Why Doctors Hate Science

[T.A.M.]

Do you think there's an under supply of physicians?

If so, what do you think are the causes and how may they be mitigated?

(I'm listening)

Not a simple answer. I think there is an extreme under supply of physicians in rural areas, and an adequate or perhaps slight under supply in urban areas.

Causes/Mitigating factors are many, but as I see them, are:

1. You can put the doc in the rural, but you cannot put the rural into the doc. By this I mean you can put a physician in a rural environment, and he will function, but you cannot force him to love rural life, and so for most they leave when they get tired of it.

2. Too few positions at medical schools. Some of this is self regulating, some of it is the cost to educate them.

3. Here in Canada, some of the problem is an exodus to the USA. The average pay per visit in Canada is about $30-$35. I have a physician friend in the USA who says the average pay for a visit there (where he works) is $115.

TAM

 

[T.A.M.]

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

Interesting. Some of it is tradition. Some of it is to prepare you for the potential hours you may have to work when you finish. Some of it is pure love of torture.

TAM

 

[paximperium]

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.

I do find it amusing that UK docs are complaining about a 48hour work week. When I started residency, I regular went through a 100 work week and the surgeons regularly went higher. The 80hour max work week rule came to my hospital half way through my residency and it was such a major change.

48hours a week is not enough for certain specialties and I see signs that a 80hour work week may well not be enough. I think it is barely enough for pediatricians, ER docs and General Internists, but for a Surgeon, even with 5-6years of residency, I'm seeing some of new grads lack certain skills that was once expected from the older generation.

 

[T.A.M.]

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.

lol...

Well I entered medical school 15 years ago, and while I was not privy to their entry criteria then, I can tell you that no such criteria exists at the med school I graduated from now, AFAIK.

TAM

 

[Professor Yaffle]

lol...

Well I entered medical school 15 years ago, and while I was not privy to their entry criteria then, I can tell you that no such criteria exists at the med school I graduated from now, AFAIK.

TAM

First question at my sister's interview for medical school: "So, why on earth would the daughter of a TV repairman (said in a sneering voice)want to become a doctor?"

 

[Ivor the Engineer]

<snip>

I'm seeing some of new grads lack certain skills that was once expected from the older generation.

Could you give some examples please?

 

[fls]

Providing a flippant answer to my questions was contemptuous behaviour:

Right, 'cuz you simply assumed the outcome - that my response was non-serious and that it was so because I have contempt for you - in the same way that one assumes that changes in practice represents provision of excess services or that the presence of conflict of interest creates biased guidelines. It's of interest and useful (I assume) to uncouple those assumptions, at least occasionally.

Linda

 

[paximperium]

Could you give some examples please?

Why should I?

 

[paximperium]

First question at my sister's interview for medical school: "So, why on earth would the daughter of a TV repairman (said in a sneering voice)want to become a doctor?"

As a member of the Elite Physician's Cabal, I am very interested the answer.

Plebeians and peasants should know their place

 

[fls]

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

Yes, I've been through several nursing strikes and they do tend to be messy. I've seen threat of strike by physicians a few times, but it was doubtful that the threat would be acted upon. Looking back on my experience with the department of health, it seems that the main influence comes about when positions cannot be filled because of poor terms.

Linda

 

[Ivor the Engineer]

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.

But its common knowledge that volunteer work, preferably within a medical setting, is highly advantageous when applying to medical school, so anyone with any common sense who is interested in medicine is going to do 6months in a hospice or similar setting to appear to be the correct kind of candidate.

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.

I was thinking more of the situation selecting people with a competitive nature, rather than just high academic scores.

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.

I'll start searching.

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

TAM

http://radio.weblogs.com/0108814/stories/2002/06/25/doctorsVsGeeks.html

Unfortunately, geeks have done too good a job of simplifying what they do for users, hiding the complexities of the systems they build, and their ultimate value to society. I think the reality is that doctors keep individuals' physical infrastructure functioning and geeks keep society's infrastructure functioning. How many people would lose their lives tomorrow if the telephone system stopped working? if the avionics in all 747s failed? if the GPS guidance system in a cruise missile failed? if the computer systems running the nation's power grid failed? Don't kid yourself. Geeks do a job that is likely far more important to the safety and welfare of a larger number of people than the medical profession does. They just do it in a quiet, unassuming way that doesn't require elevating individual accomplishment. And people do take it for granted. That should be a tribute to the geeks for a job well done.

One day, the medical profession will have eliminated all of the mystery surrounding the human body. When that day comes, doctors as we know them will likely cease to exist. Medicine will just become one more system for the geeks to model and implement. Until then, people are going to continue to elevate those who keep them alive and continue to overlook the others who merely simplify their lives, even if they don't know who's who.

 

[Ivor the Engineer]

Why should I?

Because it would be interesting to know what knowledge and/or skills you think newer physicians are missing.

 

[Ivor the Engineer]

Right, 'cuz you simply assumed the outcome - that my response was non-serious and that it was so because I have contempt for you - in the same way that one assumes that changes in practice represents provision of excess services or that the presence of conflict of interest creates biased guidelines. It's of interest and useful (I assume) to uncouple those assumptions, at least occasionally.

Linda

*Sigh* (I'm doing that a lot recently)

You know, I'm aware of a study which does contradict the phenomenon of PID and I was hoping my posts may have motivated someone to post it. What I found interesting about it was that it was performed in Norway. Other research I've looked at was about the ultimatum, dictator and trust games in behavioural economics. One of the studies compared the behaviour of two very similar groups of twins, one from the US and the other from Sweden. The striking difference between the two groups was the Swedish participants were far more likely than their US counterparts to trust their twin with 100% of their stake. Another piece of research demonstrated that students who take economics courses become more self-centered than before they took the courses.

This got me thinking about whether PID may be influenced by culture and learning, and so in countries where capitalism, individual responsibility and self-reliance are considered more important than solidarity and community, PID would be more prevalent.

 

[fls]

I thought geeks were those side-show performers who pounded nails into their nasal cavities?

Linda

 

[Professor Yaffle]

As a member of the Elite Physician's Cabal, I am very interested the answer.

Plebeians and peasants should know their place

The right answer, or the one she gave?

 

[roger]

All I know is that the doctors here in Boulder are obviously woefully undertrained in incentivived.

When I went in for my allergies the doctor suggest I waterboard myself, I mean buy a cheap nasal irrigation thingy at Walgreens, rather than take drugs that he could prescribe.

When I was in the hospital recently the doctor mentioned a bunch of tests he could do, but then advised me not to do them because other symptoms would rear their head in plenty of time if I had anything those tests would find.

When wunky was in the hospital yesterday the doctor spent a lot of time in examination eliminating tests that he could perform, and then advised her that an over the counter medicine would actually be better than anything he could prescribe her.

Who trained these people????

 

[kellyb]

*Sigh* (I'm doing that a lot recently)

You know, I'm aware of a study which does contradict the phenomenon of PID and I was hoping my posts may have motivated someone to post it. What I found interesting about it was that it was performed in Norway. Other research I've looked at was about the ultimatum, dictator and trust games in behavioural economics. One of the studies compared the behaviour of two very similar groups of twins, one from the US and the other from Sweden. The striking difference between the two groups was the Swedish participants were far more likely than their US counterparts to trust their twin with 100% of their stake. Another piece of research demonstrated that students who take economics courses become more self-centered than before they took the courses.

This got me thinking about whether PID may be influenced by culture and learning, and so in countries where capitalism, individual responsibility and self-reliance are considered more important than solidarity and community, PID would be more prevalent.

That actually makes a lot of sense.

 

[T.A.M.]

First question at my sister's interview for medical school: "So, why on earth would the daughter of a TV repairman (said in a sneering voice)want to become a doctor?"

Yikes. I guess not all medical schools, or entrance interviews, are of the same standards or conduct.

A shame.

TAM

 

[T.A.M.]

But its common knowledge that volunteer work, preferably within a medical setting, is highly advantageous when applying to medical school, so anyone with any common sense who is interested in medicine is going to do 6months in a hospice or similar setting to appear to be the correct kind of candidate.



I was thinking more of the situation selecting people with a competitive nature, rather than just high academic scores.



I'll start searching.



http://radio.weblogs.com/0108814/stories/2002/06/25/doctorsVsGeeks.html

1. You have a point, and I agree, there are ways to build what is considered the "Desirable" resume for entrance. That is why it is only one of many factors. Even the interview is to be studied for. A week or two before, you try to keep up on current events, start asking yourself questions about deep, thought provoking issue.

2. Competitive...absolutely. We would always say our medical school class was all chiefs and no indians. It was a challenge to get a group of students to work as a team, as each one wanted to be the leader, and no one the follower. That, however, is one component they LOOK FOR, in applicants, as it is what will HOPEFULLY, allow the future PHYSICIAN to be the team leader in the health care team, which he/she often is.

3. The end of medicine, as a human practice, is far from at a close...if ever. As much as it is science based, and evidence based, you cannot replace the art of medicine, or the instinct that the years of practice and training provide.

TAM

 

[T.A.M.]

All I know is that the doctors here in Boulder are obviously woefully undertrained in incentivived.

When I went in for my allergies the doctor suggest I waterboard myself, I mean buy a cheap nasal irrigation thingy at Walgreens, rather than take drugs that he could prescribe.

When I was in the hospital recently the doctor mentioned a bunch of tests he could do, but then advised me not to do them because other symptoms would rear their head in plenty of time if I had anything those tests would find.

When wunky was in the hospital yesterday the doctor spent a lot of time in examination eliminating tests that he could perform, and then advised her that an over the counter medicine would actually be better than anything he could prescribe her.

Who trained these people????

Canadians.

TAM