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Wait but you were saying earlier that it's hard to hire people and doctors need more support because it's expensive. Wouldn't the admin staff help with this??
Oh trust me I am pretty severely blackpilled on the Western medical institution, although I do admit that modern medicine has miracles aplenty. My mother's life has been saved on three different occasions by relatively recent medical inventions. So I'm grateful.
But I also wasted over $20k in my early twenties trying uselessly to figure out my chronic pain issues with TMJ, sciatica, RSI, and other various health stuff. Was told by multiple doctors I'd need surgery if I ever wanted to use a keyboard and mouse again. I'm pretty close to recovered now but... anyway that's a story for another day lol.
I didn't realize they were taken away! Ugh yeah it's so fucked. I've seen studies on like the efficacy of doctors based on how long they've been on shift and it's terrifying. Going to the hospital seems like such a crapshoot luck of the draw type situation in some respects.
Think admin like university admin - hospitals are laden with nursing executives, management and so on who at best ensure compliance with various regulations but often are just money drains. Admin in the sense of support staff would be great. Feminism has caused some of the pain here - support staff used to be competent women because it was women's work, now it is often people who can't get other forms of work (not saying I think the change is bad, just noting it).
says nothing about aggressive, trigger happy proceduralists
With respect to patient safety basically the research says that hand offs (to new doctors) are bad and sleepy doctors are bad. About as bad. It's cheaper to overwork the doctor so we go with that. If you've ever studied overnight or stayed up late gaming it is tempting to think of it as the same thing. It is not. Saving (or risking) a patient's life in a fugue state on hour 30 of no sleep and not realizing you'd done anything at all until 20 minutes after the fact is fucking horrifying.
In any case the specific thing with duty hours is that in the 16 hour max shift world you'd just be expected to stack 16 hour shifts indefinitely. With 24s you typically manage to get a "post-call day" meaning you'll do something like 8am-to 10am the next day, but have the rest of the day off "to live your life" aka pass the fuck out, which enables something resembling recovery.
These days the option is typically to take the sleep deprived resident/fellow or have a midlevel who works nights. I don't know a single doctor who'd ever take the midlevel over the physician, no matter how tired.
Ahhh I see. Ty for all the explanations.
Wow this sounds horrific. I can't imagine. No wonder doctors are emotionally repressed and not able to handle healing modalities that incorporate emotions. Brutal. I actually am gaining a lot more sympathy for doctors reading your responses.
Do you have any recommendations for like picking a good time to schedule a surgery for instance, as a patient? Or finding a good/competent doctor?
Being a physician (in general, not just the U.S.) is a very strange mix of job attributes, you need to be reasonably bright, hardworking, educated, dedicated, some baseline level of ability in connecting to others and it tends to generate what you'd expect from that description, reasonable amounts of prestige, good compensation, job security. However you also have the total opposite. Brutal scheduling you don't usually see in the white collar world, constant exposure to the worst segments of the population, incessant abuse and threats (sometimes physical) from patients and even other staff, lots of death and misery... Theirs a reason why bed side manner is often so limited, and why substance abuse and other bad outcomes are rampant in MDs and RNs.
That said people often feel it's worth it because of the good you can do. It's only within the last 10-15 years that the vibe really changed for the worse.
With respect to getting good care...it's extremely difficult. I can't tell most of the time if it's outside my areas of knowledge and social connections. The things that make patients feel like they are getting good care are very frequently orthogonal to actual quality. Classic examples are things like "oh yes I know my body and this needs an antibiotic" "yeah sure fine" "wow what a great doctor!" (that was a bad doctor).
Avoid the temptation to assume good bedside manner or vibes equals good doctor. Often it means people pleasing or good salesman (but not always, especially in disciplines like Psychiatry). Same with spending less time with you, could be because they are busy and over-scheduled and doing a lot of good, or could be because they are greedy and trying to do too much.
How do you protect yourself? Stick with academics, private practice has a higher ceiling but it's hard to tell who is actually good, in academics you tend to have multiple eyes on everything which is very helpful. Doesn't have to be the tippy top, just trainees in general means better care.
All kinds of lore exists for this, for instance an orthopedic surgeon might tell you that you want someone 5-10 years out of residency so that they've had time to develop and practice technical skills but they aren't so far out that they've gotten stuck in their ways and have fallen behind on advancements in the field. However individual ability variation and procedural expertise is so variable that I don't really think you can use this rule.
The gold standard would be things like finding a PT, and asking "which physicians in your area seem to have better outcomes when you follow their patients for outpatient therapy after the surgery."
That kind of stuff is nearly impossible for a lay person to suss out, and even if you have friends you can ask you run the risk of them having maligned incentives or poor insights into their own technical skills or judgement of others.
Do you know anything about healthcare systems in other parts of the world? Would you recommend medical tourism to anywhere?
Depends on what you mean. With respect to differences in the trainee experience, not as well as I'd like. Well enough to answer the question of "how do I get a good doctor in X country?" No.
For the question at hand, plenty. INCOMING RANT.
TLDR- No the U.S. has EASILY the best healthcare system in the world.
You'll note that for the most part the people who say we (the U.S.) have a deficient healthcare system are the same ones making all kinds of other claims we (as in the average Mottizen) have immense concern about.
If you can afford it (which is admittedly a big if) the U.S. still offers the best healthcare in the world. We often see people throw out outcome measures but they tend to be misleading. The U.S. is stuffed with obesity and other comorbid conditions and ....other forms of intractable problems that naturally lead to bad outcomes. Those same people would do worse elsewhere.
If you already have a rare genetic disease, an incurable condition, cancer, or DM2, CHF, and COPD - you'll get the best care here, should you be able to afford it. You may be more likely to end up with problems here, but you'll get better treatment.
That's because we are rich as fuck and have tons of resources and a huge chunk of global research is done here. Doctors also get paid more than elsewhere which means we drain everyone else's doctors and researchers, likewise we also work more than elsewhere which means more experience and faster care. Our training is also the best, often to a comical degree (which makes sense - we suffer through those hours and people are motivated by the pay). That's the carrot that goes along with the sticks I was whining about.
Wait times are a big difference with Canada, you may complain about waiting two-three months to see a neurologist in the U.S. but you'll wait two-three years north of the border.
Medical tourism does have a role, especially if you don't have unlimited money, but it's very easy to get grossly deficient care, end up with "customer service" care, or other problems (see: BBL complications). If you know the one hospital in Mexico or India that actually has good care that might turn out well, but it's still an actuarial game - if you have complications from anesthesia you are way more likely to die abroad, for example.
Also watch out for things like rationing and end of life care differences.
Other stuff adds some complexity here, as the U.S. does have some problems and while some European practice guidelines are inferior to our some are probably superior or more beneficial to such and such population of patients.
These tend to be very specific things though that don't alter the main point.
Scott would probably say something about the FDA, approval processes, cost disease and so on. Yeah people die because we take awhile to approve stuff but as far as I can tell we also make certain kinds of mistakes less frequently. It's complicated and individual patients can fall in or out of favor of those trends but ultimately it's likely the better structural approach.
Does that answer the question?
Yes, thank you for the detailed reply
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Whew well that's both depressing and reassuring, knowing that there's not much I can do anyway hah.
Thanks again for all the detailed replies my friend.
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