I’m not sure transactional is the right word. The problem you are identifying is physician bandwidth, or more fundamentally, insufficient physician supply to meet medical demand, which leads to lower quality care.
That doesn't sound quite right to me. There is a lack of physicians, especially family/general, which makes everything harder.
But that doesn't nearly account for everything. It is also true that the system is set up very transactionally, and that this makes it difficult to address many chronic issues as well as they could be.
If you are lucky, you have an involved general practitioner who has a long history with you, good notes, and time to get into difficult analysis. For many people currently this is a pipe dream. Hell, many people are reliant on ER for basic care - a system that is fundamentally incompatible with this sort of baseline and evaluation.
There are problems beyond just supply and demand. The reason in my experience that someone might use the term transactional is that at any given appointment, most doctors will only choose to focus on one or two topics or concerns. And generally, to get any sort of treatment option for those they'll need some sort of code for insurance to reimburse for the visit. This is especially true for specialists, whom if you visit enough doctors you'll realize push procedures or specialized tests very heavily because that's what makes money. In the current system every single aspect of medical care must have a price tag attached, must be composed of transactions and codes, or the doctors won't get paid. When the concept of "what is the diagnosis" implicitly morphs into "what is the billing code", medical care becomes a fractured and transactional experience rather than a holistic assessment. (And for any doctors reading this, I know that "holistic" is one of those quack trigger words, but those quacks are responding to an unmet need even if their treatments and diagnoses are pure bunkum.)
I think you’re absolutely right that that physician bandwidth is the cause, I think you could characterize the transactional medical experience as a side effect of that problem.
When I say transactional, I mean that each interaction has a cause (“what brings you in today?”) and an action (“try this medication”, “see this specialist”); each visit is like a full story arc from start to finish.
Compare that to psychotherapy where each visit is more like a continuation of the previous session — a narrative. IMO, people who suffer from chronic conditions would benefit from a model that draws on the narrative aspect of therapy.
I attended medical school and excelled in my organic chemistry courses as an undergraduate. In my view, organic chemistry is a difficult course for many because it is quite multidiscplinary and requires multiple modes of thinking/reasoning.
- Basic chemistry (chemistry 101): Concepts like bond formation, electronegativity, acid-base reactions, etc
- Memorization: Functional groups, reaction types, etc are fundamental building blocks (much like writing and speaking requires a knowledge of words).
- Deductive reasoning: Getting from molecule A to molecule B requires long chains of intermediate steps that logically follow from previous steps
- Visuo-spatial: This is probably the one faculty that comes naturally to some and absolutely does not click for others.. Understanding organic chemistry fundamentally requires an appreciation of how molecules and groups interact in 3-D space. Understanding spatial patterns and interactions also helps with memorization (e.g. it is easier to remember why certain functional groups behave the way they do)
- Linguistic: This may seem trivial but many struggle with the grammar of naming molecules (IUPAC nomenclature)
It is true that organic chemistry is a weeder course for pre-meds. However, I do think it is a relatively good filter to select people who excel across multiple cognitive dimensions, which is required for success in medical school. Now whether or not this is required to produce good doctors can be debated, but I suspect that in certain corners of medicine, particularly the more cerebral specialties like nephrology or academic medicine in general, rigorous undergraduate courses such as organic chemistry are absolutely pre-requisite.
I ended up leaving medicine and am now a founder of a biotech startup, so take my opinions with a huge grain of salt :)
I think organic chemistry is hard enough as a subject to where students shouldn't have to face the additional difficulty of having adversarial teachers. A weeder course shouldn't be the same class students are expected to learn how to teach themselves material. If anything, a weeder course should have the best teachers in the department.
How to help make sure the teachers don't burn out is a different issue. I imagine it's hard to be the teacher of these kinds of classes year after year.
I doubt more than 10% of people who buy crypto are "experts". In the sense that most of them can't explain how a blockchain works (even roughly), what problem it's really supposed to solve, and what the actual difference between BTC and ETH is, let alone other chains, DeFi, NFTs, etc.
The reality is that it's very, very difficult to understand crypto in any real sense. And that's without considering that whichever side of the argument you lie on - crypto is a weak proposition insofar that so is gold and cash.
The only way to understand it in a real sense is to realize that currencies don't have to make any sense whatsoever. If people accept it, it's a viable currency. Literally nothing else matters.
Fun fact: 90% of USD doesn't physically exist according to the Fed itself.
It's mainly a solution to the Byzantine Generals problem which is basically about forcing trust among the trustless or untrustable. How does it solve that? By forcing the participants to invest in the system in such a way that they can only participate in a trustable way. That may seem like circular reasoning, but the details get into nested rabbit holes that cross computer science, cryptography, psychology, and economics.
Best to read up on it for more explanation. As it's over a decade old it should be trivial to find commentary in your preferred language and level of analysis with only the simplest of queeries.
