1) As u/DevX101 said, "The article is based on a collection of anecdotes from responses to a Facebook question: '75% of med students and residents are taking either stimulants or antidepressants or both. True or false?'"
It looks like the 75% number is invented and not actually reflective of survey results.
2) Med students would be exactly the type of people that would know that caffeine is technically a stimulant. There are also a decent number of students with valid prescriptions for ADHD, which they would be on regardless of medical school.
3) Medical school has always been hard. But the amount information one has to intake and regurgitate seems to have steadily increased. Meanwhile, medical school remains four years long. Technology has evolved to help students absorb more faster. Spaced repetition. Watching lectures at 2x speed. Massive Q-banks. But you have wonder whether this is sustainable.
Five years of medical school is a bit untenable because of the debt. Additionally, our education system is not set up to move the preclinical years to undergrad (which I believe other countries do).
4) I suspect depression is seriously underdiagnosed in med students and MORE students should be taking antidepressants than those currently on them.
I find that seriously messed up. Maybe it's not 75%, but let's assume an extra margin should be taking antidepressants to exist in the highly competitive med school environment. Further, let's assume that antidepressants progress and competitive programs keep raising the bar based on entrants and dropout rate..
Our public health goal seems to be to develop a society so stressful that psychiatric drugs are not for unbalance in the patient compared to a healthy control but to make unhealthy people that can survive hyper-competition and are maximally profitable for institutions.
Yes, I agree with you that the environment needs to be changed so that it is more hospitable from a mental health standpoint. But this doesn't change the fact that you have medical students right now that are not being treated for the clinical depression from which they are suffering.
One of the absolute issues with the statement "75% of med students are on antidepressants or stimulants" is that it conflates appropriate medication for diagnosed disorders with illegal misuse of Schedule II stimulants for competition. Your typical first-line antidepressants (eg, sertraline, escitalopram) aren't scheduled and are pretty easy to obtain via a PCP visit. They don't offer a "competitive advantage" unless people consider stuff like "being happy" or "not wanting to kill oneself" as an unfair competitive advantage in medical school.
> keep raising the bar based on entrants and dropout rate..
Dropout rates in med school are actually extremely low, at least in the US. Burnout rates as physicians, however...
If you have constant problems and no social support network, you need to spend your way out of all of those problems. That leads to people maxing out their credit, working as hard as possible for their employer, and being afraid to leave their jobs. Which equals mondo economic growth.
We used to have a society where people generally took care of each other and made a little money for specialty items as part of their career. Money was used to change your position, not to maintain it. The economy was much smaller then.
For doctors, brain drugs → knowledge → saving lives.
For athletes, body drugs → strength → showing off.
"Showing off" isn't really something we require much of in society, or see as a moral good (however entertaining we happen to find it when it is done well.) "Saving lives" is something we want to happen as much as possible, to the point that we might be willing to ask the people doing so to harm themselves a bit to get it done.
A better comparison to doctors might be, say, firefighters: body drugs → strength → saving lives.
Would it make sense for a firefighter to take anabolic steroids if it increased the maximum weight they could lift-and-carry out of a burning building? I don't know. I don't think there's an automatic answer to that.
Similarly, a firefighter who does steroids might be better until he dies of a heart attack at an inopportune time causing additional deaths. But the real risk as far as I am concerned is that if the steroids are allowed and the tests are standard, then his eventual choice is to take steroids or not be a firefighter. Play that out enough and you have a doped out society that is quantitatively better on what you choose to measure, but highly toxic, needing bail outs for long term side effects, and making short term labor discounts until you figure out where the no free lunch thereom has stashed the harm.
Also I would argue that professional athletes playing their chosen sport for the entertainment of those watching are doing far more than showing off, they are in fact paid employees of high revenue corporations.
With that said I don't think athletes should be using anabolics nor do I think doctors should be using anti depressants except under the recommendation of a neutral psychiatrist.
Yes, we value professional athletes more as people. However, we value the work of doctors more. In fact, the doctors themselves value the work more. That's why—like firefighters, or rescue workers, or police, or soldiers—they're willing to "burn their lives" (or risk their lives) to get the job done.
Micro-econ 101 isn't enough to explain this effect. You need an understanding of the desirability of jobs (and preference-functions that go into making jobs desirable), and how people are willing to trade off capturing less value as pay, for satisfying more of their other preferences.
You're right that professional athletes are paid employees of high-revenue corporations. Which is to say: they're paid a lot because 1. the corporation is getting a lot of benefit from their work, but 2. the athlete themselves is not getting much terminal-preference-satisfaction from the job itself, and so the athlete demands high monetary compensation for the work. (Compare: coal miners, oil-rig workers, etc. These people have risky jobs that they don't have any intrinsic desire to do; they're highly paid jobs because nobody would do the job if they weren't.) In the case of professional athletes, it's not quite that nobody would do the job, but rather that nobody with as much skill would do the job—the talent pool as a whole is large, but the top of the talent pool (the people everyone wants to see, and so the only valuable people from advertisers' perspectives) is small enough to create a seller's market for that talent.
Doctors, meanwhile, want the job (saving lives) to get done more than anyone else. That's often a large part of why they became doctors—because their preference-function ranks "saving lives" quite highly, so they will enjoy a little "saving lives" more than a large amount of something else. Thus, even though we as a society also value saving lives, we don't have to compensate doctors as much as professional athletes for doing it.
I would also argue that while doctors do indeed want to help people, most of them would not go into the profession unless they were well compensated.
But the number of professional athlete jobs are limited enough that the only the best need apply while there are far more roles for doctors so you get a variety of skill levels and the market prices them as such.
Don't get me wrong I would much rather my money go to educating doctors to the maximum of their ability rather than paying to watch sports. I just don't think the based on the way pro athletes are praised and viewed that society feels the same way. Doctors have unfortunately become a commodity in much the same way as the police and fire departments or sanitation. But doctors have the distinction of working in a very much for profit industry so they are paid more than police, firemen etc. Society does indeed value the role they as a profession play overall more than they do sports but not as individuals but as a service.
My understanding is that there isn't much overlap between the sports with the most highly-paid athletes, and the sports with the highest risk to long-term health. Martial athletes, or even participants in full-contact sports like American Football or Rugby, aren't nearly as well-paid as participants in sports like basketball, baseball, or soccer. Heck, e-sports "athletes" are highly paid as well, and there is next to no long-term health risk in what they do.
I'm not sure why this is true, but I'll hypothesize anyway: corporations don't want to invest in athletes who can't retire to a life of being a charismatic PR mouthpiece for said corporation. If you get permanent brain damage, your value as a spokesperson goes way down. So corporations don't tend to be as interested in those sports—at least, from the POV of sponsoring the athletes.
There's probably an interesting curve you can compute by summing up the "athlete sponsorship expenses" for a given sport, and then dividing it by sum of the expenses of other market-interest-correlated activities that said corporations engage in, like franchise merchandizing or sports video-game production. I would bet that, the more risky a sport is, the less they spend on branding the athletes, in proportion to how much they spend on branding the teams, the country's league as a whole, or the sport itself.
And certainly, kids want to be athletes, regardless of the risk. I would argue that 1. many kids choose this path long before they can accurately weigh the risks and rewards of a career path, and then 2. they get stuck in it, because they (and their parents) have invested so much effort into cultivating their talent in the sport. (It's not simply loss aversion, but more like being 1% of the way into cornering the market on a lottery drawing by buying all the tickets. If you stopped there, you almost certainly wouldn't win, and would just lose all the money you put in; but if you continue, there's a clear point at which winning becomes increasingly probable, so as long as you can continue down that path, you feel incentivized to do so.)
This still means, though, that when you interview the average olympic athlete (the people who have "won" this competition) and ask them what they do for fun... they don't have much to say. They've put everything into this one bet; they have no other talents or hobbies or passions, because they never had time to cultivate them.
> Society does indeed value the role they as a profession play overall more than they do sports but not as individuals but as a service.
Yes, correct, that's closer to what I meant than what I said myself. :) Look at it like buying a smartphone: just because there's huge demand for the product, doesn't mean the average worker at a Foxconn factory is getting rich.
The middle-man—the hospital, in this case—is satisfying the societal demand, and therefore is "getting rich"; the doctors, meanwhile, only get rich to the degree that they manage to negotiate better pay from the hospital. That negotiation is sometimes explicit, but is frequently implicit, with a kind of collective bargaining going on just by social-status moves of doctors as a group causing the salary-level which no doctor with their "pride" would accept, to go up and down. (You can tell that this is happening because of the existence of "free clinics." Voluntary work is different-in-kind, so it frequently crops up in industries where the workers are too prideful to ever work "for cheap." Without this pride, you wouldn't see "free clinics", but rather budget clinics.)
Educated and physically capable men with some wealth typically became warriors in the past. They certainly didn’t become blacksmiths/builders/engineers/whatever. Maybe there’s something to be said for an entire industry and culture around letting this type of person act out their aggression in a less violent way. Probably serves a huge good to a stable society in general, so that the builders can build in relative peace. If you believe that prices reflect value, then definitely more good to pay these dudes to tackle each other than it is to pay for doctors and teachers - Can’t care for the raped and pillaged.
Funny though that now we get the less-fortunate rungs of society to fight the wars now.
There are 2.5 doctors per 100 people. I would imagine there are far less high percentile world-class performance athletes.
Corporations then bid on those scarce high performance athletes against other coporations.
Obviously there are minimum physical requirements to serve in the military, but once you're in you are not going to start saving more lives because you can run a little bit faster.
Modafinil, one of the common study drugs that med students are known to use, is used by quite a few militaries.
Look up the percentages of professional athletes that have ADD diagnosis which grants them a waiver to use amphetamines during a game.
This likely has little to do with mental health.
From this, it's hard to draw any conclusion at all about the prevalence of antidepressant or stimulant use. I'm surprised to see such shoddy work on HN's frontpage; the title is provocative and leads to discussion, but there's nothing to back it up.
It would seem to me the med profession is an ideal place for technology / AI. Docs aren't magicians and House (the TV doc) is fictional.
Furthermore, it would seem to me that the aggregation of patient data / symptoms / outcomes would be more beneficial than the single opinion of the one or two docs that see.
I'm not trying to dismiss the human element or the knowledge / experience of any single doc, but certainly that shouldn't remain so silo'ed.
My father had a (severe) stroke almost 18 months ago. He's doing well and ultimately got good / great care. That said, my sense was most docs favored their (subjective) optinions over what I presumed would be known best practices, etc. Mind you, my assessment is subjective. None the less it was a pattern that existed across multiple shift and med facilities.
As someone that works on healthcare AI, you'll have to believe me when I say AI physicians are the jetpack of the 21st century. The populace might think they're right around the corner technologically, but there's a lot of obstacles, both technical and human that make it pretty unrealistic. The need for physicians isn't going away anytime soon. In the same way, the profession of piloting hasn't been threatened by autopilot.
And let's not forget regulatory/legal obstacles. Even if we convince doctors and patients of the benefits of AI in healthcare we still have to teach the old farts in Washington what AI is, what AI isn't, and convince them it isn't dangerous. Anyone who watched the Facebook hearings can see how steep that learning curve will be.
House (the TV doc) wasn't, IIRC, a particularly-strong example of an intelligent/clever/omniscient/"magical" doctor. House was:
1. willing to do non-therapeutic experimental procedures for the sake of differential diagnosis. (I.e., he was willing to do small amounts of harm to patients in order to get their bodies to tell him something, where other docs would only ever try procedures in DDx that had some likelihood of being ameliorative in-and-of themselves.)
2. good at synthesizing a true patient history from relatively little—and much of that potentially-false—information.
Other than that, he was just a regular doctor (who was a specialist in infectious disease and nephrology) who was good at team-building by hiring experts of complementary specialties, and then focus-firing all that group expertise at the problem at once, rather than doing the standard medical specialist-to-speciaist chart handoff.
Really, any doctor could be House, if they set out to do so and practiced the skills involved. The real fiction was a hospital willing to set up the kind of "diagnostic medicine" department that House headed, where you've got five experts working on one patient at a time.
> That said, my sense was most docs favored their (subjective) optinions over what I presumed would be known best practices, etc.
My impression, from having a few doctor friends, is that "best practice" is generally either old news or p-hacked hooey. There are many therapeutic approaches that very obviously work in clinical practice, even though—according to medical academia—their effect-size is "neligible." (For example: https://slatestarcodex.com/2018/11/07/ssris-an-update/)
Ideally, you'd collect statistics on what doctors believed from informed clinical experience, and then teach other doctors that as clinical best-practice. Right now, though, we just teach them the stuff we've "proven" in academia, and then let the real world slap them in the face later on.
AI diagnostic tools could be useful in some limited circumstances. The problem is in gathering the necessary data (especially coded data) to feed into the AI. So it won't necessary save any effort. The need for human radiologists to read images may decline as pattern recognition technology improves.
And then the local pharmacist corrects it :)
Antidepressants are a terrible solution to depression and should only be used in rare cases. They blunt your feelings so that you can keep on with your depressing life choices with out making the changes you need to be really happy. Depression is an indication that you need to make major life changes. It's not a chemical imbalance.
But, I can go a step further and prescribe a cure for depression that will work for 99% of the population, that means you.
1) Get outside into nature at least 3 times a week.
2) Break a sweat doing some physical activity at least 3 times a week.
3) Spend less than 10hrs combined
per week on your phone or computer doing non productive things like watching shows, flipping through social media or reading HN.
4) Eat healthy food every day.
5) Sleep 8hrs per day. If you are following the above this should not be a problem.
6) Maintain your relationships with family and friends on a daily basis. This means spending time making meaningful connections, perhaps doing some of the things listed above.
If you do the above consistently for at least six months and don't see significant results then perhaps you need the drugs but the drugs will have subtle but profound costs in terms of quality of life.
If you are unable to do any of the above then you are not living in an environment which promotes good mental and physical health.
But hey, it's so much easier to pop a pill and everyone else is doing it.
"Depression is an indication that you need to make major life changes. It's not a chemical imbalance" is about as un-researched and un-qualified of a statement one could make. Google Scholar exists. Wikipedia exists. Everyone is has access to these resources.
In my country, it's six years long.
Yup. The reason being is that the prereqs for med school are all classes you need to take as a bio major anyway.
These are the common prereqs (each school is slightly different, which is stupid):
1 yr biology
1 yr general chemistry
1 yr organic chemistry
1 yr physics
1 yr calculus
1 course in writing
This seems far from a foregone conclusion. What makes you think that people use prescription drugs without regard to their life circumstances?
Many people acquire prescriptions for their stimulants of choice based specifically on their life plans. I literally personally know two people who, in preparation for (one medical, one law) school, secured supplies of amphetamine from their doctor.
And Johns Hopkins estimates 250K deaths a year from medical errors. I wonder how many of these are from lack of sleep.
The big difference between writing code and doing medicine is that patients won't stay the same when a doctor leaves for the day. With 8-hour shifts and 40-hour weeks, covering a patient around the clock requires 4-5 people. Those people will have 21 handoffs during that week. Each one of those handoffs is an opportunity for information to get lost, for understanding to fade, for followups not to happen. If people work 12 hours, that's only 4 handoffs. 16 and it's 10. 24 and it's 7.
Obviously, at some point the harm from overwork outweighs the harm from handoffs. But it's not an easy decision to make. When I'm debugging some weird, urgent problem, I know how valuable it is to stay with it, to keep all the state loaded in my head until I figure it out. And hospitals are full of weird, urgent problems.
When I had back surgery, due to a miscommunication in the nursing staff turnover I wasn’t given any pain relief 3 hours after a major surgery until late the next day.
My grandmother was given PT on the wrong limb. Again, poor handoff.
A friend got a big congratulations from the OB doing rounds when she was in the hospital. Small problem: she was there for complications of miscarriage.
In particular, both OB and PT on wrong limb are not just handover errors. First I am bit surprised that babies and miscarriages mix - they don't in here (so you know which it is based on room, but I think cause of split is something else). PT on wrong limb is error of not checking what you are supposed to do before administering - but also sounds like error people are more likely to do under time pressure or when tired and falling into routine.
All in all, after major procedure you are in hospital for days and they have to move you between doctors and nurses many times.
Surgeries performed by the Ob/Gyns are housed on a specific floor. The situation was that there wasn’t a transition as the shifts changed due to understaffing, and the person doing rounds didn’t bother to read the chart.
In my surgical recovery state, the reasoning was poor situational awareness and burden on the nurses. Data was located in 4 different EMRs and they missed it.
Half my family is engaged in various medical professions. Every one of them is dissatisfied with how these systems work.
The "it is totally impossible without 28h+ regular shifts" sounds like team in first category.
Not blaming individuals here, these problems are cultural and systematic and largely steam from leadership.
They need to solve the problem with handoffs. It's a big problem, and problem requires rewriting a lot of the process, but there's nothing more to it. It's solvable.
The institution however, has beaten any imagination out of them and replaced it with resistance to change.
Maybe someday AI and NLP technology will serve to automate much of the data capture, but we're many years away from those technologies being a practical reality.
That said, the arguments for the status quo are laughable. There's no other field of human endeavour where people claim that 24 hour shifts are >safer< than 8 hour shifts. It's not like handoffs have even been eliminated: handouts are just done 3 times less, but by profoundly sleep-deprived people, who have to reiterate the last 24 hours to the incoming staff.
When people defend behaviours of this nature, it's a 'culture smell': to a greater or lesser extent, the proponents have been indoctrinated to cling to a local maxima.
The reduced fatigue is offset by the increased number of patient handoffs between shifts. More handoffs = more errors. My wife is a resident and she supports 30 hour shifts for residents for this reason. The difference between your judgement at hour 23 and hour 29 is less of a risk factor than a 20% increase in handoffs.
That is, what about the hand off is so risky? Are we fixing that?
Too many hackers make the mistake of thinking that human bodies are deterministic machines that respond consistently to inputs just like computers. The reality of medical care is far more complex.
And, I do want to echo the sibling post. Just because I am asking questions like this does not mean that I am not thankful for the job you do. Thanks!
Just with the two you gave, automating the recording of lab results should help. Such that you never have to copy from a readout to a record. That should just happen. (Consider how many shipments and other things are transferred with minimal errors every day.)
Similarly, why have a shorthand that is known only to you? We have plenty of things like that in computers. Not everyone has my macros. That said, they expand to known things. Or contract from them.
So, I would hope we have folks working to help in this area. I'm not convinced we don't. I do think it gets presented adversarially all too often. There is no need for that.
That said, I meant the question genuinely. I suspect that we aren't just ignoring the problems.
What about the difference in judgement at hour 8 vs hour 29? Honestly, the fact that there's not much benefit for working "way too many hours" vs "way too many hours + 6" doesn't surprise me. It's the difference between "a reasonable number of hours" and "way too many hours" that should have more of an impact.
And how much would handoff issues be reduced if everyone was working an 8 hour shift?
It's a feedback loop. Those residents are working themselves to the bone aiming for a big payoff in a high prestige, high income profession.
The fix you want is isomorphic to just hiring a bunch more doctors to handle the workload, which will dilute the existing pool making it both lower income and lower prestige.
Basically, Residents are willing to work hard because they want to be part of a profession where residents have to work hard. That's not really an issue of regulatory structure (though I totally agree that work hour limits are a common sense thing that should absolutely be enforced by some authority).
This is a very good idea and we should do this.
A lot of the deaths from lack of sleep wouldn't be counted as medical errors. E.g. medical errors includes accidentally doing surgery on the wrong person, but doesn't include fucking up a surgery that you actually need to do. C.f.:
That is so true. During my Zivildienst, for nurses were required either by law or by collective agreement to have at least ten hours of free time / rest between two shifts. The morning shift was 06:00 to 14:00, the late shift was 13:00 to 21:00, so if somebody worked the shift one day and the early shift the next day, they could either leave an hour earlier on the first day or come in an hour later on the second day. But Doctors working 24 hour shifts were not seen as a problem.
In Germany, this is weirdly intertwined with the pay structure of medical doctors, so any attempt to improve working conditions would also result in lower wages, which the medical doctors do not like, either, so the whole situation is somewhat stuck.
EDIT:  When we had a military draft in Germany, one could become a conscientious objector and serve in a civilian institution instead, for example Hospitals or nursing homes.
He mentioned the guy that started the residency program, Halstead, in John Hopkin turned out to be a cocaine addict. He stressed that a doctor needs to work all the time. No one knew about his drug addiction until he had passed away.
He even tried to get rid of the addiction by checking into a rehab up north but came away in addition to the cocaine addiction but also a morphine addiction as well.
Actually, residents have them too. They can work upto 24 hours straight plus 4 more hours for "transition".
Yeah, the that's right. The residency governing organization said 28 hours straight is completely acceptable - and preferred in some situations.
Heart disease: 635,260
Accidents (unintentional injuries): 161,374
Chronic lower respiratory diseases: 154,596
Stroke (cerebrovascular diseases): 142,142
Alzheimer’s disease: 116,103
Influenza and pneumonia: 51,537
Nephritis, nephrotic syndrome, and nephrosis: 50,046
Intentional self-harm (suicide): 44,965
This would have been more interesting if antidepressant usage were isolated.
That seems to exclude caffeine from coffee.
Ctrl-f for 'coffee' to see some sample responses.
To compare the 2, the amphetamine feels more artificial bodily wise. However ingesting about 500mg caffeine has the similar bodily feel as 10mg amphetamine. Given the amphetamine did some tricks like time delayed whereas the caffeine did not, does make it harder to compare. The caffeine did stay just as long, and provided a much longer bodily high.
These days, I just drink coffee and stay away from pills and powder. Safer.
How do alcohol and cigarettes not fit this definition!? Meanwhile, edible cannabis is relatively safe and Ecstacy has shown promise as a component of PTSD treatment. Just a few examples...
"Well, marijuana is a schedule 1, so we can't test it for legitimate applications. And since it's schedule 1, it has no medical applications".
There is absolutely no scientific or chemical basis of "schedule". It was originally a way for Republicans (Nixon, Reagan, etc) to use the law to arrest hippies and black people. And we have no further to look at crack/powder cocaine and sentencing disparities. Crack was inner city and primarily used by black people. Whereas powder cocaine was used more by whites outside of the inner city core.
They are both stimulants. I've done both, like I said. So yes, for my body (n=1) I can indeed compare them. And it was sincere and honest.
And the only reason why caffeine isn't schedule 2 is the same reason why alcohol and nicotine isn't either. That's purely a societal reason, and no basis in chemistry. If caffeine/coffee was discovered last year, it would be schedule drug. Look no further than kratom.
It also has some nasty side effects that come with abuse. Mental problems being the first ones, depression, anxiety, mood swings ...
What difference does it make if it's a prescription stimulant?
What if the headline had said "75 % of med students are on drugs" but actually it just means that 75 % of med students occasionally take acetaminophen or aspirin for headaches? Those are indeed drugs, but wouldn't you feel misled? People drinking coffee is not newsworthy, so one wouldn't expect an article about it. I haven't looked at the data the article is based on, so I don't know if something like this is what's going on, but I think this is the point village-idiot was trying to make.
Sorry to be do blunt but casually ignoring things like modafinil which seems to be the go to drug for staving off sleep if you want to be able to pass drug tests is a bit of a mistake.
Subjectivly most users of modafinil find it "weaker" than coffee because there is no rush associated with it as there is with coffee, you just can't sleep when you take it.
So if the point you're making is actually just virtue signalling with the "well some drugs are worse than others because I guess they are classified as controlled?" bullshit then please provide an actual reason why the comment was disagreeable.
The point the comment was making was very simple: providing a single percentage that includes as a category things that are very different is misleading. In the extreme, saying "95% of the US takes painkillers at a rate considered addiction" where painkiller is defined as aspirin or heroin, is not a very useful metric
2. I'm not judging people who use any of these drugs, whatever their purpose. If it were up to me, all drug laws would be repealed and the state would have no say about what anyone is allowed to put in their own bodies. I'm only pointing out that there are stark differences between caffine and drugs like amphetamine, methylphenidate, and, yes, even modafinil, and lumping them all together as "stimulants" isn't useful to this discussion. (If modafinil is no better than caffeine, why does anyone bother going through the hassle and expense of obtaining it when caffeine is dirt-cheap and easily accessible?)
This discussion is not about villifying drugs or people who use them, it's about the unreasonable, inhumane workload that medical students are expected to handle. If 75 % of medical students feel the need for and take steps to obtain prescription drugs, whether illegally or by getting a prescription, then there is clearly something wrong with medical school. If 75 % of medical students drink coffee or other caffinated beverages, that is not a cause for concern (for me, at least).
If I considered walking across the room as a form of workout, I could pretty confidently say that 99.99% of Americans exercise once a day. But that wouldn't yield me much in the way of insight.
No, you are wrong. Mental health among doctors is a huge issue in the field right now. In some states having a recorded case of depression is enough for you to have a license review.
Behind closed doors everyone will tell you to lie about your mental history. If you need help, you better make damn sure you're going to someone who will take cash and not keep any records of your appointments.
Doctors are literally having their entire careers put at risk because they admit they're human.
(Reddit thread discussing that article)
That is absolutely ridiculous, the ADA doesn't imply that anyone with any disability needs to be accommodated for any job, just that reasonable accommodation be made. For instance, someone in a wheelchair will be unable to do many jobs, regardless of accommodation,such as framing carpentry and roofing.
As someone who has gotten ADA accommodations related to mental health, there are absolutely limits. Due to my hand tremors, no hospital in the nation would allow me to be a surgeon, regardless of qualifications. Ditto for police departments, due to said mental-health issues.
I believe even the police are subject to the disabilities laws, the medical profession too. In which case they most likely can't even ask.
(Not a lawyer, just a bumbling Internet commentator, you'd be insane to take me seriously, etc)
However, which jobs would a person with a psychiatric disorder be disqualified for? Couldn’t one argue that all jobs that require a brain would be off-limits? Probably not, but where is the line drawn?
And for some jobs, e.g. you want to work undercover for the CIA as a field agent, your mental state is not what would be strictly considered normal.
You can bet that almost everyone in these jobs has some skeleton in the closet that would officially be a problem. Some years of depression or other psychiatric illness, a proclivity for scandalous sex, having used an illegal drug a couple of times or even regularly, an unofficial child somewhere, some hidden medical issue that popped up once and was never talked about again, etc. With the common case that the issue has little, no or even positive effect on job performance.
This is anecdotally true from off-the-record conversations with exceptional individuals I know. The list of disqualifying parameters is just there so the bureaucrats can cover their ass when an aneurysm causes the loss of a billion-dollar aircraft, and to prevent blackmail with information that can be easily found.
But regarding blackmail, I think the bigger problem is that honest and harmless things can be used for blackmail in the first place. Everyone has smoked a joint and had some compromising photos taken, it shouldn't be such a big deal.
This is like telling someone "we need to figure out how to use technology to prevent people from spending years of rote memorization before they can speak <X_foreign_language>!"
Also, this is what happens in practice anyway! Doctors don't remember a lot and constantly have to look things up ( as is understandable and expected ). You must be a master of the "grammar of medicine" though. Otherwise you won't be able to construct well formed sentences... aka medical thoughts.
You need some memorization to give some concrete instances of the grammar, of course; however, going overboard on the "vocabulary" is not constructive and shifts the focus onto knowing a lot of words, not knowing how to construct great sentences. It's like a writer that knows a lot of uncommon words, but ends up having nothing meaningful to say... because the power of writing is not in the vocabulary alone, but in the craft of composition.
They don't bootstrap this search every time. Enough of the basics have been instilled that they will know what they should look up.
For example if you named the bones in the fingers as left, thumb, two then it’s little effort to recall. Instead people need to recal the stuff like distal phalanges. Math is arguably worse with redundant notations for the same thing. So, I see the benifit of avoiding creating multiple systems.
PS: I would include tendons, joints, and muscles etc not just 206 bones in that example. Also, that was rather off the cuff as left/right could confuse things so maybe you want port vs starboard or something.
What's your point? It seems to be that medical terminology (or the expert body of knowledge that distinguishes someone with anatomical or medical knowledge from the layperson) is an artificial construct which imposes undue restrictions on the easy transfer of this knowledge - guild behaviour.
Every realm of knowledge has its own language which must be learned in order to be proficient. In briefly reading your other replies in this thread, it seems like you feel that computing and programming don't have these restrictions - that is absolutely not true, just ask anyone who has been trying to learn programming themselves but is stuck on the difference between a method and a function (only to find out they are the same thing).
It is not possible to be an expert without gathering the knowledge, the language, and the real understanding necessary to partake in the field. Anything else is simple arrogance, to assume that any specialised field that people spend decades learning, is actually just arcane crud and cruft that disguises the simplicity hidden within
Math however is trying to be as clear as possible and more elegant notation generally though not always wins over time. Mathematics don’t still use Roman Numerals even though they worked.
PS: Languages change over time, programmers dropped the term subroutine. This can look messy, but it’s benifical over time.
I understand your last comment about languages changing over time (technical languages) - medicine is no different. See for instance the Dukes grading of bowel cancer, now largely superceeded by TNM Grading which carries specific histological and pathological meanings (as dukes does) but is applicable to all cancers.
Ah, yes, the best way to learn all the intricacies of a human: osmosis.
Good luck attaining knowledge that takes 8+ years of focused study in medical training today through osmosis over 30 years of "on the job" training, being paid $0 because you are still "learning" and can't contribute to anyone's actual medical care during that time unlike a resident physician.
“Distal phalanges” are the far away phalanges, which are the bones that are in an array like a phalanx in the extremities.
The problem is that language changed after that, and the expectation for those words to make intuitive sense changed in the broader culture doctors were pulled from.
They’re then faced with having to rename everything, breaking with the established record and creating confusion or having to explicitly teach the names.
I’m also curious what you think is redundant in math notation.
Taking classes that use different notation for the same thing is annoying.
That said, I started with: ‘Math is arguably worse with redundant notations for the same thing.’
He asked “I’m also curious what you think is redundant in math notation.”
3,4, residency: poorly compensated labor
Residency is after medical school, and that's the first time you start earning a meager paycheck. In medical school, even when you're "working" with patients, you still pay tuition.
Med students are probably the most numerous users of spaced repetition tools like Anki. The rest of us are doing it the inefficient way.
I would greatly prefer my doctors to not skip up-front memorization.
I would have thought that name "spaced repetition" explains why.
(Before somebody complains of layman mob rule, remember checking a proof vs inventing a proof does and should require far less expertise.)
What technology do you anticipate using? Johnny Mnemonic neural implantation?
Medical school today would be like learning programming by memorizing the x86 ISA spec.
Which is a pre-med subject.
There is a minimum amount of material in any subject that needs to be available for rapid recall in order to be an expert in that subject.
A wide variety of different areas have been studied to relate performance to level of learned information. Linguistic fluency requires easy recall of vocabulary. High rankings in chess depend on the recognition of thousands of distinct patterns. Musical improvisation requires thousands of hours of tedious repetition and practice. Effective programming requires a body of knowledge encompassing a variety of topics, a lot of which will be memorised as a side-effect of repeated exposure.
But if you think you can be a better doctor than a doctor by scanning the indices of medical textbooks -- realising a little late that you are unfamiliar with a lot of the terms and also unsure in what order the concepts need to be assimilated before you can apply them -- then at least make sure your will is up to date.
I'm all for a liberal arts approach of understanding other layers of abstraction for more context, but empirically this is not how the vast majority of premeds experience the orgo requirement. And if liberal arts was really the goal, then corresponding amounts of public health classes would also be required (layers of abstraction above and below at equal distance). But that's not the case. Clearly then it's not about a broader perspective but instead about weeding people out arbitrarily for sake of some combination of wages and egos.
I'm not a doctor or on that track. But I am a musician and programmer, at say 1000+ hours for the former, and 10,000s of hours for the latter. Not once have I engaged in flash-card-style rote memorization for either, especially not for any written test. I am certainly full of random facts by now, but the knowledge I hold most valuable is not that which I could also get from API docs or stack overflow.
No doctor, med student, or premed I have ever met studdied their field remotely like the ways I've studdied mine. Is being a doctor inherently that different? I can't see why not, and if I look at economics and public health research the arguments I give leap out at me.
(I also studdied Chinese for a few years when I was younger and definitely did not do enough flash cards. Now that is a field (language learning) where rote memorization is inherent to the problem at hand.)
My wife is in med school. It has nothing to do with technology.
It comes down to an insane risk aversion present throughout all of medicine. If you can't prove an alternative method is empirically better, it won't even get tried. If it's not tried, you can't get the numbers.
Even when things are obvious improvements or carry limited down-sides, the whole medical field is hesitant to pursue them.
There IS technology that does help with memorization. Many, many students use Anki for spaced repetition. Most subscription study sources offer some kind of spaced rep (USMLERx Flash Facts, Firecracker, etc). There is also Sketchy and Picmonics for pictorial memorization of microbes and drugs.
Most doctors aren't researchers. You don't need that much education to practice medicine and fit the role of what people need when they seek a doctor. It has to change, because the current state of affairs is out of control. People are losing all that they have to the raping of the medical industry.
You can't practice medicine without knowledge. You can't learn how to practice medicine without knowledge.
What knowledge is required?
medical ethics, et cetera.
If you don't have a knowledge base, you simply can not practice medicine because you don't understand how things actually work...
Critical thinking without knowledge isn't critical thinking, it's ignorance.
Nonsense. Why does a heart surgeon need to know anything about psychiatry? What does a radiologist need to know about cellular biology?
The equivalent for programming would be forcing someone to understand how transistors work at the atomic level, CPU architecture, and OS structure before letting them write a webapp. It's definitely one of the problems in medicine. There's way too much useless knowledge required leading to a limited supply of people being able and willing to master it. Plus, it makes it much more expensive and time consuming to train all of those people.
They seem to follow a pretty similar career arc. If you take a typical CS grad they're going to go through a couple years as a junior dev, couple more as a more senior one, and then five years or more in they are ready to be in charge of their own project. That's pretty similar to the intern -> resident -> attending pattern that doctors follow.
Honestly, the biggest difference between having a career in programming and being a doctor is the gate keeping. In programming, you can drop out of high school and 20 years later be an expert in the field. There's a path for talented people to go from junior -> dev -> senior -> lead -> principle -> whatever. There's no path like that in medicine. Sure, as a nurse you can go from LPN -> RN -> NP but that's where it ends. Your only option at that point is to spend 4 years and hundreds of thousands of dollars. And there's really no reason for that.
Heart surgeons have patients with psychiatric problems. And patients are typically on psychiatric medications, which have cardiac side effects.
More broadly, heart surgeons are also general surgeons, and some psychiatry base knowledge is necessary to understand their patients.
Heart surgeons don't have to be psychiatrists, but they need some knowledge in it, which is why it's a 4 week rotation in medical school.
Which they don't treat. That's why we have psychiatrists.
>And patients are typically on psychiatric medications, which have cardiac side effects.
Which is something a cardiologist should know. Knowing which mental illness they treat and how it does that isn't relevant.
Medications that are prone to abuse, ones that may be more complex to take, ones that can be dangerous if someone takes too many... all are things the cardiologist should be aware of which takes some basic psychiatric knowledge.
There are few in cardiology, but many physical health meds can definitely create psychiatric side effects. How do you differentiate those from an existing psychiatric illness?
There's a large body of literature that recognizes the links between cardiac care and mental health, resulting in poorer outcomes, increased system utilization and costs, etc. Saying "this is my area, that's yours" exacerbates this problem.
> Which they don't treat. That's why we have psychiatrists.
People with mental illness also have heart problems that need heart surgery. It'd be nice if heart surgeons had a bit of understanding of psychiatry so they can avoid diagnostic overshadowing. This is a significant problem that contributes to the shorted lifespan of people with severe mental illness.
It's difficult to unhorse a debating partner who refuses to allow any evidence but their own imagination.
Oh nonsense. There's plenty of evidence that lower trained providers are just as effective as doctors.
Midwives are equal or better than doctors:
No difference between Nurse Practioners and Drs:
Of course we don't have studies comparing what the equivalent radiologist not because it's strictly impossible for it to happen. But because it's strictly illegal.
There's also evidence that the way doctors are trained isn't the only possible way.
Humanities and social science majors who omitted organic chemistry, physics, and calculus, and did not take the MCAT do just as well as traditional students:
Performance in medical school does not correlate with performance in residency:
>Just let it go. You are making an apex fool of yourself in the eyes of each and every health professional reading this
Put up or shut up. Where is your evidence based argument that cardiologists who have a psych rotation have measurably better patient out comes than those that don't. Or that a radiologist with more biochem knowledge is a better one?
Or does your self-righteousness exclude that 3 professionals telling you you misunderstand could maybe have a point? I certainly earn less than you do and have no MCAT, does that make me more truthful? CRNAs also have to learn a lot about cell biology, is that also useless cruft? Something that is taught in med school is to critically review one's own reasoning!
Forget your petty certitudes and slow down. If there was an easy way to do much better, even the AMA could do nothing to stop it. I certainly don't expect to persuade you and therefore will not take the time to "put up" and brandish more useless Cochrane reviews, but you might consider the remote possibility that you are wrong. And extremely arrogant.
Go hide under a rock!
Medicine doesn't resemble neatly modulular systems with crisp APIs. A nodding familiarity with distant specialities is required because very frequently a patient cannot be well-treated by a single specialist.
I have a psychiatrist, an endocrinologist and an orthopaedic surgeon. They all take an intense interest in what the others have investigated, diagnosed or treated. More to the point, they have enough overlapping knowledge to profit from their interest.
> The equivalent for programming would be forcing someone to understand how transistors work at the atomic level, CPU architecture, and OS structure before letting them write a webapp.
Webapps don't often come down to distinguishing between conditions which are benign through uncomfortable, disruptive, disabling up to fatal, and besides, our hardware cousins have striven mightily to hide the messiness of reality from us. Medicine doesn't have improvable subject matter to protect it in the same way.
You can’t just delete the baseline foundational knowledge.
A given radiologist shouldn't be predicting the imaging manifestation of cellular disease. They should be using their knowledge of how known diseases or conditions appear on scans to diagnose the issue. The people that need to understand things on a deeper level are the ones trying to devise new tests or scans to expand front line radiologists diagnostic abilities.
Radiology is a particularly egregious case. If it weren't for legal protection the profession would be dramatically different. It's obviously stupid to spend a bunch of time training them to interpret and diagnosis a bunch of different scans. Basic efficiency would be to train Person A to interpret chest X-Rays, person B to do CT scans, Person C for leg X-rays and have them spend all day doing that one thing. Instead, radiologists spend a decade learning how to interpret a hundred different things and spend 1/100 of their time on each of them.
In other words, let's say that a patient has a fever. Chest X-ray was done.
High-school educated "radiologist" sees the image. Does he understand the anatomy? The variations of anatomy? Pathological manifestations of potential causes of fever? How to exclude image artifact versus include potential sign of pathology? What about findings that are not related to fever but need to be identified, further characterised and further imaging required for follow-up? What about signs of infectious fluid versus non-infectious fluid like blood or extravasated fluid?
What about when the ordering physician wants to discuss the findings with the "radiologist"? Will that "radiologist" actually understand anything that the physician is talking about?
There is a role for AI assisting in rapid analysis of radiological studies, however radiologists can never be replaced because AI will never perform to the level of or have the same functions as a physician radiologist.
Because you're looking to identify patterns and match them to known ones. To use an analogy, I can teach you to identify statues of Hindu Gods without teaching you anything about Hinduism. For example, to identify Ganesh you need to know that he has an elephant head. Knowing that he has an elephant head because Shiva cut his human head off doesn't really help you.
>In other words, let's say that a patient has a fever. Chest X-ray was done.
>High-school educated "radiologist" sees the image. Does he understand the anatomy? The variations of anatomy? Pathological manifestations of potential causes of fever? How to exclude image artifact versus include potential sign of pathology? What about findings that are not related to fever but need to be identified, further characterised and further imaging required for follow-up? What about signs of infectious fluid versus non-infectious fluid like blood or extravasated fluid?
All of the things you mentioned are things that a radiologist interpreting a chest X-ray needs to know. What you need to explain is why someone interpreting a chest X-ray needs to understand Organic Chemistry. And the vein structure of the leg. And the typical development pattern of a child. And the various mental illnesses a person might have. And interpret a knee MRI.
>There is a role for AI assisting in rapid analysis of radiological studies, however radiologists can never be replaced because AI will never perform to the level of or have the same functions as a physician radiologist.
No, but I could easily take 10 people, train them each 1/10th of what a radiologist studies, and have them perform just as well as 10 radiologists by routing the right stuff to the right person.
While specialization is coming to all of Medicine, we tend to cluster by body region/disease state, rather than by modality. This is because all of the modalities provide complementary information and you must be able to cross reference across the various manifestations of disease.
All of medical knowledge is iterative. Unlike programming, you can’t just abstract the low-level programming. The premedical curriculum provides the baseline knowledge to understand pharmacology, which is essential when trying to understand our interventions in physiology and pathophysiology. We need to know both physiology and pathophys when interpreting imaging to know how disease manifests and what is abnormal versus post therapy related change.
We have to know how referring clinicians will treat disease, and know the major complications to look out for on imaging. We discuss their treatment plans during tumor boards and need to speak the language of the treating teams so we can tailor our interpretations to be useful.
There are no easy shortcuts here. NPs and PAs are a living experiment at a shortcut, but what I see day in and day out is that the people they consult (radiology and pathology) need to know even more clinical medicine to help the inexperienced NP or PA in knowing what to do when something happens that deviates from the protocol. Many many many times I will call with a semi-urgent unexpected finding, and just get silence on the other end of the phone. They don’t know what to do, whereas on weekends or nights when I get residents or attendings, I don’t hear this complete absence of understanding.
>While specialization is coming to all of Medicine, we tend to cluster by body region/disease state, rather than by modality.
These are contradictory statements. If Doctors typically go:
No Training -> Trained in everything -> Specialized in body region/disease state
You can easily go:
No Training -> Trained in body region/disease state -> Specialized in body region/disease state
So even if we assume it's not possible to specialize radiologists any further than they already are we can still cut the training time and difficulty.
>We have to know how referring clinicians will treat disease, and know the major complications to look out for on imaging. We discuss their treatment plans during tumor boards and need to speak the language of the treating teams so we can tailor our interpretations to be useful. We need to know both physiology and pathophys when interpreting imaging to know how disease manifests and what is abnormal versus post therapy related change.
No one is denying that there are things in medicine that are complicated and require very skilled people. What you describe is the end state of a fully educated and experienced doctor. Medicine is more or less the only field that makes you become that before you start working. Can you take a reasonably smart person off the street and have him designing plans to treat tumors in a year? No. Can you take that person and train them to identify normal appearing lungs vs cancerous ones in that time? Probably. And can that person learn on the job and develop the ability to design a treatment plan over the course of 10 years working? For sure. And they wouldn't learn everything taught in Med school. They would pick up only the things relevant to the job they are trying to perform.
>All of medical knowledge is iterative. Unlike programming, you can’t just abstract the low-level programming. The premedical curriculum provides the baseline knowledge to understand pharmacology, which is essential when trying to understand our interventions in physiology and pathophysiology. We need to know both physiology and pathophys when interpreting imaging to know how disease manifests and what is abnormal versus post therapy related change.
Going back to the comment that kicked this all off. If I handed you a cellular biology final from Med school do you think you'd be able to pass it? What about the USMLE?
>There are no easy shortcuts here. NPs and PAs are a living experiment at a shortcut, but what I see day in and day out is that the people they consult (radiology and pathology) need to know even more clinical medicine to help the inexperienced NP or PA in knowing what to do when something happens that deviates from the protocol. Many many many times I will call with a semi-urgent unexpected finding, and just get silence on the other end of the phone. They don’t know what to do, whereas on weekends or nights when I get residents or attendings, I don’t hear this complete absence of understanding.
Every other field has the ability to take inexperienced people and make them experienced. There's no reason medicine can't do the same. Your clueless NP and PA should have more experienced people to go to for help when they experience something new. The next time they get that call they wouldn't be as clueless.
As far as your targeted questions, yes, I do think I would pass a cellular biology test from medical school. I wouldn't get 95%+ but I would expect myself to get at least 80% correct.
I'd estimate the overwhelming majority of practicing physicians would pass the USMLE if they took it cold. They probably wouldn't do as well as they did after many weeks of dedicated study, but they would be above the minimum threshold.
It's not because you can't start on the path without going to medical school. And you don't need medical school to start learning radiology. I messed up my elbow in high school. They showed me the x-ray and said this is a fracture, this is a chip, etc. It wasn't difficult to understand and with enough time and practice I'd be able to see them in other x-rays. I don't see where something like Organic Chemistry comes into play.
>As far as your targeted questions, yes, I do think I would pass a cellular biology test from medical school. I wouldn't get 95%+ but I would expect myself to get at least 80% correct.
So ~20% of what you learned in cellular biology isn't needed as a radiologist assuming you only remember what you've actually needed.
From what I can tell in this exchange is that you have an innate distrust of credentialing, because you think because there is some excess therefore the entire system is wasteful. I’d argue that this is the DunningKruger effect in action.
And claiming that 20% of cellular bio is unnecessary is a silly metric when in the US 70% is passing... I don’t think that logical conclusion applies.
Yes we have more tools to look up information that we have forgotten, but as another poster here says “we aren’t bootstrapping the search each time”. If there’s something we’ve forgotten, it’s much more effective knowing where to start the search.
I agree there’s a lot wrong with our current training paradigm; the cost of medical school education is #1 with several terrible downstream effects.
However, there are no shortcuts. You have to put in the time to master the material, else you are doing your patients a disservice.
>And claiming that 20% of cellular bio is unnecessary is a silly metric when in the US 70% is passing... I don’t think that logical conclusion applies.
You're saying that you don't know 20% of cellular biology that they teach in med school. You are a practicing radiologist. Therefore, 20% of the cellular biology they teach is not necessary to be a radiologist.
I have certifications in my field. Developer, Senior Developer, and Lead Developer. If I were to retake the tests, I'd get a 100% on the Developer and Senior one without studying for a minute. Those are good tests. They reflect what you need to know to be effective. The Lead one isn't. I'd probably not pass if I took it today even though I've worked several years as a lead developer since I passed it. So despite actually working in the field and becoming a better developer I'd do worse on the test. That means it is a bad test.
So when you say that the overwhelming majority "wouldn't do as well as they did after many weeks of dedicated study" that makes it a bad test. It means that a good chunk of it is meaningless hoop jumping irrelevant to practicing physicians. A competent practicing physician should breeze through a well designed certification exam.
>I agree there’s a lot wrong with our current training paradigm; the cost of medical school education is #1 with several terrible downstream effects.
>However, there are no shortcuts. You have to put in the time to master the material, else you are doing your patients a disservice.
If someone who wants to be a geriatric doctor skips pediatrics I don't see the disservice. Or take someone like a registered Nurse Midwife. Someone with 20 years experience delivering babies. The only way for them to become competent to prescribe pitocin, antibiotics, or use forceps is 4 years and $200k worth of school? It doesn't pass the smell test.
That's not a meaningful test of correctness.
Many medical practices are organised as you describe (for example, surgeries specialising in nothing but hernias), but medical cases often transcend simple boundaries and a broad amount of understanding is required to detect that boundary violation (such as realising it's not a hernia, or that an organ near the hernia seems to be diseased, or that the patient is going into anaphylactic shock because of a surprise reaction to anaesthetics, or ... or ... or ... or ... ).
And if I go into anaphylactic shock during my hernia surgery should I be grateful that my surgeon did a Pediatric, OBGYN, Neurology, Psychology, and Oncology rotation? Or that they can draw the Krebs cycle?
Okay, that was sarcastic. But in my view no doctor knows all of those subjects in depth. Pre-med students take the basic STEM courses in order to pass their MCAT's, and then forget most of what they learned, and those courses were all just superficial intro courses anyway.
To be fair, the same can be said of most engineers.
Many med students (wisely) major in a STEM subject, so they may get into more depth than someone who majored in some kind of "studies." But what they know is a function of what they actually studied, learned, and kept up with after college, which does not make me super optimistic.
Do you remember every detail of your first grade education? Probably not, but it has served as a foundation for everything else you learned in life. How do you learn calculus if you don't learn numbers and letters?
Different people have different strengths and collaboration is all about enabling others to use their strengths. You do not need to learn most of the things on your list before you can make a positive contribution to medicine. Your list would exclude most physicians from contributing.
The problem is doctors (and lawyers) are the best unionized workers in the country. I'm all for unions, but when a certain group of laborers is much better protected than everyone else, and their work legally distinguished creating extra monopoly power, the asymmetries erase the benefits to society.
1. All the memorization acts as gatekeeping to tighten supply. This is in addition to other explicit quotas.
2. Young post trainees (residents, young associates) do the boring drudgery (and in medicine are under-compensated relative to later). This internally is a hazing ritual, pure and simple. Externally, this is again terrible for productivity. Reducing the drudgery at the top of the food chain removes the psychological yearning for improvement from those with more power. And in the resident case exacerbates the lack of competition which would force change.
The long hours of residents + stigma talked about here also exposes the rank hypocrisy.
And yes the institutions that most want to pay doctors left are totally untrustworthy with that money. So I am not advocating letting them do that.
I guess I'd like:
1. Government health care. Nobody can rationalize the value of their life on their death bed; markets make no sense for health.
2. After that (which fixes the deepest problems), switch to an apprentice style program where everyone starts as a nurse, and then some go back to school to learn more.
The way society valorizes doctors above all (including, implicitly, nurses) (this "last line of defense stuff", etc, etc) strikes me as ungrounded and, frankly, classist or sexist in many instances. There are other well-meaning individuals, and focusing on the individual level, whether patient or care-giver, is not the right approach to systemic problems.
1. Do the job that is traditionally yours.
2. Handle all the impromptu alone because no one else will do it.
The second part is the problem, and is largely due to ressource constraints.
What's clear is that the system is already in pretty bad shape, so I'm just saying that the frontline workers are not a suitable target for pressure.
BTW your view regarding the nurse to doctor transition would have been ok 50 years ago. Nowadays, nurses are hyperspecialized in their own niches. If you meant to say "you should know how to make a bed before doing heart surgery", I heartily agree that it would do great good to everyone if docs were to experience what life is lower down the care ladder.
I was aware that nurses are far more trained today. But is their training that orthogonal to the doctors? I was thinking doctors starting with nurses in tandem with nurses allowed to operate more machines, do more radiology, etc.
You may also be surprised by the fact that specialist nurses are well paid and would often never want to "upgrade" to being a doc, precisely be cause of the additional constraints. Finally, the ego of specialist nurses rivals that of docs, and they are even stronger unionized.
I don't think it's really possible to keep the same quality of care for cheaper by changing education because armies of residents and fellows are effectively doing slave labor and you'd have trouble finding cheaper and more efficient than a highly-trained slave. In my opinion, well applied technology is the only long term solution.
Great job enjoying such circumstances, but the evidence would point to it being a sub-par way to have residents perform at their best. Surely we could have regular-length shifts (with fixed start times so as to work with a reversed circadian rhythm) and more overlap to solve the patient hand-off problem.
At a bad medical school, maybe.
Pretty much anything can be taught as blank facts, versus a method that stimulates critical thinking.
Programming, for instance. ;)