Morning Ed: Healthcare {2018.09.06.Th}
[Hc1] This is about medical school, but it’s actually a fascinating microcosm of the psychoses of the American upper and striver classes.
[Hc2] There is a thing in this country where we attribute things to our economic system or laws despite the fact the trends are happening everywhere.
[Hc3] While I think this is easier said that done, and will actually carry some administrative costs, but the end result may be an incentive towards streamlined pricing which will serve everyone good.
[Hc4] Is physician burnout more caused by fatigue or moral injury? As we evaluate my wife’s career, one thing that stands out at us is that despite being miserable in some respects she was professionally happiest when working for the IHS. {Related}
[Hc5] Sam Kean argues that doctors should read fiction. I’m not exactly Mr Literary Arts, but non-fiction snobbery is an especially stupid kind of snobbery.
[Hc6] I can’t imagine how this might turn out wrong.
[Hc7] India may be overhauling its health care system.
[Hc8] Given the scale of salaries, I doubt this has much of an impact, just as loan repayment programs tend to be unsuccessful. If we ever get serious about lowering doctors salaries to that of other countries, though, the cost and duration of med ed is going to be a part of the equation (among other things).
[Hc9] Sometimes I feel like everybody in the industry is just trying to grab what they can before it all comes tumbling down.
Tangentially related, but the concept of “Moral Injury” in Hc4 is interesting and I will need to sit with it and think more. (I am beginning to detect some symptoms of what you might call “burnout” in myself – largely related to the funding difficulties, the fact that there are things going on in higher ed that I think are bad for it and for our students, and my asking myself, “If I’m asked to go-along-to-get-along with something I object to but that isn’t actually illegal or likely not truly immoral in the malpractice sense, do I blow up my career at an age when I’m basically unhireable for anything else, or do I grit my teeth and count the days until I can retire?” and I don’t know any more).
I may feel differently after my semester of teaching four classes plus supervising research is over, but yeah, I used to joke about being asked to do six impossible things before breakfast but now that joke has a sharper edge on it than I like.
I mean, yeah: doctors have it a lot lot worse than I do, but I suspect there are a lot of people today laboring in broken systems and who are wondering “Is it me that’s broken, or the system?”
Also: if the IHS is the IHS I am thinking of, an uncle who is a doctor worked with them years and years ago (Like, the late 60s/early 70s). His time there, what memories I’ve heard of it, was pretty happy – he was both in the Southwest for a while and in Alaska for a while.Report
Hc1: This is similar to law school. What comes after graduation from law school? Studying for the bar exam, which you take to actually get licensed. It is generally understood that law school doesn’t help you with that, and there is a thriving bar prep industry.Report
HC4:
When my wife went to the Mayo clinic recently, one thing she noted was that none of the providers she saw were at any time entering data into a terminal. Rather, they carried a tablet with them, and someone, somewhere (or perhaps some really smart software) was listening and transcribing everything that was talked about into the EMR, in real time.
As for the rest, I think the author is right that medical administration, especially the business side of it, needs to be open to the ideas here. But I think they, too, are in a tight spot when it comes to getting payment for services, financing capital investments, keeping the lights on, and making payroll. Even if we went to a complete socialized medical system, all the various conflicts and trade-offs would still exist, they would probably just get shuffled around a bit.Report
HC6: How can it go wrong? Same way as any DIY can go wrong – people assume it’s easy and get careless. Home electrical, plumbing, car repair, computer service, drug manufacturing – all of it does require a degree of education and care. Not as much education as the various professional interests would have one believe, but most definitely quite a lot of care to get it right.
That said, as long as people are making it for themselves and not trying to sell it or otherwise distribute it, I’m cool with what these folks are doing.Report