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Doctor Shortage: Collapse Immanent!
Re: Doctor Shortage: Collapse Immanent!
by Novus » Tue 31 Jan 2006, 21:40:04
Post peak lawyers will be the first ones burned at the stake and eaten as they have the least skills and tend to piss people off the most.
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Re: Doctor Shortage: Collapse Immanent!
by smallpoxgirl » Tue 31 Jan 2006, 21:55:14
$this->bbcode_second_pass_quote('PenultimateManStanding', 'W')hat's going on, smallpoxgirl? Any insights as to why our medical system is imploding?
Well...I think it is a natural progression of the paradigm that established modern medicine. Back in the 1800's the robber barrons had so much money they didn't know what to do with it all, so they started the concept of "philanthropy" which essentially boiled down to restructuring society in their image. One of their foremost projects was the consolidation of medical care into the hands of a small number of individuals who would have extensive scientific education and have the right class concious orientation. The basic promise was that science could give you a longer happier life. Well...the problem is that science isn't a static thing. Nobody ever talked about what was a reasonable length for a life. What is a reasonable standard of happiness? So ultimately you end up chasing your tail. Should we spend $20K on a course of Xigris that will improve a patient's survival from an episode of sepsis by 10%? Does it matter if the patient is 90 or 20? Unless you set some rational standards on what is a reasonable length of life and what is a reasonable standard of happiness then things like Xigris and Viagra and 80 year olds getting their 4th heart bypass will consume all the available resources in society.
The paucity of primary care doctors is not an unrelated issue. Medicine is all about the glamourous lie that technology will make you happy and beautiful and give you enternal life. Primary care is a whole different kettle of fish. It is all about trying to understand people, and what their real issues are. It's about listening to people when they tell you about their husbands death and holding their hand. It's not very much about PET scans and the slick new $20K a dose immune modulating drug (that 3 years from now will turn out to cause lymphoma and ear hair and a third hand growing in the middle of your forehead.) American medicine is all about the worship of technology. Small wonder the little technocrats coming out of medical schools don't want to deal with people.
The difficulty and expense of medical training was never established based on the subject matter. The first concept was that doctors needed to have the right class conciousness and higher incomes. Based on that concept the robber barons in conjunction with the AMA lobbied for stricter medical licensing standards, exclusion of non-allopaths from licensure, and longer and longer educational requirements. Don't be tricked into believing that the poor doctors can't afford to go into primary care. The expensive training requirements were established largely at the behest of doctors in order to limit the supply of doctors and justify higher sallaries.
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Re: Doctor Shortage: Collapse Immanent!
by PenultimateManStanding » Tue 31 Jan 2006, 22:20:41
well expressed and pretty much what I thought. There's another hitch in the plan, though: lawyers, the sworn enemy of doctors, no? Doctors worshipping technology are faced with diabolical word mechanics who spin their latin mumbojumbo spells on the one hand and manipulate simple jurors on the other. Lawyers specialize in human nature and weaknesses of the mind while doctors focus on the inhuman tech side of things. If it weren't for peak oil, I would expect the lawyers to win utterly in the end.
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Re: Doctor Shortage: Collapse Immanent!
by MicroHydro » Wed 01 Feb 2006, 01:43:09
Here is a 1st person account from a 20 year ACP member. After closing my practice in California, I had to pay a "tail coverage" premium to my insurance company. That sum was equivalent to 18 years of insurance premiums in New Zealand.
Admittedly, I didn't leave the US because of the horrible professional business environment. But, working a system where primary care is the focus (rather than maximizing profits for GE, Merck, and Bill Frist's hospital chain) is wonderful. Care for children under 6 is 'free' (publically insured) here as is accident care for anyone.
Admittedly, I didn't leave the US because of the horrible professional business environment. But, working a system where primary care is the focus (rather than maximizing profits for GE, Merck, and Bill Frist's hospital chain) is wonderful. Care for children under 6 is 'free' (publically insured) here as is accident care for anyone.
"The world is changed... I feel it in the water... I feel it in the earth... I smell it in the air... Much that once was, is lost..." - Galadriel
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Re: Doctor Shortage: Collapse Immanent!
by smallpoxgirl » Wed 01 Feb 2006, 13:49:22
$this->bbcode_second_pass_quote('PenultimateManStanding', 'T')here's another hitch in the plan, though: lawyers, the sworn enemy of doctors, no?
Well...you have to look back on how the doctor-lawyer thing evolved. IMHO our lawyer affliction is also pretty much self imposed. The problem is that doctors started pedaling this completely unrealistic superhero version of what scientific medicine would do for the world. So then if things don't turn out well, or god forbid, you make a mistake, then the patients are completely disollusioned and start looking for a lawyer. If we had built a more healthy understanding of who we are (i.e. human beings) and what we can and can't do for people, then people wouldn't have such unreasonable standards and be looking for a lawyer at the drop of a hat. The other piece of the lawsuit equation is that we have built this expectation that doctors should be at the top of the income bracket. When rich people screw up they get sued. If your gardener screws up your yard, you're probably not going to sue him because what would be the point.
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