands. This is the second factor, that "hides" and normalizes occasional slip-ups. </End of this wall of text> I unfortunately don't really have a solution. I'm sure there are brilliant UX designers here on HN who could help ease and streamline the admin workload. I suppose a dedicated politician/presidential candidate somewhere could take this upon themselves to campaign for. (Seriously, the NHS was part of the discussion behind Brexit. Supporting doctors is a brilliant political strategy, the NWA didn't have a song called "Fuck the paramedics".) There have been many instances of things catching on once found successful somewhere, be it procedures like the Heimlich or concepts like Lean Manufacturing. Therefore I don't doubt that one good Harvard Review paper showing a 20% decrease in all-cause patient mortality, with trials underway in a few hospitals, is all it will take. Question is, who will bell the cat‽
uniqueuid 3y ago
Thanks for the perspective. I have doctor friends and everyone seems to just blindly accept that some jobs are not jobs, they are identities. You never pause being a doctor. But your comment shows that even in life-critical environments, we do have ways of organizing work so individuals can bear it. Fire brigades are another example. Time to push for a change. And time to call some people and ask whether they are truly ok right now.
Rinzler89 3y ago
The understaffed healthcare system works with overworked doctors on the basis that having a tired and overworked doctor is a lot of the times better than having no doctor at all, because (s)he most likely can end up saving more lives than taking with their tired brain. If your operations have a 90% survivability rate it could still be considered a success despite those 10% they end up killing, because 90% is a lot better than 0%. Meanwhile a tired pilot is more binary, it either can have 100% passenger survivability if things go well or 100% fatality if things go tits up, meaning the risk are too high to take chances. It's basic game theory.
- uniqueuid 3y ago
  Good point, and you can turn it around: Doctors are never "finished". They could always do more to help patients. So in contrast to aviation, where there is a clear corridor of things to do, doctors have no natural upper bound on their work.
- eviks 3y ago
  but the alternative isn't having no doctor at all, but to get more doctors, so the "basic game theory" is about why the limits on more doctors stay in place despite the higher risk of death etc.
  - Rinzler89 3y ago
    > but to get more doctors Have you found that magic fountain of endless doctors?
    - uniqueuid 3y ago
      Sure, it's very easy! Just do things that prevent burnout (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/) and the job gets more attractive, drawing more students and producing less attrition: - Valuing work gives meaning (money, appreciation) - Autonomy gives feeling of control - Managing burden prevents overwork, exhaustion and fatigue
eviks 3y ago
Complicated question, on potential factor: maybe because the doctors kill one by one instead of in batches, so the ridiculous artificial entry limits that result in very high workload, but results in artificially high pay, doesn't meet a strong enough force to be adjusted?
closewith 3y ago
> The question is, why is it okay for medical professionals to wear themselves down to the bone (sometimes literally, like in this article), while some other professions take care to avoid it? I think the answer here is that if you there aren't enough pilots, schedules can be reduced. You can't scale back (in any ethical way, anyway) the demand for healthcare. People will just die at a higher rate and outcomes will worsen.
- user_7832 3y ago
  Thank you for your comment, that's a very good point. I self-replied a bit lower with more discussion on this, primarily to the effect that the "solution" in that case would be to hire more doctors. The concept of a "standby" doctor (like a volunteer firefighter) could be used (more), for eg retired former doctors/nurses.
  - novok 3y ago
    There is a lot of protectionism & abuse in the doctor system, to the point where I think common tropes are put as fronts to keep up a status quo to hide the reality. You have to look at actions vs. the statements at this point. "The purpose of a system is what it does" Statement: We need more doctors in Canada. Actions: It's much harder than 20 years ago to get into med school or a residency (USA medicare). It's even harder to go to med school in Canada than the USA! Doctors from other countries have much higher testing standards than local med school graduates in Canada to get licensed. To the point where they move to the USA because it's easier to start working than it is in Canada itself. Foreign Doctor moves to canada and becomes a taxi driver is a trope in Canada because of the excessively high barriers.
protastus 3y ago
I share the same objection about the lack of regulation in the medical profession worldwide. My best friend from high school became an MD and I witnessed doctors in training being proud of powering through extremely long, back to back shifts with little rest. Meanwhile, as an engineer I've seen short and strict shift limits on employees operating machinery like trucks and forklifts. Under the obvious principle that insufficient sleep impairs judgement, put lives at risk and creates massive liability.
nradov 3y ago
For inpatient hospital care, research has shown that transitions in care are particularly risky for patients. When one doctor goes off shift and hands off a patient to another doctor, sometimes things fall through the cracks. In theory all of the data needed for a smooth transition should be documented in the patient chart, but in practice this doesn't always get done plus there is some tacit knowledge which clinicians build up by observing a particular patient which can't be put into words. This risk of iatrogenic harm has been used to justify long hours, particularly for residents in teaching hospitals. I'm not saying that it's necessarily a good idea or that there are no better alternatives, just explaining some of the rationale.
- user_7832 3y ago
  Thanks, I commented a bit above already to a similar response. I would say that there's a balance between very short shifts and 24(or more) hour shifts. 12 hours for example is doable occasionally/with breaks in between shifts. Right now the pendulum is at one extreme. [0] - https://news.ycombinator.com/item?id=40025540 https://news.ycombinator.com/item?id=40025540
- tum92 3y ago
  I haven’t read that literature very closely, but will say that I have seen lots of handoffs, and they generally involve someone who has been working 12+ hours, very often 24+ hours, who needs to hand off 10s of patients to 3+ people, all of whom have things to do and can be hard to schedule around, before they can go home. It is not at all surprising to me that these kind of hand offs result in things being missed, and equally obvious that decreasing the patients per provider and increasing hand off window hours would at least reduce some of those errors, if not outright improve them. Bonus points for putting the peak of handoffs into late morning hours, where much more of the decision making is completed. Of course, the only way to do that is to either: 1) drag hours out longer, which I think lots of MDs would be fine with if they weren’t expected to turn around and do it again in 18-36 hours, requiring increased staffing Or 2) increase staffing all around and just maintain more reasonable ratios
postepowanieadm 3y ago
It's even worse. In the EU the working week is to be an average of about 48h. ...unless you are an medical professional, then you "may" opt-out and work up to 78h. It's completely legal, and regulated by the law of the EU:) https://www.europarl.europa.eu/meetdocs/2014_2019/documents/empl/dv/empl20150416_eurofound_wtd_/empl20150416_eurofound_wtd_en.pdf https://www.europarl.europa.eu/meetdocs/2014_2019/documents/...
tarkin2 3y ago
The cynic in me says they have bad working conditions since they're public funded: governments, to a large extent, don't want to increase or divert taxes to provide better working conditions since they'd rather give their friends in the private sector a slice of the immovable and highly lucrative pie. A partly-privatised healthcare system only works when all agree to balance the intangible long-term benefits of universal healthcare with tangible private-sector financial-gain. I don't see this happening when the private sector is seen as the panacea of all social-ills and when universal healthcare isn't seen a means to increase productivity.
derbOac 3y ago
The answer is implied, right there in the first paragraph: "... I’ve never been diagnosed with a mental illness." At least in the US, there's a kind of masochistic pride in the physician community, that everything he described in his essay is laudable, noble, to be emulated. Nowhere does he acknowledge the risks to his patients or whether the costs are worth it in the end, or if a different system might be better. And he's holding up the lack of mental illness diagnosis as if it's something to be proud of, as opposed to never being diagnosed with say, cardiovascular disease or cancer. He's proud he's never sought help or tried to change anything. Sure he mentions problems with patient care in passing, but what he's really upset about is "just being another employee". In the end in his mindset whatever he's complaining about is better than the alternatives, which is ceding over some of the care responsibilities to others or opening up healthcare to a more competitive market so he's not the only provider who could provide those services (note the comment about denying other physicians income). The AMA and physicians union (yes it's a union) basically guarantees this in lieu of having real competition, decreased income, and so forth. Why is it different in something like aviation? My guess is because the failures are more visible, they're on the nightly news, people are there posting pictures on social media? For whatever reason, I don't think pilot organizations ever managed to remove themselves from scrutiny in the same way as physicians did. We see pilots as highly skilled professionals, but part of a system, with alternatives, and the subject of fair scrutiny from outsiders who are not pilots: engineers, safety experts, investigators and so forth. In my experience when these kinds of issues come up in healthcare though, everyone defers to physician groups themselves, as if no one else has expertise enough to scrutinize them. I imagine too at some level, part of the issue is that the pilots themselves are subject to their own mistakes: if a pilot crashes a plane, they take themselves out at the same time. If a surgeon makes a mistake and kills a patient, they still walk home and can rationalize whatever they want, all they want. I'm growing unsympathetic to these types of essays (the one linked). If physicians want me to empathize with them more, maybe they should stop stigmatizing mental unwellness and recognize it in themselves. Maybe they as a professional group should admit that others could take on some of the load, maybe even better in some situations. It feels a bit like they create a mess out of selfish greed or ego and then expect me to feel bad for them.
- mlyle 3y ago
Tarq0n 3y ago
I think it has to do with the cost structure of the good. Healthcare is dominated by labour costs, which means in industrializing economies it lags behind in productivity and labour starts getting squeezed to try and keep prices at a reasonable level. A pilot, despiute being in a highly skilled profession, is only a small part of the puzzle when it comes to the cost of flights.
simonbarker87 3y ago
My assumption is that is a doctor does nothing the situation will get worse. So therefore them doing anything is seen as a step in the right direction, they will improve things over the base line? A pilot isn’t in charge of a deteriorating situation, then doing something could make things worse below the base line (a tiredness induced mistake) so therefore make sure the only do stuff when fit to do so? Note I’ve used questions on both of these examples as it’s more of a half thought and a feeling that a statement or fully fleshed out thought. I guess the summary is, I’d rather have a tired doctor work on me in an emergency than no doctor work on me. I’d rather not fly on the plane than have a dangerously tired pilot fly the plane. That’s being said the system clearly needs improving and we need more medical professionals to balance the work load.
deleted 3y ago
[deleted]
jstummbillig 3y ago
Compared to aviation, bad outcomes in medicine are a) not news material and also b) taken into account beforehand. Phobias apart, we simply do not expect to die, when we fly. In contrast, we openly consider % survival rates of medical procedures. These rates have human error already baked in, and would be lower if humans made less errors. And then there is the primal fear of not getting help, if needed, because no help was available, which certainly works on our collective will to action here. A 50% survival procedure for medicine might work, because it's either that or death. Aviation is always a few plane malfunctions (not even outright crashes) in quick succession away from the entire industry crashing.
rors 3y ago
My partner is a surgeon in the UK. She's planning on leaving the profession at the end of the year. We talk a lot about what is wrong with the medical profession. One issue is the type of person attracted to the profession. They're incredibly academically talented, not driven by money, and desire status and recognition. Surgeons are the most extreme cases of this personality type, as they're harder jobs to get and have a lot of pressure. These people are the types who get their head done, roll up their sleeves, and get on with things. They're not used to asking for help or additional resources. They're the sort of people who care for others! Medicine self-selects for martyrs. In addition, you have so many hoops to jump through (training, specialisations, etc) with significant time investment that can be lost in moments by pissing off training directors or other senior doctors. My partner ends up working more than her contracted hours because her bosses expect her to, although they would never explicitly enforce stricter rules. If she works her contracted hours she can kiss a consultant job (UK equivalent of attending) goodbye as her bosses won't provide a reference for the role. Because the stakes in medicine are literally life and death, meaning that it is heavily regulated. There are horror stories around the GMC, the UK regulator, and doctors are terrified of being investigated. They adopt a legalistic mentality where they only treat if they're sure that they won't get prosecuted. It's very different from aviation with its no blame culture. Finally, another factor that is making medicine so tough is that it is a success story! People live longer, and pathologies that were once fatal can be managed with ever more complex treatments. As demographics lean to older populations, then the demand keeps increasing.
makeitdouble 3y ago
I've looked at all the other replies and very few mention the obvious: self-regulation is hard. Hospitals are mostly held as public services, and having more doctors better handled arguably costs more (in training, infra, shift management etc). Gov gets to decide if it wants to pay more, or even change the status quo and bails on it. It's the same deal for teachers in public schools and other public servants, their mental health management is lagging, their salaries and treatment as well, dispatch and promotions are a PITA etc. I don't think govs are inherently bad at it, just that there's no check and balances most of the time. Same way private companies are bad at self regulation and need an external force to get regulated. Mandatory unionizing and better avenues to sue for better conditions could be an answer?

user_7832 3y ago

(My musings/thinking-aloud): One partial hypothesis/answer is that there are far fewer pilots/cabin crew than there are doctors/medical staff, and hence it's easier to treat pilots properly. But fewer people makes it harder to let someone off if they haven't slept well so I don't really buy that. Another is that the medical profession is much more "flexible"/fluid in its needs, unlike flights scheduled in a regular manner. However, that doesn't mean it's not possible to give doctors an 8 hour workday, and substitute/bring more doctors for other shifts. In fact, this is exactly what happens in many 24-hour manufacturing plants/operations. Foxconn doesn't let a sleep deprived employee make an iPhone, but it's okay to let a sleep deprived doctor perform life-saving/potentially deadly operations? Another possibility is that "it would cost more" to have 3 docs instead of 1. Which might be supported by anecdotal evidence on how expensive things (including salaries) are in the medical field. However (especially if you're only familiar with the US healthcare system), this doesn't explain how doctors in say India are overworked. The "real" reason, I think behind all this? The first part is it's because it's "easy" to compress and push an 8 hour shift to a 24 hour shift, fatigue be damned. The costs are "hidden", it's likely even with fatigue a 99% successful operation is still 95 or 90% successful. Everyone can rationalize it and go about with their day. "Oh, unfortunately people don't always make it". Not, "there was a 20% chance they wouldn't have made it but an 80% chance it was because the doctor was fatigued." When an aircraft crashes, 300 people may die instantly. This gets front page coverage on a newspaper. However, a few deaths "here" and "there" don't really show up, even if they tally up to thousands. This is the second factor, that "hides" and normalizes occasional slip-ups. </End of this wall of text> I unfortunately don't really have a solution. I'm sure there are brilliant UX designers here on HN who could help ease and streamline the admin workload. I suppose a dedicated politician/presidential candidate somewhere could take this upon themselves to campaign for. (Seriously, the NHS was part of the discussion behind Brexit. Supporting doctors is a brilliant political strategy, the NWA didn't have a song called "Fuck the paramedics".) There have been many instances of things catching on once found successful somewhere, be it procedures like the Heimlich or concepts like Lean Manufacturing. Therefore I don't doubt that one good Harvard Review paper showing a 20% decrease in all-cause patient mortality, with trials underway in a few hospitals, is all it will take. Question is, who will bell the cat‽

uniqueuid 3y ago

Thanks for the perspective. I have doctor friends and everyone seems to just blindly accept that some jobs are not jobs, they are identities. You never pause being a doctor. But your comment shows that even in life-critical environments, we do have ways of organizing work so individuals can bear it. Fire brigades are another example. Time to push for a change. And time to call some people and ask whether they are truly ok right now.

Rinzler89 3y ago

The understaffed healthcare system works with overworked doctors on the basis that having a tired and overworked doctor is a lot of the times better than having no doctor at all, because (s)he most likely can end up saving more lives than taking with their tired brain. If your operations have a 90% survivability rate it could still be considered a success despite those 10% they end up killing, because 90% is a lot better than 0%. Meanwhile a tired pilot is more binary, it either can have 100% passenger survivability if things go well or 100% fatality if things go tits up, meaning the risk are too high to take chances. It's basic game theory.

uniqueuid 3y ago
Good point, and you can turn it around: Doctors are never "finished". They could always do more to help patients. So in contrast to aviation, where there is a clear corridor of things to do, doctors have no natural upper bound on their work.
eviks 3y ago
but the alternative isn't having no doctor at all, but to get more doctors, so the "basic game theory" is about why the limits on more doctors stay in place despite the higher risk of death etc.
- Rinzler89 3y ago
  > but to get more doctors Have you found that magic fountain of endless doctors?
  - uniqueuid 3y ago
    Sure, it's very easy! Just do things that prevent burnout (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/) and the job gets more attractive, drawing more students and producing less attrition: - Valuing work gives meaning (money, appreciation) - Autonomy gives feeling of control - Managing burden prevents overwork, exhaustion and fatigue

eviks 3y ago

Complicated question, on potential factor: maybe because the doctors kill one by one instead of in batches, so the ridiculous artificial entry limits that result in very high workload, but results in artificially high pay, doesn't meet a strong enough force to be adjusted?

closewith 3y ago

> The question is, why is it okay for medical professionals to wear themselves down to the bone (sometimes literally, like in this article), while some other professions take care to avoid it? I think the answer here is that if you there aren't enough pilots, schedules can be reduced. You can't scale back (in any ethical way, anyway) the demand for healthcare. People will just die at a higher rate and outcomes will worsen.

user_7832 3y ago
Thank you for your comment, that's a very good point. I self-replied a bit lower with more discussion on this, primarily to the effect that the "solution" in that case would be to hire more doctors. The concept of a "standby" doctor (like a volunteer firefighter) could be used (more), for eg retired former doctors/nurses.
- novok 3y ago
  There is a lot of protectionism & abuse in the doctor system, to the point where I think common tropes are put as fronts to keep up a status quo to hide the reality. You have to look at actions vs. the statements at this point. "The purpose of a system is what it does" Statement: We need more doctors in Canada. Actions: It's much harder than 20 years ago to get into med school or a residency (USA medicare). It's even harder to go to med school in Canada than the USA! Doctors from other countries have much higher testing standards than local med school graduates in Canada to get licensed. To the point where they move to the USA because it's easier to start working than it is in Canada itself. Foreign Doctor moves to canada and becomes a taxi driver is a trope in Canada because of the excessively high barriers.

protastus 3y ago

I share the same objection about the lack of regulation in the medical profession worldwide. My best friend from high school became an MD and I witnessed doctors in training being proud of powering through extremely long, back to back shifts with little rest. Meanwhile, as an engineer I've seen short and strict shift limits on employees operating machinery like trucks and forklifts. Under the obvious principle that insufficient sleep impairs judgement, put lives at risk and creates massive liability.

nradov 3y ago

For inpatient hospital care, research has shown that transitions in care are particularly risky for patients. When one doctor goes off shift and hands off a patient to another doctor, sometimes things fall through the cracks. In theory all of the data needed for a smooth transition should be documented in the patient chart, but in practice this doesn't always get done plus there is some tacit knowledge which clinicians build up by observing a particular patient which can't be put into words. This risk of iatrogenic harm has been used to justify long hours, particularly for residents in teaching hospitals. I'm not saying that it's necessarily a good idea or that there are no better alternatives, just explaining some of the rationale.

user_7832 3y ago
Thanks, I commented a bit above already to a similar response. I would say that there's a balance between very short shifts and 24(or more) hour shifts. 12 hours for example is doable occasionally/with breaks in between shifts. Right now the pendulum is at one extreme. [0] - https://news.ycombinator.com/item?id=40025540 https://news.ycombinator.com/item?id=40025540
tum92 3y ago
I haven’t read that literature very closely, but will say that I have seen lots of handoffs, and they generally involve someone who has been working 12+ hours, very often 24+ hours, who needs to hand off 10s of patients to 3+ people, all of whom have things to do and can be hard to schedule around, before they can go home. It is not at all surprising to me that these kind of hand offs result in things being missed, and equally obvious that decreasing the patients per provider and increasing hand off window hours would at least reduce some of those errors, if not outright improve them. Bonus points for putting the peak of handoffs into late morning hours, where much more of the decision making is completed. Of course, the only way to do that is to either: 1) drag hours out longer, which I think lots of MDs would be fine with if they weren’t expected to turn around and do it again in 18-36 hours, requiring increased staffing Or 2) increase staffing all around and just maintain more reasonable ratios

postepowanieadm 3y ago

It's even worse. In the EU the working week is to be an average of about 48h. ...unless you are an medical professional, then you "may" opt-out and work up to 78h. It's completely legal, and regulated by the law of the EU:) https://www.europarl.europa.eu/meetdocs/2014_2019/documents/empl/dv/empl20150416_eurofound_wtd_/empl20150416_eurofound_wtd_en.pdf https://www.europarl.europa.eu/meetdocs/2014_2019/documents/...

tarkin2 3y ago

The cynic in me says they have bad working conditions since they're public funded: governments, to a large extent, don't want to increase or divert taxes to provide better working conditions since they'd rather give their friends in the private sector a slice of the immovable and highly lucrative pie. A partly-privatised healthcare system only works when all agree to balance the intangible long-term benefits of universal healthcare with tangible private-sector financial-gain. I don't see this happening when the private sector is seen as the panacea of all social-ills and when universal healthcare isn't seen a means to increase productivity.

derbOac 3y ago

The answer is implied, right there in the first paragraph: "... I’ve never been diagnosed with a mental illness." At least in the US, there's a kind of masochistic pride in the physician community, that everything he described in his essay is laudable, noble, to be emulated. Nowhere does he acknowledge the risks to his patients or whether the costs are worth it in the end, or if a different system might be better. And he's holding up the lack of mental illness diagnosis as if it's something to be proud of, as opposed to never being diagnosed with say, cardiovascular disease or cancer. He's proud he's never sought help or tried to change anything. Sure he mentions problems with patient care in passing, but what he's really upset about is "just being another employee". In the end in his mindset whatever he's complaining about is better than the alternatives, which is ceding over some of the care responsibilities to others or opening up healthcare to a more competitive market so he's not the only provider who could provide those services (note the comment about denying other physicians income). The AMA and physicians union (yes it's a union) basically guarantees this in lieu of having real competition, decreased income, and so forth. Why is it different in something like aviation? My guess is because the failures are more visible, they're on the nightly news, people are there posting pictures on social media? For whatever reason, I don't think pilot organizations ever managed to remove themselves from scrutiny in the same way as physicians did. We see pilots as highly skilled professionals, but part of a system, with alternatives, and the subject of fair scrutiny from outsiders who are not pilots: engineers, safety experts, investigators and so forth. In my experience when these kinds of issues come up in healthcare though, everyone defers to physician groups themselves, as if no one else has expertise enough to scrutinize them. I imagine too at some level, part of the issue is that the pilots themselves are subject to their own mistakes: if a pilot crashes a plane, they take themselves out at the same time. If a surgeon makes a mistake and kills a patient, they still walk home and can rationalize whatever they want, all they want. I'm growing unsympathetic to these types of essays (the one linked). If physicians want me to empathize with them more, maybe they should stop stigmatizing mental unwellness and recognize it in themselves. Maybe they as a professional group should admit that others could take on some of the load, maybe even better in some situations. It feels a bit like they create a mess out of selfish greed or ego and then expect me to feel bad for them.

mlyle 3y ago

Tarq0n 3y ago

I think it has to do with the cost structure of the good. Healthcare is dominated by labour costs, which means in industrializing economies it lags behind in productivity and labour starts getting squeezed to try and keep prices at a reasonable level. A pilot, despiute being in a highly skilled profession, is only a small part of the puzzle when it comes to the cost of flights.

simonbarker87 3y ago

My assumption is that is a doctor does nothing the situation will get worse. So therefore them doing anything is seen as a step in the right direction, they will improve things over the base line? A pilot isn’t in charge of a deteriorating situation, then doing something could make things worse below the base line (a tiredness induced mistake) so therefore make sure the only do stuff when fit to do so? Note I’ve used questions on both of these examples as it’s more of a half thought and a feeling that a statement or fully fleshed out thought. I guess the summary is, I’d rather have a tired doctor work on me in an emergency than no doctor work on me. I’d rather not fly on the plane than have a dangerously tired pilot fly the plane. That’s being said the system clearly needs improving and we need more medical professionals to balance the work load.

deleted 3y ago

[deleted]

jstummbillig 3y ago

Compared to aviation, bad outcomes in medicine are a) not news material and also b) taken into account beforehand. Phobias apart, we simply do not expect to die, when we fly. In contrast, we openly consider % survival rates of medical procedures. These rates have human error already baked in, and would be lower if humans made less errors. And then there is the primal fear of not getting help, if needed, because no help was available, which certainly works on our collective will to action here. A 50% survival procedure for medicine might work, because it's either that or death. Aviation is always a few plane malfunctions (not even outright crashes) in quick succession away from the entire industry crashing.

rors 3y ago

My partner is a surgeon in the UK. She's planning on leaving the profession at the end of the year. We talk a lot about what is wrong with the medical profession. One issue is the type of person attracted to the profession. They're incredibly academically talented, not driven by money, and desire status and recognition. Surgeons are the most extreme cases of this personality type, as they're harder jobs to get and have a lot of pressure. These people are the types who get their head done, roll up their sleeves, and get on with things. They're not used to asking for help or additional resources. They're the sort of people who care for others! Medicine self-selects for martyrs. In addition, you have so many hoops to jump through (training, specialisations, etc) with significant time investment that can be lost in moments by pissing off training directors or other senior doctors. My partner ends up working more than her contracted hours because her bosses expect her to, although they would never explicitly enforce stricter rules. If she works her contracted hours she can kiss a consultant job (UK equivalent of attending) goodbye as her bosses won't provide a reference for the role. Because the stakes in medicine are literally life and death, meaning that it is heavily regulated. There are horror stories around the GMC, the UK regulator, and doctors are terrified of being investigated. They adopt a legalistic mentality where they only treat if they're sure that they won't get prosecuted. It's very different from aviation with its no blame culture. Finally, another factor that is making medicine so tough is that it is a success story! People live longer, and pathologies that were once fatal can be managed with ever more complex treatments. As demographics lean to older populations, then the demand keeps increasing.

makeitdouble 3y ago

I've looked at all the other replies and very few mention the obvious: self-regulation is hard. Hospitals are mostly held as public services, and having more doctors better handled arguably costs more (in training, infra, shift management etc). Gov gets to decide if it wants to pay more, or even change the status quo and bails on it. It's the same deal for teachers in public schools and other public servants, their mental health management is lagging, their salaries and treatment as well, dispatch and promotions are a PITA etc. I don't think govs are inherently bad at it, just that there's no check and balances most of the time. Same way private companies are bad at self regulation and need an external force to get regulated. Mandatory unionizing and better avenues to sue for better conditions could be an answer?