
Doctors Tell All, and It’s Bad - ivank
http://www.theatlantic.com/magazine/archive/2014/11/doctors-tell-all-and-its-bad/380785/?single_page=true
======
kyro
The sad truth is that this is due to a variety of problems at a variety of
levels. Of course, all that follows is highly dependent on the team, hospital,
and location.

A the lowest-level, you have doctors who're just assholes. Unfortunately, they
don't do a good job at filtering out abrasive personalities upon entry to
medical school. In fact, I'd say in some ways they self-select for that type
of person. I've worked with heads of departments at huge hospitals who've
openly discussed their salaries with me in patient rooms or brushed off a
patient's concerns in a condescendingly paternalistic manner only to laugh
with colleagues about it the second they step out of the patient's room. I've
argued many times with specialists running their own clinic about their
exorbitant fees and clever ICD-coding skills -- that some brag about
developing -- to squeeze every penny out of insurers, all justified by "we've
got to make a living." Assholes in medicine run rampant.

Up one level and you have the sheer morbid nature of medicine that physicians
deal with on a day-to-day basis. I've given chest compressions to trauma
patients with self-inflicted gunshot wounds to the head, and cleaned maggots
out of a patient's festering diabetic foot. To the outsider, it is all
incredibly shocking and gruesome, but as a physician you grow callous to it.
Unfortunately, many times that means growing callous to all emotions and
stunting your ability to empathize. Mix that with a superiority complex and
you get things like Hispanic Hysteria Syndrome.

Go up a level and you've got a huge logistical and resource problem. Hospital
physicians, particularly residents at teaching hospitals, are often overloaded
with responsibilities and patients. They often feel they cannot give every
patient and every obligation full and thorough attention because they are
being bombarded by pages for new admissions, calls from other staff, etc. I
have seen residents breeze through a list of patients, only giving minimal
attention to each, just to avoid being chastised by a superior for not
fulfilling all responsibilities in the short time allotted. And when you are
severely limited to the number of open beds you have, and you've got a crowded
ED, it becomes a game of who can we push out the fastest without killing.

At a higher level, you have a hospital who needs to keep the lights on, needs
to pay salaries, needs to maximize profits and yet treat patients as best as
they can. Unfortunately, many hospitals are being swindled by suppliers who're
working through group buying organizations [1], inflating costs and making it
difficult for hospitals to hit their margins.

There's a lot more I could go on about.

~~~
sillysaurus3
If you find time, please do go on about it. It's very interesting.

~~~
lisper
+1 (Yes, I know it's bad form, but in since point counts on comments are
invisible this is the only way to let the OP know that others are interested)

~~~
ahlatimer
OT, but you can see the score of your own posts.

~~~
Dylan16807
Sure? The problem is that kyro can't see any potential upvotes on sillysaurus3
specifically asking for more.

------
joshgel
I'm a medical resident at a prestigious teaching hospital. I hate to admit it,
but I've lost my empathy already.

The experience most interns have on day 1 is a massive increase in
responsibility and work load as compared to medical school. Whereas most
medical students in their 4th year "manage" (under the very close supervision
of residents) 2, 3, or maybe 4 patients, on day 1 of intern year they are
suddenly expected to be responsible for upwards of 10-12 patients (under
supervision, but considerably less supervision than med students). Interns go
from spending most of their time studying and learning medicine, to being
suddenly, constantly busy with often mind-numbing tasks. We interns joke that
we are nothing more than secretaries, doing tasks for our boses all day
without time to sit down and think for ourselves, despite the M.D. we just
spent years earning. Eventually, we get better at prioritizing, we learn the
system, and we learn by doing.

But, early in intern year, we can't prioritize, we don't know the system,
frankly we can't even keep which patient is which straight in our heads. But,
regardless, we still have n number of tasks to do by the end of the day.

Spending extra time talking to patients isn't part of n. Empathy isn't an item
in n. Figuring out a patient's priorities for their health aren't an item.
Those are extras.

And to get home on time, after my 12-14 hour shift, all I have to do is my
list of n tasks, which is substantial. So, we quickly learned that long
conversations with patients are the enemy of getting home on time. And pretty
quickly, we start to eliminate those conversations. Then, we figure out that
other things patients need, like empathy, a careful history taking and
detailed physical exam, family discussions, etc also stand in our way of
getting our work done on time.

Eventually, we learn the ability to keep our patient's complex medical
problems straight and become much more efficient at getting our work done
quickly. So, realizing we have more time, some of us go back and start to do
the things that really matter to patients, like those things listed above and
in the article. But, we've already learned, or forced by the system to learn,
that we can get away with not doing those things, so as soon as we get a
little extra busy or are a little extra tired, those are the first things we
skip.

Then, suddenly, we start second year and can now be asked to work 24-28 hours
straight, and now we have 18-24 patients instead of 10-12 that we are
responsible for and the system again drains us of the very thing we enrolled
in medical school to be.

~~~
angersock
What's keeping us from creating more physicians to meet the (obvious) demand?

Why the hell should you need to pull 24-28 hour shifts?

~~~
ceejayoz
> What's keeping us from creating more physicians to meet the (obvious)
> demand?

It takes a lot of money, resources, and existing doctors' time to train a new
doctor. One thing that's likely to help a bit is the move to nurse
practitioners and physician assistants for much of primary care.

~~~
maxerickson
If we had more doctors, it seems that it would also cost less to train more
doctors (assuming that more doctors made the average doctor's time less
costly). An unfortunate feedback loop there.

------
vacri
_Spend a day in an emergency room, and chances are you’ll be struck by two
things: the organizational chaos and the emotional detachment as nurses,
doctors, and administrators bustle in and out, barely registering the human
distress it is their job to address._

There is a difference between 'spend a day' and 'work long-term'. Medical
staff are normal people; there's no training that makes you immune to
compassion fatigue. When you go into an ER and it's all new to you and
chaotic, it seems crazy that _these people are in pain_ and _those people just
don 't care_. But do it every working day of your life, and you have to
buttress your emotion against it. Not to mention that it's a fine line to
walk, showing enough compassion. If you let emotion get the better of you,
you'll be less effective in your actual job of helping people. Throw in the
occasional patient that is trying to pull the wool over your eyes, and you
become to what looks to outsiders as a callous, uncaring individual. It's not
to say that all ER staff are saints, but whenever considering the ER
environment, don't forget to view it from the shoes of the people who work
behind the counter long-term.

My own realisation of this buttressing: I used to work as a medical tech in
what was essentially an outpatient clinic that did some patients on the ward.
I remember one day, several years in, casually wandering up to the ward with
my equipment, when I turned the corner and was met by a wailing wall of family
coming the other way. "Oh yeah - hospital is not a nice place to be. Normal
people only come here when something is really bad...".

~~~
hga
Imagine the mental fortitude necessary to be a "life and death" doctor as I
put it (also includes ophthalmologists since loss of eyesight is a very bad
thing), _knowing_ that some of your patients will inevitably die, and that
sooner or later you're going to make a mistake that will kill one.

~~~
JshWright
Everybody dies... Everybody makes mistakes... It's all just a matter of
delaying the inevitable. Worst case, you fail to delay it at all (or maybe
hasten it a bit).

------
cesarbs
I was just talking to my wife about this. I've recently been to the doctor
because of some headaches I was having. They did some blood work, and when it
came back I got a call from the doctor saying we should check my liver
function again in 3 months. I wasn't very concerned because ever since I was a
kid I have heard that (I guess some normal values for me are outside the range
considered normal for most people).

This week, I logged in to their patient portal because I wanted to look at
some previous blood test results. I was absolutely startled when I saw that my
AST and ALT counts were pretty high, about twice the upper limit for what is
considered normal.

But then I realized that I had that blood work done around the time I had
started strength training and increased the amount of protein in my diet. A
quick online search revealed that a single strength training session increases
AST and ALT levels for up to seven days. Considering I had been exercising
multiple times a week, it was completely normal for my levels to be elevated.

Now, why didn't the doctor simply ask me if I had been strength training? Such
a simple question would have explained the abnormal test results and saved me
some distress.

~~~
toasted
your doctor knew it was probably unimportant, could be caused by a myriad of
things, and a repeat blood test in a few months would be normal and mean they
could forget about it.

Because of the patient portal with its ability for patients to access info
they don't understand the significance of, you were "absolutely startled" and
"distressed". If you didnt have access to those results then you wouldn't have
been concerned.

Regardless of all that, you should still have repeat LFT's because you don't
know for sure that "strngth training" was the cause of the problem.

Honestly, Doctors find navigating the minefield of clinical decision making
difficult enough, trying to make judgements on sensitivity/specificity of
tests and investigations, positive predictive values, remove confounding, drug
company propaganda, publication bias etc etc without patients trying to get
into it all as well. Should I spend 1 hour explaining to every fucker with a
headache why a CT head is more likely to cause brain cancer than it is to
diagnose it?

The solution to the US healthcare woes is NOT more patient autonomy and
decision making. The solution is moving towards a less money orientated system
and trying to encourage altruism and alignment of patient's goals with
doctor's actions.

~~~
nitrogen
_Should I spend 1 hour explaining_

Yes, absolutely. Medicine needs to descend from its status as a high
priesthood and be a little more accessible.

~~~
VLM
The question is if that's the best possible use of his time to improve the
lives of the most patients.

A stereotypical micro vs macro problem where the best possible micro solution
is likely not the best possible macro solution.

To some extent its a systemic problem with levels of support. Every customer
that calls into a call center claiming space aliens are controlling their
minds should not be transferred to argue with the VP of software development
for an hour.

~~~
nitrogen
Possible solutions: reduce the scarcity of doctors capable of explaining
ionizing radiation, add more non-doctors who can do more than just draw blood
and check vitals, etc. Part of the macro problem is that a lot of micro
problems are caused by insufficient communication and a lack of patient
knowledge.

~~~
philwelch
They're called "nurse practitioners" and it's a massively growing field.

------
SoftwareMaven
It's unfortunate that medical care has become almost adversarial. Our system
is set up to treat acute conditions, but most people are being seen for
chronic problems and our understanding of causes and training for treatments
of chronic problems is woeful at best. Worse, both patients and doctors want a
pill to make everything better.

After dealing with poor health for 30 years; I finally took my health into my
own hands. After a series of self-experiments and a lot of journal reading, I
now feel like I'm finally reaching health, but every time I see a doctor, it's
the same battle ("OMG, your cholesterol is 239; you are a dead man walking!"
Yeah, I don't think so).

There is a lot of good information out there, but there is also a lot of
complete crap, and doctors have to deal with truly informed people as well as
people who only think they are informed. Worse, much of their continuing
education is not much more than paid infomercials, making it hard to trust
they are getting truly balanced information.

Add to all of this the fact that you have seven minutes with your doctor to
work it all out, and it is failing.

There are a few things that can be done, IMO, to help:

1\. The AHA, ADA, AMA, AND and other medical organizations need to stop taking
so much money from corporate sponsors.

2\. Education about and treatment of chronic conditions need to be treated
very differently than acute conditions. The treatment for Type 2 diabetes
should not default to Metformin.

3\. We need more time with doctors to work on treatment plans that can be
carried out.

4\. Medical school and continuing education needs far more, unbiased education
about the value/dangers of nutrition, environmental contaminants, etc, in
chronic disease. Alzheimer's prevention starts in a person's 30's[1].

Unfortunately, we see the same kind of care given for stiches as for metabolic
syndrome. And it's not working.

1\. Based on a current hypothesis that it is the effect of "Type 3" diabetes.

~~~
kaybe
There is metamed which can help you with the research. It seems to have helped
at least some people.

[https://www.metamed.com/](https://www.metamed.com/)

(Found a long time ago via LessWrong:
[http://lesswrong.com/lw/gvi/metamed_evidencebased_healthcare...](http://lesswrong.com/lw/gvi/metamed_evidencebased_healthcare/))

~~~
ceejayoz
Thought I remembered the name of this one.

[https://news.ycombinator.com/item?id=5296694](https://news.ycombinator.com/item?id=5296694)

One of their first medical advisors was a disbarred doc who lost his license
for writing online pharmacy prescriptions. I'd do some serious research into
credentials before throwing in the $5-50k they charge.

They also had a "health researcher" whose primary credentials were "eagle
scout":
[https://news.ycombinator.com/item?id=5296594](https://news.ycombinator.com/item?id=5296594)
[https://news.ycombinator.com/item?id=5296724](https://news.ycombinator.com/item?id=5296724)

~~~
hawkice
So, obviously you can't retroactively become professional, but it looks like
they've cleaned up their act since then.

[https://www.metamed.com/ScientistsDoctorsResearchers](https://www.metamed.com/ScientistsDoctorsResearchers)

They have a Chief Medical Officer, and all but one of the researchers is an
M.D. -- the guy who was ordered to suspend his medical license is gone, and so
is the eagle scout.

------
exratione
People overestimate the state of medicine with respect to autoimmunity, which
is funny in a way because they are largely completely in the dark as to how
fast medical research is moving in all fields, and think that many types of
near future treatment are a lot further away than is in fact the case.

The workings of the immune system are rather like the workings of metabolism:
the present vast knowledge, the stuff that takes years to learn and which
encompasses many disciplines as no one person can know enough of all of it to
make a career of that, is actually basically just a sketch of how things work.
It is a map at the high level. When it comes to the all-important details
there are decades of work left at even at the present pace and with the damn
impressive biotechnology the research community has now in order to get to
even a moderately complete picture.

So there's a reason why many forms of autoimmunity are really hard to
diagnose, and why you'll find that a great many diagnoses of exclusion are
mild autoimmune conditions: here's what's wrong with you, it's the bucket we
put people in when you have some symptoms and all the tests we have come back
negative or with ambiguous results. Those tend to be the ones where nothing
can be done at present. The author of the article should at least be happy
that she is one step up from that situation.

The immune system has so many ways of running awry due to malprogramming that
there really should be more work done on more gentle ways to reboot it - strip
out all immune cells and start over with the patient's stem cells to
repopulate it. Aggressive reboot methods involving chemotherapy have been
pretty effective when trialed, but that's not something you'd want to do
unless there was no alternative.

The advent of biologics for immune suppression have turned the research
community away from the possibilities of the wipe clean and start over
approach, however, which I think might be a mistake in the long run.

~~~
bernardlunn
I agree, research into autoimmunity and chronic inflammation generally in
western medicine seems very weak. Its better in traditional chinese and
ayurvedic. Elimination diets are one form of "wipe clean and start over
approach" that works for some people

------
tomohawk
Speaking of adversarial - many people do not know that if they leave a
facility against medical advice (AMA), insurance will probably not pay for any
of the treatment and they'll be stuck with the bill. So, if you get into a
situation where you strongly disagree with the physician or where you aren't
being cared for properly, you need to be careful how you extract yourself.

~~~
cooper12
Hmm, this startled me so I looked it up and it seems that the research on the
matter shows that this belief is the result of misinformation on the part of
physicians and patients [1] and that studies [1][2] have shown that of the
small percentage of patients whose insurance didn't pay after leaving AMA, the
reason for rejection was mainly because of problems with the bill itself.

[1]
[http://www.uchospitals.edu/news/2012/20120203-billing.html](http://www.uchospitals.edu/news/2012/20120203-billing.html)

[2]
[http://www.ncbi.nlm.nih.gov/pubmed/22331399](http://www.ncbi.nlm.nih.gov/pubmed/22331399)

------
crazy1van
Maybe it is because doctors receive so much training or maybe because we are
at our most vulnerable when we see them, but I think we lose sight of a few
important points when we talk about doctor-patient relationships versus other
relationships --

* Doctors are human. Some will do extraordinary things. Some will make mistakes. Some will be assholes. Many will do all three at some point in their lives.

* Medicine is a business. There are financial incentives pushing and pulling on the doctor's behavior. Not saying it dictates everything they do, but denying its existence is folly. Just remember, there is a financial transaction involved every time you interact whether you see it or not.

* No one cares about your well being more than you and those that love you. Yes, doctors are well educated and, yes, they definitely want to heal you. But they aren't going to stay up all night researching your symptoms, the treatment options, the drug interactions. Your loved ones may start from a far less informed place, but they will give every thing they have to heal you. To them you are a best friend, a sibling, a child, a spouse. To doctors you are one patient out of dozens or hundreds. This backseat google-doctoring infuriates medical professionals, but it is unavoidable. This isn't a condemnation, it is just reality.

~~~
zo1
" _Some will be assholes._ "

Agreed, I'm just glad I'm in a position where I can simply walk out on a
doctor being an asshole to me. And then proceed to the next practice over.

If enough people do that, things would be much better. Unfortunately, that's
not always possible.

~~~
robk
This is the problem with socialized medicine. You don't really have the option
and you're stuck with whatever doctor the system gives you.

~~~
VLM
Why? You're conflating a hyper authoritarian scheduling system with a vastly
superior simple and cheap billing system.

There is no particular reason both have to be implemented at the same time.
Maybe its culturally popular but there's certainly no technical reason.

I live in a former 1st world non-socialized medicine country and I have no
option in where I go for medical care other than on a very meta level of which
employer I work at and where I live ... in an emergency (heart attack, car
accident) the ambulance drives me to the closest ER, there is no free market
deciding which is "better". In a non-emergency, my cheap health insurance
contracts with precisely one large medical chain in my area, so if I'm willing
to do something like medical tourism and fly to another state I could select a
new doc, but again no free market ...

~~~
underpantsgnome
> former 1st world non-socialized medicine country

This is a painfully accurate description of the USA

------
j_lev
Some questions:

1) How far along are we in terms of those computers that were predicted in the
80s to one day replace doctors? Not trying to antagonize but I can't see any
harm in having a row of booths with terminals that patients can log into and
start answering questions about symptoms, being led through the
"troubleshooting" steps, etc. There's a lot of time spent just waiting around
in hospitals, waiting rooms, etc. Maybe you could have a swipe card that saves
your progress on the terminal, combines it with the lab results. The system
wouldn't replace a GP just yet but it would instead work alongside the GP.

2) Are there any crowd-sourced solutions available yet for these cases where
doctors clearly have no idea? Someone enters all their symptoms and people
discuss online and try to come up with some possible options.

3) How much are insurance companies responsible for the sorry state of health
care in the US? I was speaking to my friend who says that he pays $850 bucks a
month (up from $800 a month last year) on top of what his company pays. I've
heard other stories about people basically being a slave to their company
because they can't leave due to the generous benefits. I've also heard that
insurance companies pay back only 60 cents in the dollar, so to make up the
same $100 a doctor was previously earning he now has to charge about $170 (the
other option is to be cut from the network of doctors used by the insurance
company). And is this the logical conclusion for health care? Will
Canada/Australia head the same direction? Seriously, there is a massive
opportunity for the US to fix some of these problems now, yet it just seems
that you guys are heading in entirely the opposite direction.

~~~
angersock
(working in a health IT startup)

On 1:

So, the big thing is that you never actually want to _replace_ the doctors.
Their egos won't allow that, they'll see it as an existential threat (which it
is), and most importantly: you don't want to give that kind of power to a
device which doesn't function as a moral agent.

On 2:

Sometimes, you'll be getting advice from somebody like tptacek...sometimes,
you'll be getting advice from losethos. I wouldn't trust my healthcare to
random bozos on the internet.

On 3:

Almost all of it is their problem, I'd say.

The increased focus on billing and everything else means that the doctors have
to deal with madness they wouldn't have to otherwise. The fighting and billing
cycle can take literally a year, so no honest doctor is at an advantage _not_
billing everything they possibly can, and any institution (read: hospital) is
_going_ to force that sort of hand-wavy arithmetic (because of the opposition
of insurance providers, in turn because of previous bad actors).

The amount of money thrown into these maws anyways (from both insurance and
Medicare, a weird issue unto itself) serves to raise the price floors so that
you can't even pay for yourself if you want to, because you're literally on a
different marketplace.

The companies also go and force you to use doctors that aren't necessarily
convenient to you, maybe many miles away. If you try to use a local physician,
well, tough shit, you might have to pay for them anyways.

I could go on and on and on and on...

It's a fractal of sadness.

~~~
j_lev
Thanks for the insights

------
jasonisalive
_The rhetoric of medical reform draws mostly on economics: Experts differ
over, among other things, how to structure “insurance mandates” and what
constitutes “overutilization” of a rapidly expanding array of high-tech
procedures and diagnostic tests._

Sounds like the tell-tale signs of socialist dysfunction, from which all the
other problems stem. The solution is simple, but, unfortunately, poorly
understood and highly resisted: restore a free market for health goods and
services.

~~~
blahedo
Free market solutions don't work for health goods and services, because free
market solutions require a feedback loop that is unavailable. At the provider
level, in many cases you only have the option to be a repeat customer if they
_don 't_ give you good service the first time round. At the level of the
insurance agencies themselves, an unfettered free market approach pushes them
in the direction of denied claims and policy rescissions (as we've seen!), and
the customer doesn't (and often can't) discover they've made a bad choice
until too late.

One thing that _would_ be good about a more free-market-y approach would be an
increase in transparency about costs; but that's something that would be an
improvement under a socalist or any other model as well.

~~~
yummyfajitas
Free market solutions work just fine. I fled the semi-socialized US system to
enjoy the unfettered free market medical system provided by India at least
twice, and will probably do so for future medical treatments.

Many medical services are repeated even if good service is provided. For
example, 2 years ago I injured both my L5/S1 and L4/L5 disks. 2 years ago
L5/S1 was treated, but the L4/L5 was left alone since it did not cause any
problems. This year my L4/L5 started causing serious pain - the first guy did
a great job so I went back. Another part of the feedback loop is reputation -
if one of my friends needs similar treatment they'll probably go to the same
guy unless they are very sensitive to cost (I didn't go for cheap).

I have no idea where this meme that free market health care looks like the US
comes from. Maybe Canadians don't realize there are more possibilities than
simply Canadian and US health care?

~~~
angersock
So, erm, what about all the poor people in the US that can't take a journey
out to Asia when they need care?

(I don't automatically disagree with your free-market assertion, mind you...we
have quite a captive one here. You just need to use a bit better
justification.)

~~~
yummyfajitas
I didn't claim that medical tourism is the solution to all problems. I merely
claimed that there are highly effective free market medical systems. I.e., the
world is bigger than simply USA and Canada.

------
AmadKamali
Some thoughts and observations by a practicing anesthesiologist:

1.Improving patient outcomes, improving patient satisfaction, reducing medical
errors and curtailing costs etc are very hard problems. There are no easy
answers. Doctors know about this( because this affects us also) , routinely
discuss it, try to solve/amend whatever is in their power but the overall
nature of these problems is such that without nation wide measures and policy
changes no concrete improvement can be achieved.

2\. Becoming somewhat emotionally detached/blunt etc is a requirement for the
job. There is no survival without it. It happens to all doctors. It happens to
family and friends of people who end up in hospitals for months. Even with the
detachment adverse patient outcomes do affect the treating doctors and this
emotional trauma piles up over the years.

3.Same for abrasive personalities. There is so much push and pull going on
between doctors of different specialties, between doctors and nurses, between
doctors and administration, between doctors and insurance companies, between
doctors and patients and their relatives that anybody not
strong/abrasive/assertive enough looses his ground which affects both the
doctor and the patients under his care adversely.

4.Generally a lay person reading up things on his own doesn't bring anything
useful to a discussion with the doctor. Sometimes there are real options in
which even the doctor is not sure of benefit/risk ratio. The patients should
take decisions in these cases. Same for major operations and interventions.
But for majority of cases average lay person is better off following the
advice of his doctor than relying something he read on internet.

5\. A job of doctor will probably be one of the last jobs to be replaced fully
by machines. Just like parenting.

6\. Doctors are not against technology or threatened by it. For example a lot
of lab tests that are automated now were performed by hand by
pathologists.They are very happy to use these new technologies. Their role
hasn't diminished. The lack of enthusiasm for health IT software is because
most of it sucks.It adds to workload, doesn't provide any value, and adds
another layer of responsibility/anxiety. Most doctors will run to anything
that only marginally improves their ability to handle workload.

And the list can go on.

Some interventions that might work are:

Checklists. simple, easy to use and practical checklists .

Mandatory leave/ time away from patients. The more acute/emergency
oriented/high stress specialty , the more the need. For example I think
specialists in Anesthesia/critical care/emergency
medicine/gynecology/neonatology etc should have 3 months of leave away from
patient care every year to stay sane.

>fulfilled doctors make for more-satisfied patients. Tackling the problems of
Kaiser Permanente’s Colorado medical group, he took the counter intuitive step
of demoting “patient-centered care” as a goal, and elevated “preservation and
enhancement of career” for doctors to first place. He restored to them the
sense that their work is, as Barron Lerner’s old-fashioned father put it, a
“rare privilege” to be pursued with a sense of responsibility, rather than
harried accountability.

ABSOLUTELY TRUE!!

There is promise in healthcare analytics, predictive analytics and things like
auto flagging of unusual events. Doctors are used to analytics and algorithms
and will embrace any good solution to these.

Similarly, machine learning/AI can play important role in things like reducing
medical errors and postmortem of adverse events. These should be combined with
training for human factors.

Continued medical education in its present form is very ineffective.
Continuing medical education and remedial training/retraining etc need to be
customized and focused to meet specific objectives.

------
kyllo
Son of a doctor here. My dad told me not to go to medical school. Reading this
makes me so glad I listened.

