Comment by roel_v | Hacker News Reader

Comment by roel_v | Hacker News Reader

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There are several policy areas where doctors feel they have more to add than they actually do: tobacco discussion, whether or not bicycle helmets should be legally required, euthanasia/abortion issues (the moral aspects of it, not the technical ones), ...

I think it's a remnant from when doctors were part of the 'upper class' of the village (or even city), along with the priest, the school teacher, etc. Whereas today, in more educated circles at least in my observation, doctors are just body mechanics. They derive most of their status from their pay. (Much less so e.g. in the small town I'm from, where doctors are still respected just for being a doctor - but are paid less).

Edit to add: I'm not going to modify my comment above because that invalidates all the responses, but it seems like all responses are taking the wrong message from my post: I'm not making some sort of moral judgement on the work of doctors, what I'm saying is that doctors aren't any longer so special that they're part of the intellectual elite (and hence are consulted on topics being their expertise) just for being a doctor. Sure most doctors do work that's beneficial to many people, but so do teachers, and I don't think anyone is going to claim that teachers have high status in society (because of it, or at all).

> today, in more educated circles at least in my observation, doctors are just body mechanics. They derive most of their status from their pay.

...WTF? Is it even possible to write a more egotistical comment? Most doctors (especially surgeons, etc.), along with firefighters, police, etc. derive their respect in "educated circles" not from their pay (that's some of the worst nonsense I've heard this week) but from the kind of work that they do: saving other people's lives, especially in situations where one small mistake on their end can prove fatal for one or more parties involved. That's quite sufficient to deserve a ton of respect just by itself....

Yeah, way to quote out of context.

"Most doctors (especially surgeons, etc.), along with firefighters, police, etc. derive their respect in "educated circles" not from their pay (that's some of the worst nonsense I've heard this week) but from the kind of work that they do: saving other people's lives, esp"

Ah yes, the 'everybody deserves a medal' mentality. Let's not forget the garbage man, without whom we'd be choking on our own garbage! Praise his selfless sacrifice!

In the mean time here in the real world, those firefighters and policemen you talk about are (in the case of firemen) replaced with volunteers, and paid a very basic wage (yes yes because of political/union dynamics some of that group in some US states are paid well with early retirement yadda yadda yadda - I'm talking in general). Way to show status and respect, society!

In the mean time you're spinning a straw man of how I supposedly look down upon doctors, where my actual point is that doctors aren't that special intellectually speaking. Most people reading this could be doctors if they wanted to. Does that mean we look on them? No. But it does mean we don't put them on some pedestal as if they're so smart - which is what used to happen when the majority of people had no or very little education.

> one small mistake on their end can prove fatal for one or more parties involved

This right here is why I respect the hell out of doctors. Every morning, they wake up with the knowledge that today, they could kill someone through inattention or ignorance. I'm sure that they don't think about it that way while brushing their teeth or whatever, but that's an awesome responsibility.

Do you share the same respect for airline pilots, bus drivers, crane operators and all of the other occupations that can kill multiple people through inattention or ignorance?

I do respect those people, but the comparison to my profession is ludicrous.

Here's what happened just today at work for me:

Before noon, I received two patients in septic shock. Both required intubation and central lines. One required a chest tube. Early in the afternoon I had my finger directly compressing a carotid artery that was spraying across the room as my staff tried to call in the vascular surgeon. Around 1800 PM I got a rapid GI bleeder who died spilling blood out both ends. Because it happened within 24 hours of an admission, the medical examiner had to be involved. She was young. One other existing patient in the ICU died of septic shock around 2000. I stayed until well past midnight talking to families, putting out fires, dealing with loose ends and spending time with the floor residents to make sure they know how to handle events like this without having a breakdown (not that I've figured it out yet). I just got home and will have to go back in about 5 hours from now and face who-knows-what. My friend, a neurosurgeon, is still in the neuro-ICU at this hour (it's about 0100 local time). Oh and flu season is coming up; that's when shit really hits the fan.

I realize that isn't a typical day for most doctors (nor is it a routine day for me; but not a rare one either), but it is demeaning to suggest that the emotional impact of this kind of work or the relationships developed therein could be even remotely comparable to that of an airline pilot with his/her passengers.

Oh, and I don't get paid a dime extra for being there 18 hours and assuming a bunch of extra risk. If the patient who's neck bled all over after surgery at another hospital decides to sue, I'll get added to the lawsuit, even though we saved his life.

My point is not to demand "respect" or elevate myself above anyone else; I come from a pretty humble family and stayed that way for the most part. I simply don't think anybody has a comparable work environment, especially the emotional side, which is very hard to describe to other people.

As for the parent post: opioid prescribing is complicated and is going to get worse as our "performance" becomes tied to patient satisfaction surveys. Won't affect me much, but will be a very difficult balance for primary care doctors.

Paramedics/first responders save lives too, in scenes just as dramatic or more as yours. Is being a paramedic 'high status'? No it's not. Look I'm not here to tell you or anyone anything about how useful or stressful their jobs are; hell I mean I sit at a desk all day writimg code that'll be run by 10 people ever if I'm lucky. What I'm saying is that status doesn't depend on any of that, or on how hard you work, or on how hard you studied. I'm not making any claims about whether that's right or not either, just describing reality.

Or how about this - does your boss still do the things you describe? If your hospital is medium sized or bigger, he spends half his day pushing paper and the other half controlling petty infighting between the surgeons. Yet is his job lower status than yours? Would getting his job, for you, be a demotion or a promotion? Seems to me the answers are pretty obvious.

My hat goes off to you for working so hard and being so dedicated. It sounds like you had an awful day, and I'm sorry.

Please dont take this as criticism, because I respect everything you do. But consider this:

> I don't get paid a dime extra for being there 18 hours

Why do you have to be there for 18 hours ? What if medical school weren't so difficult to get into, that there were enough doctors for each of you to work 4 hour shifts ? You could then do 4 hours of intense-pressure, saving lives. An hour lunch break, return and do 4 hours of paperwork/damage control, etc. Then go home and relax like everyone else ?

For the amount of money those patients are being charged ($10k+ per night in ICU), there's adequate money going around to hire 5 more of you to allow 6 separate 4-hr shifts of trauma coverage.

I dont know where the bottleneck is. But I'm concerned that there's an artificial scarcity somewhere, perhaps in medical school. Perhaps in the board certification. Maybe there shouldn't be a 15-year educational requirement ? Maybe a nurse with 6 years' experience could be qualified for a "micro-practice" in a limited capacity ? No, not a PA (see, now we're dealing with status/prestige ), a doctor, responsible for pt's for 4 hours/day.

I dont know where the problem is, but maybe we are just over-regulated ? We put so much care into making sure the wrong people dont get in, that now we're overworking those who do get in. In that 18 hour shift you described, do you really think you are as alert at the end of the day as you were that morning ? Overworking people undoubtedly leads to lower quality, and a there has to be a breaking point where it's going to be better to let more people in than it is to burn out the few people who do make it past the barriers.

That's a lot of sepsis. How much of that was acquired during the stay in the hospital, one wonders?

How effective can you actually be pulling 18 hour days?

I appreciate that you feel like a hero, but everywhere else in the civilized professional world we've learned that keeping such hours and being in permanent firefighting mode leads to sloppiness and inefficiency.

Then again, when we're sloppy and inefficient, we don't kill anyone.

(I've worked on software for use in ICU and other clinical environments, and frankly am utterly unimpressed at the systems doctors and administrators allow to persist at the expense of patients so that they can either feel like heroes or retain talent.)

> My point is not to demand "respect" or elevate myself above anyone else; I come from a pretty humble family and stayed that way for the most part.

I think you can demand "respect". It's not about being humble.

Ask someone who served in Iraq about his time there, it would make your day look like puppies and sunshine. Should we defer to jarheads on all matters of domestic policy?

You don't think ICU nurses or PAs (especially at big hospitals) have a comparable work environment?

What causes that kind of rapid GI bleeding?

Almost certainly an ulcer in the stomach or duodenum, especially given her medication use. If the ulcer erodes an artery, it can be catastrophic. Just not common to see it someone as young as she was. About 5-10% of "lower" GI bleeds are actually rapid upper GI bleeds. Easy to miss.

Yikes. What medications are known to have this side effect and what early warning symptoms of it can one heed?

Hell, even software programmers can kill a lot of people by letting a bug slide. But I agree that in general, doctors have a bigger and more direct responsability in that matter.

One might note that the respect due to "police" is in decline, as people are wising up to their thuggery and lack of expertise and morality.

> saving other people's lives, especially in situations where one small mistake on their end can prove fatal for one or more parties involved.

Which is why their incompetence has risen to the third-leading cause of death in the United States ( https://www.washingtonpost.com/news/to-your-health/wp/2016/0... ).

There are a lot of doctors (and especially nurses!) that provide valuable care every day. That said, we can't just blindly assume they know what they're doing and give them respect that they haven't earned--especially when the healthcare system is as fucked as it is today and they refuse to take an active role in fixing it.

The status you speak of for physicians in general is derived from saving lives - generally thought to be pretty honorable. Also, doctors who work in more rural areas are trending towards making more than those in cities and already do make more when cost of living is accounted for.

Not going to say a dermatologist or podiatrist can't save lives, but I think they get most of the respect granted doctors who do without the same effect on society.

My pet peeve is the "cosmetic surgeon", making obscene amounts of money and wasting valuable medical resources to pursue a practice of enabling vanity.

Public Health doctors get the least respect/money? And arguable do the most societal good of all, essentially saving all of us from epidemics etc.

I feel like this is a narrative for which I am nostalgic despite being too young to have ever really experienced even though I grew up in a small town. I wish that those in my community who serve their neighbors in an important way were more respected socially. Sure, the local paramedic - Sam - doesn't make a lot of money, but everyone knows he's a good guy you can rely on. Everything feels so transactional.

many paramedics work for a private company for peanuts.

Public figures are still respected. I suppose it's less so because education is more common. The Gulf between a medical doctor and your average citizen was huge

It completely depends on the type of doctor. If we're talking about GPs, then sure, their work is mostly standard and they refer anything non-standard to a specialist. But specialists are definitely held in very high regard in their social circle. Surgeons especially.

>>They derive most of their status from their pay.

No, they derive it from the insane amounts of education, training and hard work they have to put in to get to where they are at. It's basically "crunch time times two" all the time from the moment they start med school until they complete their residency, and only slightly lessens afterwards.

You know who also works hard? Juanita the single mom illegal immigrant who works one job in the chicken factory during the day and another cleaning motel rooms in the evening to feed her 4 children, and still barely scrapes by. How much status does she have?

I'm not dismissing how much doctors study, or how hard they work (outside of GP's and some specialties like dermatology). Many of my friends and family are doctors. While I agree that I might have phrased my comment a bit more carefully, it's awfully lazy to just conclude from what I said as 'doctors are only after the money'.

My real point was - being a doctor no longer (by itself) makes one an intellectual. Knowing quite a lot of doctors myself, I can tell from firsthand experience that many of them are just as (un)informed and (dumb|smart) as the, say, smartest 1/3th of the population. Doctors have lots of highly specialized knowledge, yes; that doesn't make them better on issues that go beyond medical technicalities than a mathematician or lawyer.

As a doctor, you are partially right.

There are some doctors who look at their job as technicians for money.

However there are some who really do go out of their way and give a 100% at the loss of their own family. But, probably so do some politicians...

i agree with your point, that people's qualifications in one field don't necessary entitle them to a respect from authority in another field.

tbe reason they are asking for doctors help in this is, to reduce the political fallout from people who respond to authority. They may as well also ask for help from teachers, firefighters, priests, airplane pilots (I believe Air Force even uses methamphetamines) ...

you seem to be garnering a bunch of hostile responses, so I want to say I agree with you. And I think a lot of their "prestigious education" is somewhat "prestige theater". I believe it's artificial scarcity, either to keep the prestige high, or (somewhat cynically) to keep wages high.

Yes, there has to be a rigorous QA process to get your medical license and keep practicing. That's already covered by a state board of medical examiners. Where I think the artificial scarcity comes in is medical schools. There shouldn't be this "interview" process and excessive scrutiny, 6-figure tuitions, and do-or-die levels of pressure to simply learn how to practice medicine. I think this manufactures prestige.

There should be enough medical schools for virtually anyone who wants to get in. If idiots go they will flunk out at exam time. No need to screen them at the door. No need to ensure they have "straight-A's". What they need is the willingness to learn. It should be "to be a doctor, you need to learn topics {A,B,....Z}, and once you do, and demonstrate that to the board, you are a dr."

You should be able to start out emptying bedpans and have a ladder you can climb to get to physician. I can't think of someone who would make a better dr than one who has already worked 10 years in a hospital. Go from orderly/CNA, to nurse, to practitioner, to dr. And structure the education to work around this! Once you get to nurse, allow a 3 day-work, 2day school schedule. Even if it takes you 8 years, you have an MD with basically an entire clinical rotation completed. And (theoretically) no debt! Now this person doesn't need a $200k salary to pay back their tuition loans. Ultimately this could lower medical costs for everyone.

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