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Why Doctors Hate Science

Ivor the Engineer said:
Do you have any serious answers to my questions, or am I beneath contempt?
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False dichotomy - one who is not 'beneath contempt' may ask questions that another person might not think are worthy of answer. By attempting to make the question personal, you force a person to either 'be mean' to you, or address your question, which they did not feel was particularly worthy of address in any respect - potentially because it was an emotion-based question, one designed to derail the conversation, or simply stunningly irrelevant.

Since this debate tactic is fundamentally both dishonest and stupid (dishonest since it leverages a logical fallacy into the 'poor victim' stance, stupid since it is so easily identified that only one fundamentally damaged would either believe it effective or find it likely to be), it might cause one to lower one's opinion of the person using it several notches.
 
Professor Yaffle said:
Is more sex the cause or the proposed method of mitigating the problem?
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Exactly what I was thinking.

What puzzles me is why doctors believe it is necessary to do 48+ hr. weeks to become competent. E.g.,

http://esciencenews.com/articles/20....regulations.are.failing.doctors.and.patients

Recent changes to working regulations in the UK are seriously damaging the working life and education of junior doctors and patients are also suffering, warn senior doctors on BMJ.com today. The British government must relax the regulations of the European Working Time Directive (EWTD) or it could spell disaster for medicine in the UK, say the authors.

"British medicine is highly respected worldwide because of the training provided and the breadth of experience and clinical expertise of most consultants and GPs", write Hugh Cairns and colleagues from King's College Hospital in London. But the EWTD is threatening this reputation by having a negative effect on medical training and taking doctors away from direct patient care. No amount of teaching can substitute for this practical experience, they add.

Introduced to improve workers' safety and protection, the directive changed the maximum working week to 56 hours in 2007, with a planned further reduction to 48 hours in 2009, and a minimum requirement of 11 hours rest in any 24 hour period.

According to the authors, these changes have posed considerable problems for medicine in the UK because of the need for junior medical staff to work long hours to fulfil training requirements and to provide a 24 hour service to patients.
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:boggled:
 
GreyICE said:
False dichotomy - one who is not 'beneath contempt' may ask questions that another person might not think are worthy of answer. By attempting to make the question personal, you force a person to either 'be mean' to you, or address your question, which they did not feel was particularly worthy of address in any respect - potentially because it was an emotion-based question, one designed to derail the conversation, or simply stunningly irrelevant.

Since this debate tactic is fundamentally both dishonest and stupid (dishonest since it leverages a logical fallacy into the 'poor victim' stance, stupid since it is so easily identified that only one fundamentally damaged would either believe it effective or find it likely to be), it might cause one to lower one's opinion of the person using it several notches.
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In Linda's case I don't think that's possible, though obviously I'm still trying.;)
 
BillyJoe said:
Well, the guidelines, I would hope, are evidence-based.
Are they not?
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Well, the people developing the guidelines would say they are. Individual doctors might disagree about some of them:

http://jama.ama-assn.org/cgi/content/short/301/8/868

Most current articles called "guidelines" are actually expert consensus reports. It is not surprising, then, that the article by Tricoci et al2 in this issue of JAMA demonstrates that revisions of the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines have shifted to more class II recommendations (conflicting evidence and/or divergence of opinion about the usefulness/efficacy of a procedure or treatment) and that 48% of the time, these recommendations are based on the lowest level of evidence (level C: expert opinion, case studies, or . . . [Full Text of this Article]
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Good doctors follow evidence-based guidelines but use their clinical judgement as to how to apply them to the particular patient in front of them. If they deviate from the guidelines (and this is allowed by the very word "guideline"), they must have good reasons for doing so.

Does that really happen?
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I'll refer you again to that NEJM editorial (this time the first part)

In 1990, the Institute of Medicine proposed guideline development to reduce inappropriate health care variation by assisting patient and practitioner decisions.1 Unfortunately, too many current guidelines have become marketing and opinion-based pieces, delivering directive rather than assistive statements.
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And if guideline adherence is used to evaluate P4P measures, then yes, it can happen.
 
Drive by:
Children at risk through lack of training for doctors and nurses.

When appointed to a consultant position in the UK, I had experienced about 14 years of postgraduate training (excluding research time). One of my early posts entailed a 104-hour week.
Trainees today will become consultants after as little as 5 or 6 years of training/experience (currently at 56hpw but dropping to 48hpw soon.)
 
fls said:
One uses 'and' to combine two independent ideas.

Linda
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Providing a flippant answer to my questions was contemptuous behaviour:

http://en.wikipedia.org/wiki/Contempt

Contempt is an intense feeling or attitude of regarding someone or something as inferior, base, or worthless—it is similar to scorn. Contempt is also defined as the state of being despised or dishonored; disgrace, and an open disrespect or willful disobedience of the authority of a court of law or legislative body.[1] One example of contempt could be seen in the character Ebenezer Scrooge from the Charles Dickens book A Christmas Carol. Scrooge was cold hearted, hating everything about Christmas and looked down upon everyone around him, especially the poor. The word originated in 1393, from the Latin word contemptus meaning “scorn.” It is the past participle of contemnere and from com- intens. prefix + temnere “to slight, scorn.” The origin is uncertain. Contemptuous appeared in 1529.[2]

Robert C. Solomon places contempt on the same continuum as resentment and anger, and he argues that the differences between the three emotions are that[3] resentment is directed toward a higher status individual; anger is directed toward an equal status individual; and contempt is directed toward a lower status individual. Contempt is often brought about by a combination of anger and disgust.[4] [5]
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Now enough of this nonsense! I'm finding this thread interesting.
 
Deetee said:
Drive by:
Children at risk through lack of training for doctors and nurses.

When appointed to a consultant position in the UK, I had experienced about 14 years of postgraduate training (excluding research time). One of my early posts entailed a 104-hour week.
Trainees today will become consultants after as little as 5 or 6 years of training/experience (currently at 56hpw but dropping to 48hpw soon.)
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Given that hospitals operate all day every day, could you (or someone else) explain why it is so difficult to fit training of junior staff into a 48 hour week?
 
Ivor the Engineer said:
What entry requirements to medical school make you believe doctors are likely to be more caring and compassionate than the average person in their society?

Given that there are far fewer places in medical schools than people applying for them, why would the resulting competition select for the more caring and compassionate people?

It seems one of the main motivations doctors get is interacting with and being thanked by the people they help.

Most professionals are helping other people, yet few need the gratification of interacting with them.
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1. The entry into medical school is a complex, multi-factoral one. Is it perfect? Not by a long shot. You still have the occasional one go completely off the rales...murderers, pedophiles, they occasionally happen. However, I think that trying to seek out "compassion" in a candidate is something that we strive for when selecting medical school candidates. Whether it be through the type of volunteer work that they do, or the answers to particular questions in the interview, it is looked for.

2. Because there are more people then places, there will naturally be a tendency towards the "best" of the bunch, for sure, but that is not a question answered purely with academic prowess. In my class we had english majors, music majors, teachers, engineers. Yes the bulk of the students were science (Biochem, Biology, Nursing) majors, but that is to be expected. As well, the academic average and MCAT scores are only two of many factors, and not neccesarily the most important.

3. I would say that many things motivate people to become physicians. Challenge, Curiosity, Altruism, Money, Respect, and yes, Gratitude. I suspect the need for gratitude is not a major factor by a long shot, although I would be interested in reading a study that proves me wrong on that one.

4. Your comments, to me, sound tinged with a combination of bitterness and annoyance.

TAM:)
 
Ivor the Engineer said:
Given that hospitals operate all day every day, could you (or someone else) explain why it is so difficult to fit training of junior staff into a 48 hour week?
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I think the point is that they have less experience per year if they are only working half the number of hours. So if you are reducing the hours, you should increase the years of training. But then it's not exactly a good idea to work people so hard that they are half asleep and making mistakes because of sleep deprivation. I think there is a genuine problem, but also a resistance born more of machismo from some older doctors. If they went through that hell in order to get where they are, then so should younger doctors. Like some sort of bizarre initiation rite.
 
fls said:
I participated in a doctor's strike when I was in Canada, and it was successful.

At the time I was at the university hospital. The physicians attending on the clinical teaching units were subject to the same fee schedule as specialists working in the community, even though the work that we did was very different in amount and kind from that of a community internist.* The bulk of the work was done by my section (General Internal Medicine), and while we wouldn't have minded more pay, our real problem was getting any other sub-specialist physicians to participate in the schedule. Because of the way that they were renumerated, it represented a huge pay cut for a sub-specialist to take on a 2-week stint on the hospital service vs. a 2-week stink on their hospital consult service. We took our complaints to the department of health - the work we were performing was far in excess of those who were paid the same amount and there were serious and unsustainable staff shortages due to inequalities in renumeration - but they wouldn't even come to the table and talk to us since, as far as they could tell, the services paid for were commensurate with what was needed. So we simply informed them that if what they were paying for was adequate, we were going to simply stop performing those services they had deemed unnecessary by virtue of making them not worthy of renumeration. This meant that we would no longer free up hospital beds by managing certain patients as outpatients (which required visits in excess of the once per week we could charge for), we no longer transferred patients from surgical wards to medical wards if their care became complicated (as renumeration was based on length on time in hospital regardless of whether the length was due to complications vs. babysitting for rehab or nursing home placement), we no longer accepted patients for admission who had already been seen by a specialist (the attending physician would not receive any renumeration for their complete history/physical/evaluation), etc.

It lasted for less than two days, I suspect mostly because of the effect on the surgical wards - it seems that people listen to surgeons, I wish I knew why. Anyway, they agreed to sit down and take another look at the fee schedule and as a result we moved to block funding rather than fee-for-service. But it's true that we were very reluctant to take that step and we really wouldn't have held out for very long.

Linda

*I used to fly in to smaller communities to provide consultation services and I was often asked to see hospital patients and ICU patients, as well. The typical hospital patient was similar to one of my more stable outpatients, and the typical ICU patient would be similar to one of my not-very-sick hospital inpatients.
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It seems your striking power was exceptional. For us physicians striking is so rare, that it is hard to have enough incidents to make a valid comment on their usefulness. I have seen, unfortunately, nursing strikes go on much longer than they should have, because the govt waited them out, knowing they had to provide essential services.

TAM:)
 
T.A.M. said:
1. The entry into medical school is a complex, multi-factoral one. Is it perfect? Not by a long shot. You still have the occasional one go completely off the rales...murderers, pedophiles, they occasionally happen. However, I think that trying to seek out "compassion" in a candidate is something that we strive for when selecting medical school candidates. Whether it be through the type of volunteer work that they do, or the answers to particular questions in the interview, it is looked for.

2. Because there are more people then places, there will naturally be a tendency towards the "best" of the bunch, for sure, but that is not a question answered purely with academic prowess. In my class we had english majors, music majors, teachers, engineers. Yes the bulk of the students were science (Biochem, Biology, Nursing) majors, but that is to be expected. As well, the academic average and MCAT scores are only two of many factors, and not neccesarily the most important.

3. I would say that many things motivate people to become physicians. Challenge, Curiosity, Altruism, Money, Respect, and yes, Gratitude. I suspect the need for gratitude is not a major factor by a long shot, although I would be interested in reading a study that proves me wrong on that one.

4. Your comments, to me, sound tinged with a combination of bitterness and annoyance.

TAM:)
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On point 2, going by my sister's experience about 20 years ago, at that time one of the selection criteria was making sure nobody too working class got in.
 
Ivor the Engineer said:
That sounds like a really poor organisational structure. Why do you think it has persisted for so long?
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That is a good question. A lack of privatization may be part. Govt burocracy is likely another. The power of Physicians within the work force, and the history of policing their own may be another, but I am sure there are many reasons I am not hitting right now.

TAM:)
 
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