Comment by quesomaster9000 | Hacker News Reader

Comment by quesomaster9000 | Hacker News Reader

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quesomaster9000

A personal anecdote: had been feeling very unwell all morning with back pain but needed some fresh air so went for a walk, on the way back my chest tightened to the point where it felt like a very heavy person was sitting on my chest and was having stabbing pains. I'd never experienced anything like this before.

My local GP was near by so I went there first, described what was happening to the receptionist... they said 'Call 111' (NHS non-emergency triage, for non-Brits) and shoo'd me off; I loitered around and Googled symptoms and yea... 'possible heart attack, go to A&E NOW' was the general gist. Called 111 from within view of the receptionist in case I collapsed, 15 minutes later I'm still on hold - I figured all they'd do would put me through to 999 after spending 10 mins asking questions.

Got an Uber to A&E, and had an EKG within about 20 minutes of arriving. They said it's not a heart attack, probably isn't myocarditis or pericarditis, then the weird question 'do you suffer from anxiety or any mental health problems?'...

I'm 100% sure it wasn't psychosomatic or an anxiety attack. But that was the point where their concern ended and I was discharged with no follow up from GP or any idea of what had happened. Turns out, it was acute pancreatitis caused by a gall stone - I had to pay privately to find that out because repeated GP appointments they couldn't care less.

Either way, it's an absolute clusterfuck, and this same pattern of systemic dysfunction has been repeated with pretty much every interaction I've had with NHS funded services (both hospitals and GPs), and I'm fairly sure - like in a_c's friends case - if it had've been a heart attack it would've required me to drop dead in the GPs reception for them to do anything more than just pass the buck.

The UK is down with leading countries like Colombia in the doctors-per-capita rankings. The NHS could be a lot better, and most doctors want it to be a lot better. If there aren't enough doctors to provide an adequate service - and there really aren't - it's not the front line staff who are to blame.

Is it not the same doctors that vote to cap the amount of doctors places in higher education in order to protect wages? Why are we not training as many doctors who meet the educational requirements as possible? Every year come A Level results there’s a kid in the paper with AAA grades who can’t get into medical school. It’s a disgrace.

It's so crazy how socialism keeps failing people. Totally unpredictable.

You'd be making a meaningful point if the market-based solution didn't also have some disastrous failure modes.

> In short, the NHS is more correctly seen as nationalised rather than socialised medicine, achieving the first three levels of a socialist health service identified here. It can be said to have socialist principles in the limited distributional sense and has some socialist means to achieve these.

https://pubmed.ncbi.nlm.nih.gov/10170226/

The study is from 1997, and the NHS has definitely changed in the 25 years since, arguably becoming more privatised since the Health and Social Care Act 2012 (among other decisions).

I'd still rather deal with that than the market driven system in the USA.

Btw, NHS is not socialism.

That's even worse! All the downsides and the workers don't even get to control the means of production.

The UK generally does somehow manage to hit the sweet spot of all the expense and duplicated effort of market solutions with all the remote decision making and political weaponisation of government solutions and get the worst aspects of them both.

It's called starving the beast. A decades long deliberate policy of funding cuts which ultimately drives people into private care.

Seems to me it’s a governmental decision? [1]

> Despite the NHS’s clear need for more medics, the number of medical and dentistry students each year is capped by the government to control costs, as it subsidises the courses.

> The Secretary of State for Education, James Cleverly, commented recently that it's not possible to "flick a switch" to increase the numbers of doctors undergoing training, due to having to ensure there is enough funding and capacity for teaching and placements.

1. https://www.newstatesman.com/spotlight/healthcare/2022/08/am...

I did not know this thank you for bringing it to my attention. Seems like a pretty feeble excuse from Cleverly though. In my opinion, anyone who's capable of it and wants to should study Medicine should be supported in doing so because the societal benefits are so great. The fact that we stop 17,000 from doing so is an absolute disgrace. We waste money on a lot of shit in this country, I'm sure the money could be found to send more people on to study medicine. It seems to be universal across the country that councils lay new block paving only to dig it up a few months later on a whim for some reason or another, that could be a place to start.

Oddly enough, I’ve heard the same thing regarding doctors voting for a cap. Wonder where that’s from?

It’s an awful excuse; I agree with you. If we were to be quite "cold" about this and think of it in a purely beneficial sense to the economy, surely the economic benefits of a healthy population far outweigh the costs, although I imagine it’s quite hard to "quantify" such a measurement?

Depends on how you see it, medical degree is a supply chain problem, subjected to the same bullwhip effect. We can't predict demand of doctors 5 year down the road. The worst we could do is to treat today's demand as demand for 5 year in the future. If we double the supply today, in 5 years we will have double supply, hopefully without another pandemic. Many things could happen, if funding stays the same, benefits among all doctors will be affected, or we appropriate funding from other endeavours. If the demand doesn't sustain, funding get cut, less students find it attractive as a career, supply reduces. In reality many more factors get into play. So when Cleverly said "we can't flip a switch", there are some merits to it.

https://en.m.wikipedia.org/wiki/Bullwhip_effect

That's an interesting idea, but a lot of people in the profession would reject a move like that, as it would put downward pressure on their earnings (amongst other things):

> BMA meeting: Doctors vote to limit number of medical students (Andrew Cole)

> Delegates at the annual BMA conference voted by a narrow majority to restrict the number of places at medical schools to avoid “overproduction of doctors with limited career opportunities.” They also agreed on a complete ban on opening new medical schools.

> David Sochart, from Manchester and Salford, warned that in the current job climate allowing too many new doctors into the market would risk devaluing the profession and make newly qualified doctors prey to “unscrupulous profiteers.” A glut of doctors would undermine competition and would therefore lower standards and ensure mediocrity, he claimed. He said, “Patients and health care should not be treated as mere commodities, and neither should medical students. We must not allow another lost tribe of doctors to be consigned to the wilderness.”

> Grant Ingrams, representing GPs, said that doctors should not be trained if there was no job at the end. He warned that this could spark another “brain drain,” adding: “It is wrong and immoral and a waste of taxpayers’ and students’ money.”

> But Paul Flynn from the consultants committee said that the root problem was a lack of effective workforce planning and warned members against a kneejerk response. “This is what blighted workforce planning. It would be hypocritical if we were to do it ourselves.”

> The BMA’s chairman, Hamish Meldrum, said he sympathised with the sentiments of the motion but asked members to vote on evidence rather than “gut reactions.” “We want to see an expansion of [the numbers of] GPs and consultants,” he said, “and for that we need more students.” But the motion was passed by a small majority (58% versus 42%).

> Members also agreed to a motion accepting that some specialties might need to raise the total number of years spent in training to accommodate the demands of the European Working Time Directive.

> Stephen Austin, from the consultants committee, said that the time needed to acquire the necessary competences was likely to increase—especially in procedure based specialties—and that the only sensible solution was to increase the total amount of time in training.

> Members also voted to press for an agreed minimum national level of funding for study leave to overcome the widespread national variation in the amounts that are currently available.

https://www.proquest.com/openview/b0c6c69bed2854a96acfd2889d...

From 2008, but I haven't been able to find any publicly-available discussion from within the medical profession that's more recent.

It's honestly an absolute disgrace. Train them, and if there are no jobs, let them go overseas and work. The government constantly bangs on about Britain's 'reputation overseas' what on earth could do more good for it then literally exporting people who save lives. I honestly can't see any justification for this other than doctors profiteering and it makes me sick to my stomach.

The British Medical Association is in a position to veto changes to the number of medical students being educated in the UK, as its members have a monopoly on providing medical training, which is why they hold votes on such things at their conferences:

https://www.proquest.com/openview/b0c6c69bed2854a96acfd2889d...

Matters like this are normally discussed behind closed doors, and there is plenty of horse-trading, with favours being negotiated, and assurances, and understandings that are reached before major changes are "unilaterally" "announced" by the Government. There are different factions within the medical profession, and none of them want to lose out when there are changes. Priced into the government's announcement they they are going to train more doctors, therefore, are a range of promises and commitments to the medical profession to make sure that this will proceed without incident.

Interesting, thanks for that. Do you know if that only happened the once? I can’t find references to another vote like it.

From what I can see elsewhere, the tone seems to have changed slightly since then?

> “We welcome the news that there will be extra funding for medical school places as this desperate need for more doctors in training is a recommendation that we made in our Medical Staffing in England report, which we issued last month.“

> “However, this increase in student places must not come at the expense of extra funding for the existing workforce or reductions in funding in future years, because tackling the waiting lists and backlog are going to require sustained investment over many years. And the government must make clear that there will be sufficient clinical placements for all those who succeed at medical school.

https://www.bma.org.uk/bma-media-centre/bma-says-increased-m...

A generous take on it seems that the BMA don’t want to make things worse for existing doctors.

I suppose if the government funded the NHS more, ensured that existing doctors wouldn’t be worse off, one would hope that the BMA would be fully supportive of training new doctors?

I suspect that this was one of the first years that reports from that conference were made available in a digital format, and that the way that issues like this have been dealt with subsequently has taken into account the likely impact of similar documents coming to wider public attention. I don't think it's something that people have stopped talking about in their professional circles, and I imagine senior figures would be able to tell ministers exactly what people think and what would happen.

Part of the difference is probably that the 2021 article is a press release aimed at the public, rather than an internal discussion that lead to a vote. With enough money I imagine you could make everyone happy, and doctors' standard of living is at just as much risk of being inflated away as anyone else's, so it's no surprise that the professional body would support training more doctors subject to guaranteed funding including for medical educators and clinical placements (all of which will have a direct impact on their members' salaries, bonuses and allowances). How exactly that will work out, and how's it's going to play to the public, we'll have to wait and see.

Now imagine you'd had to pay thousands of dollars for that trip to the ED. Otherwise that doesn't sound any different from an experience with the medical system in the US. One of the first questions you're asked is if you have insurance (in Texas it's not assumed), so they can determine what class of patient you are.

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