Comment by tpoacher | Hacker News Reader

Comment by tpoacher | Hacker News Reader

Define "finish". For that matter, define "faster".

When I was working as a junior doctor, I had colleagues who "saw" 10 patients in the space I saw 3.

Whenever I was on call at night, I could spot the patients who were "seen" by those colleagues, because it was always the patients who crashed or needed their meds re-writing to remove the allergy risks or needed to have their bloods ordered and taken, or even had to be re-clarked from scratch because the history and exam were utter bullshit, not to mention dangerously so. (I once re-clarked an old lady who was admitted for confusion affecting her ability to communicate and was about to receive all sorts of scans and radiation. When I talked to her, it turned out she had just lost her hearing aid and couldn't hear anything.)

Still, it was always the "tenners" who were praised.

(PS. I no longer work as a doctor. Fuck that shit.)

(PS2. Obviously this isn't unique to medicine. I have the same problems inheriting crappy untested code now, haha.)

Ha. Reminds me of my grandmother. She's quite old now but the doctors told us she had dementia. One day Mum was telling me about it and I said, "make sure they understand she's deaf, and will just smile and nod if she doesn't hear properly."

Next appt, mum goes with her and lo and behold, she doesn't have dementia, she needs a new hearing aid.

(deafness runs in my family, if you're interested: https://medium.com/@veb/my-journey-to-a-cochlear-implant-8ce... - had to remove part 2 because lawyers...)

What happened next, and why did lawyers make you remove part 2?

Pesky lawyers thinking they can really make stuff disappear from interwebz.

https://web.archive.org/web/20170112221346/https://medium.co...

> Still, it was always the "tenners" who were praised

You figure why "we are rolling down" (loss of quality as a value, "decadence" - loss of purpose (what do those colleagues think they were there for?), loss of good sense, loss of perception).

I have already narrated at HN the story of the evaluation in which the subject was criticized for being not as fast in responding as the colleague - who gave wrong answers.

I think I have also read in these pages our moderator DanG noting the qualitative difference in general separating prompt posts and meditated posts. It's not that the concept of "reflection" is gone, it is that it has generally declined. Surely, over ten years of "bad school" social networks helped that. Plus, economic and sociopolitical factors promoting the use of cheaper personnel in looser monitoring.

Edit: plus, overly-literal-interpreting-people dealing with overly-sloppy compilers of (Key) Performance Indicators...

I don't think there is something inherently bad about social media. I mean Tv / Radio sped up the time from an event to when people hear about it - and the first time people here is when people shape their perception of the event.

Hence if your side of the story is out at the same time as the news of the event, you get a good chance of shaping people's perception of the event.

If you wait a week, day or hour, it may be too late.

I am not sure it is good bad or other. Maybe it does not matter to you that millions hear one side if the "right" people hear your more considered side. (perhaps we call that lobbying)

Speed has meant it's harder to get a considered reaction. But then again, by middle age most things in the world are either things we have seen before so have an instant reaction, or frankly are not worth reacting too.

( Name checks ;) )

> I don't think there is something inherently bad about social media

Good that that's your opinion, just I hope you have not understood that is the position of the parent post, which wrote «over ten years of "bad school" social networks helped [the decline ... of the concept of "reflection"]». It meant that people have been encouraged to "fast respond", which boosts the diffusion of low quality. Lack of depth, cheap processing...

> the first time people here is when people shape their perception of the event

And duly reflection, the point, is there so that the new informational members in the Weltaufbau are well criticized before getting entrenched.

Why should have «speed [in the time from an event to when people hear about it] ... meant it's harder to get a considered reaction»? One's reaction to information is not really a function of the distance in time of the event in the information. The problem noted is with those ethological drives against «considered reaction».

I miss some of your points - but the last paragraph is fair.

I assume by emphasising "bad school" you say that the parent was also saying social media not inherently bad, but the way it was implemented was?

I think that we could design (regulate?) better social media (I have high hopes that something similar to the "this looks like anti-vaxxer posting, here are some links to scientific consensus on the issue) would help move us from facebook to wikipedia. But I may be blinded by my own privilege

> I miss some of your points

I will rephrase a core concept more plainly: people are supposed to be trained to be "reflective": whatever input (intellectual, emotional, informational, ideal - so external or internal - etc.) they get, it should be put on a buffer with a label "tentative, provisional, waiting for further validation, digestion, development". Whatever incites to shallowness, cheap, immature thought, reaction etc., is against civilization.

> social media not inherently bad, but the way it was implemented was

Yes indeed. Some environments clearly "point towards evil".

I was mainly thinking about incitation to rush, quick consumption, construed emotional response etc. But already the policy of one of the biggest boards out there, encouraging upvoting and downvoting according to "feeling", (mis-)educates people to give value to a knee-jerk reaction (which should at most be there as a preliminary orientation) and consolidate it through the psychological trap of a statement of position, and create identities in the deterior sense, self-images based on stagnating undiscussed assumptions.

> design (regulate?)

You need to promote, through function and policy, better examples and work recursively from them (let them lead and criticize). In fact, the very example you provide is all about credibility of the proponents.

> Still, it was always the "tenners" who were praised.

I believe the US does not align financial incentives with the quality of care provided.

Healthcare in the US is a runaway scam: https://ourworldindata.org/grapher/life-expectancy-vs-health...

There has been a massive change in US healthcare from a “fee for service” payment model to a “value based care” payment model over the last 10 years.

https://www.cerner.com/perspectives/between-fee-for-service-...

https://www.decorm.com/understanding-fee-for-service-and-val...

There are many posts online about doctors and pharmacists about the pros and cons of tying their reimbursement to patient outcomes.

That seems to fly in the face of the private health insurance system that many of us are forced to use. I believe there are many more value based healthcare situations now than before but suspect that it’s still a tiny fraction of healthcare delivery in the US.

25%+ of US residents receive taxpayer funded healthcare, via Medicare, Medicaid, Tricare (military), or other government programs. I think electronic medical records will only accelerate it to non taxpayer funded populations as it will greatly ease the ability to track data even when switching from one managed care organization to another.

Unrelated question. My girlfriend is an anesthesiologist and she is quite distraught with the fact that she is being payed less than me for working significantly more hours on a job with vastly more responsibility and risk (I work on embedded devices which have 0% chance of causing injury or death). She doesn't want to consider career switch because she already invested 12 years of her life into medicine. I am supportive of course, but to me this is a clear example of a "sunk cost fallacy". How did you get over that?

Based on the 12 years of education, I am guessing you are in the US. Median anesthesiologist income is ~$400k/year.

The odds of her earning similar, even per hour, if she switches to programming may cause sticking to being a doctor make more sense.

Nope, Eastern Europe. We both got pretty good education (even got to study abroad for a few semesters) and it was free for both of us, but her annual pay is around 30k$ while mine is around 35k$ (the median wage is about 15k$). Its really easy to earn more than that if you remotely work for a German or American company, but as a doctor you cant do that unless you move (not an option).

Oh, my bad. Yes, that changes things quite a bit. I am surprised it takes 12 years in Eastern Europe. I thought it was ~8 years in Europe.

6 years college minimum. Mandatory one year of general practice and then you can apply for specialist education. Specialization can then take years to begin, but it can also start right away depending how lucky you are and you do it for five years minimum. So that makes it 12 years minimum. After that, most hospitals require you to stay working there for another 5 years otherwise you have to pay for specialization school (about 30k$). After that, you are free to live your life :)

The sad truth is that your girlfriend in the wrong country. It's the same in mine, where many doctors move to nearby countries where they can earn many multiples more.

I am assuming you are an engi. If so, it's about the leverage. Her time, responsibility, and risk is 1:1. An engi's time can lead to exponential returns, and mistakes can lead to exponential disaster.

Leverage just set the ceiling, then you enter on offer and demand kind of world. Software developers just have it good in 2021.

Also, if OP lives in a low income country, he has better options to sell himself compared to a doctor, normally constrained to the local market.

Not sure what you mean by "exponential", but mistakes by an anaestheseologist can certainly lead to disaster. Like, people can die. I'd think at least for the people doing the dying that's quite "exponential" enough. How is the possibility of killing people if you make a mistake on the job more "risk is 1:1" than for a software developer (or "engi", as the trendy kids apparently call it nowadays)?

I told myself exactly what you just said. That this thinking was effectively the "sunken cost fallacy".

In the end it was about prioritising my personal satisfaction and 'happiness' over what a more conservative mind would think 'I should do' (one aspect of which was the financial sense). I am not super rich nor super successful at my choice of profession now (partly because I'm 10 years older than everyone else in my position right now, which can be an issue in itself), but I largely enjoy what I do despite the stressors and pressure that my particular position puts me in, and I'm trying to use my richer experience to 'catch up' career-wise as quickly as I can, so to speak.

I's not a black and white decision of course, and I'd be lying if I said I have zero doubts. There are still moments where I think "what if I hadn't left". Would I have been happier staying miserable but with lots of money to choose my preferred form of misery? :p Is it better to be 'poor' (by comparison) due to cost of the 10-year career lag in the new field, but in a more fulfilling profession? In general, 9 times out of 10 when I think about it I'm happy it was the right decision and not one that I regret. But there's still that 1 in 10 which nags you, especially when you get together with your old colleagues who are driving ferraris and talking about how delicious that £1,000 champagne bottle was last week while skiing in the Alps. (I actually despise that lifestyle, but for some reason it still stings when it's rubbed right in your face...)

As for how I made the decision to leave, for me the big moment was when I realised I was bound to rebel sooner or later, because my psychology, sense of satisfaction, social life, and quality of life were all crap. This gives the sunken cost fallacy new context: your options are not just "not leave" vs "leave now". This in itself is the fallacy of the false dichotomy! Other options also included "endure another 10 years before giving up", "endure another 20 years", "endure another 30", and so on.

So the question got reframed into "leave now and waste 10 years of medicine? Or leave in 10 years' time and waste 20 years of medicine?". Similarly, "If I leave now, do I still have a sporting chance of achieving something meaningful in the new field before I have to retire? How does this change if I delay this start by another 10 years instead?"

It was easy to make the decision to leave right away after that. :)

You became a coder after leaving medicine? I'd love to read a blog post about that journey!

Not a 'coder' coder per se. I'm a biomedical engineering researcher, which so happens to involve writing a lot of code. :)

> I no longer work as a doctor.

I'm curious if you'd be willing to discuss why?

Honestly, every time I answer this question, it's a bit like when the Joker answer's how he got his smile (i.e. the answer is different every time, hahah).

In the end, I think what it boils down to is that I wasn't happy doing it, and I found something else that I felt more passionate about and found a way to do that instead. (while retaining some of the medical context which would set me apart from my peers in the new profession).

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