It must be difficult to be a well-intentioned and competent doctor in the USA, other countries too for that matter. The implosion you describe and collapse of trust in the medical system is one of a few silver linings to the disaster of the last 3 years. It's way, way overdue. My wife and I are well into retirement years and have real…
It must be difficult to be a well-intentioned and competent doctor in the USA, other countries too for that matter. The implosion you describe and collapse of trust in the medical system is one of a few silver linings to the disaster of the last 3 years. It's way, way overdue. My wife and I are well into retirement years and have realized for decades their objective is always to turn you into a revenue source, and they don't mind destroying you to do it. That fact has been as obvious, for a LONG time, as the scamdemic lies were. Nice to see more waking up, not that I really expect this to end well.
Sadly, I believe it's much easier in the USA than most other Western democracies. Despite everything I complain about, we have much more latitude here and patients frequently fly over from Europe to see USA doctors.
A lot of docs come to the US to train thinking that it's some kind of medical mecca; most of the ones I've met return home gladly and as soon as they can. They have received both training in their specialty (which they could have obtained at home), and an education ( about propaganda, which they could not have obtained at home).
That may also be due to immigration law. In the old days, it's my understanding, that foreigners who studied in the USA had to return to their homeland, or at least leave the USA for five years or some such, before they could return and presumably become resident aliens working here. Decadent as we are, the USA is still a damned sight better than most of the world. If this were not true, then millions of (mostly) poorer impoverished people would not eagerly seek to come here, legally or otherwise.
Perhaps such laws are still on the books. Doesn't really matter, since laws don't mean much any more -- just ask the millions of illegal aliens already here. The government doesn't even enforce laws any more; they don't even know how many illegals are here.
True, but my point was that most of whom I know who came here felt it was better back home (both in Europe and in Asia) and based on my experiences I have my dental work done in Asia because the quality and service is somewhat superior to what I've had in the US.
I'm not a huge consumer of medical "services," so have little personal experience to base a judgement on, but from what I've seen, the docs elsewhere are generally far superior to what we have were, the propaganda notwithstanding. I've known more than a few who come here thinking that they would get something special by training here, but they soon realize that their hopes were really dreams.
We are friends of a cardiac vascular surgeon who came here for a fellowship at a "world renowned" program who was shocked and more than a little disgusted at what was going on, and was recrutited to stay here and teach, but he turned the offer down without hesitation. Things were much better at home. His daughter recently graduated from a med school in their home country in fact. Could have easily come here for training if desired but she knew she'd get real life experiences there that she'd never get here.
For instance, the "world class" hospital I mentioned only allowed* its eye residents to assist in surgery during their last year whereas first year residents actually perform eye surgery in their first year (but under very strict guidance), and come out of their programs with judgement and skills that put ours to shame.
People typically want to think the best of their country and even the ancient Greeks had the methods of pandering to that sentiment well rehearsed. Plato's Menexenus explains it all and is a fascinating read. Short yet enlightening too. https://freeclassicebooks.com/Plato/Menexenus.pdf
Ideally, I wouldn't want the first year guys to do mine either, but I sure as bleep wouldn't want the guys who left training with no hands on experience and little responsibility trying their luck on me.
The first year guys start out doing simple things and tackle more complicated stuff as they demonstrate increasing competence and they are very strictly supervised.
I'm a younger (61) senior, still relatively healthy thank goodness; I must reluctantly agree with your dreary observations. I would add to your "silver lining" list that, for me at least, the unprecedented mendacity, the bad faith from all quarters especially since January 2020, had made obvious the rot that has existed in the system for many decades prior. The sooner all this collapses and, hopefully, a freer system replaces it the better. Otherwise there's a very real chance that most of the world is really staggering into some form of global authoritarian state, a brave new world, a 1984, whatever.
This may collapse and be replaced with a freer system as you say. You know what happens then, don't you? Ten generations max and it's sick and ready for the ashbin again. The cycle continues. Is there a point to the endless rise and fall cycle? I dunno, beyond my pay grade. I do know humankind can't sustain a decent society in the context of civilization. Hunter-gatherer groups do much better in that regard. Seems that's what we're designed for and we can't handle modernity. One huge advantage primitive groups have is psychopaths can be eliminated, rather than allowed to thrive.
You’re exactly right. As I tell people, your doctors chose their careers and livelihood over their sacred oath to guard your life. You’re no longer patients. You’re a cash register.
I made a point to set myself up so that I would never be held in a career position where I would have to make those choices, but in many other fields, doctors are forced to either advocate for their patient or be safe with their employer and its often very hard to do both because doctors have a lot less power than they used to compared to corporate health care systems.
It's disappointing, although not in the least surprising, that doctors don't have an organization that has advocated for their ability to practice as so many would prefer. Instead, they've passively allowed the entire system to degrade and along with it their autonomy and ability to truly serve patients. If there is such an organization it's so ineffective as to be invisible. I will never forget when, as a young teen in the 60's I asked my mom why we weren't stopping by the cashier to pay as we left the clinic. When she explained "oh, nobody pays, everybody has insurance that pays" I knew instantly what that meant - the system would inevitably be taken over by the very worst individuals, and become a corrupt mess. Why most people can't understand how a system with every incentive to raise prices and no incentive toward efficiency must fail is beyond me. High prices benefit insurance companies, that should be obvious but apparently is not.
"Why most people can't understand how a system with every incentive to raise prices and no incentive toward efficiency must fail is beyond me. High prices benefit insurance companies, that should be obvious but apparently is not."
The fact that we're forced to buy health insurance is another clue that supports what you wrote there.
There are few incentives for delivering quality care either. In fact, it often works just the opposite as we can now clearly appreciate.
Also, the freedom from liability seems to encourage sloppy or harmful work and not only that, but government funding obviously encourages a race for the bucks and the short cuts that typically entails.
The object is to do just enough to get the handouts with little regard for the results. I have a brother, an engineer, who went to Bosnia after the war, with USAID. He was (naively )concerned about quality until a superior took him aside one day and told him that the object was just to spend money. Reminds me of the shocking scandals that took place when the railroads were being built in the USA 150 years ago. Apparently the situation regarding government favoritsm, spending, and graft has only worsened since.
If we cannot abolish monster government, then we should at least abolish corporations, but I doubt that'll ever happen.
Tragically, most doctors today function as little more than hired hands but that goes as well for anyone employed by large corporations. You are smart for seeing the trap and having the guts to avoid it.
It's really sad to think of how many years and how much effort docs have invested to secure their own slavery.
Just as the military seems to be finding it difficult to find good people, medicine will increasingly find that to be true as well. Part of the problem is that the quality of our journalists and politicians has been in a tailspin for decades too.
they get kick backs from pharma. Either in the form of vacations, parties or free fancy dinners. I know this.
So, if you are a doc in a "group", you might be able to decide how to treat your patients conservatively, or you might give in to the pressure of offering a new med that is horribly expensive but "we can give you a coupon". pharma needs people taking meds, Not old meds, new meds
You cite a good example of where it's useful to know about basic psychology: A rational person will tend to choose his own well-being, loyalty to family, friends, tribe, religion, nation, etc. over those of outsiders. There are many other ways that could be phrased: A rational person tends to act in his own self-interest. Sure, there are cases where a person will act altruistically and sacrifice himself for others or for a group, for an ideal he believes in. But that's rare. In other words, you are a fool if you put yourself into a position where you hope someone will put his own interests aside. Hoping that someone will risk his own ass just for you is not a smart way to bet. Note that none of the foregoing says a person so acting is "evil." Yes, surely the would-be beneficiary would be expected to feel that way. Yet the impartial observer would say no, the would be benefactor is merely acting in his own self-interest, and the "victim" is in the wrong, expecting others to act against self-interest.
That's why some knowledge of pop psychology is helpful. For example, consider an economic transaction (and seeing your doctor is one). How is the other party compensated? Complications like the risk of fraud always exist, but a lot can be inferred by knowing actual or likely potential conflicts of interest. Of course it depend upon the situation. For example, in court, plaintiff and defendant optimally want a lawyer who represents their interest only. The judge should be impartial, having no conflicts of interest either way. Alas, the real world is rarely so clear-cut. Oftentimes, the best one can do is to be aware of the actual or probable conflicts of interest and manage how they may influence the other party's behavior.
A final comment: I NEVER was taught anything remotely like the above in school, and I've got a BS STEM degree and a MA in a liberal art. The closest I came to moral insights might have been in various religion teaching I received. Yet the psychology or morality I outlined above is basic stuff. I learned it from articles, independent reading, even from economics texts.
It must be difficult to be a well-intentioned and competent doctor in the USA, other countries too for that matter. The implosion you describe and collapse of trust in the medical system is one of a few silver linings to the disaster of the last 3 years. It's way, way overdue. My wife and I are well into retirement years and have realized for decades their objective is always to turn you into a revenue source, and they don't mind destroying you to do it. That fact has been as obvious, for a LONG time, as the scamdemic lies were. Nice to see more waking up, not that I really expect this to end well.
Sadly, I believe it's much easier in the USA than most other Western democracies. Despite everything I complain about, we have much more latitude here and patients frequently fly over from Europe to see USA doctors.
A lot of docs come to the US to train thinking that it's some kind of medical mecca; most of the ones I've met return home gladly and as soon as they can. They have received both training in their specialty (which they could have obtained at home), and an education ( about propaganda, which they could not have obtained at home).
That may also be due to immigration law. In the old days, it's my understanding, that foreigners who studied in the USA had to return to their homeland, or at least leave the USA for five years or some such, before they could return and presumably become resident aliens working here. Decadent as we are, the USA is still a damned sight better than most of the world. If this were not true, then millions of (mostly) poorer impoverished people would not eagerly seek to come here, legally or otherwise.
Perhaps such laws are still on the books. Doesn't really matter, since laws don't mean much any more -- just ask the millions of illegal aliens already here. The government doesn't even enforce laws any more; they don't even know how many illegals are here.
True, but my point was that most of whom I know who came here felt it was better back home (both in Europe and in Asia) and based on my experiences I have my dental work done in Asia because the quality and service is somewhat superior to what I've had in the US.
I'm not a huge consumer of medical "services," so have little personal experience to base a judgement on, but from what I've seen, the docs elsewhere are generally far superior to what we have were, the propaganda notwithstanding. I've known more than a few who come here thinking that they would get something special by training here, but they soon realize that their hopes were really dreams.
We are friends of a cardiac vascular surgeon who came here for a fellowship at a "world renowned" program who was shocked and more than a little disgusted at what was going on, and was recrutited to stay here and teach, but he turned the offer down without hesitation. Things were much better at home. His daughter recently graduated from a med school in their home country in fact. Could have easily come here for training if desired but she knew she'd get real life experiences there that she'd never get here.
For instance, the "world class" hospital I mentioned only allowed* its eye residents to assist in surgery during their last year whereas first year residents actually perform eye surgery in their first year (but under very strict guidance), and come out of their programs with judgement and skills that put ours to shame.
People typically want to think the best of their country and even the ancient Greeks had the methods of pandering to that sentiment well rehearsed. Plato's Menexenus explains it all and is a fascinating read. Short yet enlightening too. https://freeclassicebooks.com/Plato/Menexenus.pdf
*That may have changed by now.
I’m not sure I want a first year resident doing my eye surgery. Not sure I want a fourth year assisting it either.
Ideally, I wouldn't want the first year guys to do mine either, but I sure as bleep wouldn't want the guys who left training with no hands on experience and little responsibility trying their luck on me.
The first year guys start out doing simple things and tackle more complicated stuff as they demonstrate increasing competence and they are very strictly supervised.
I used to see a fair number of Canadians.
I'm a younger (61) senior, still relatively healthy thank goodness; I must reluctantly agree with your dreary observations. I would add to your "silver lining" list that, for me at least, the unprecedented mendacity, the bad faith from all quarters especially since January 2020, had made obvious the rot that has existed in the system for many decades prior. The sooner all this collapses and, hopefully, a freer system replaces it the better. Otherwise there's a very real chance that most of the world is really staggering into some form of global authoritarian state, a brave new world, a 1984, whatever.
This may collapse and be replaced with a freer system as you say. You know what happens then, don't you? Ten generations max and it's sick and ready for the ashbin again. The cycle continues. Is there a point to the endless rise and fall cycle? I dunno, beyond my pay grade. I do know humankind can't sustain a decent society in the context of civilization. Hunter-gatherer groups do much better in that regard. Seems that's what we're designed for and we can't handle modernity. One huge advantage primitive groups have is psychopaths can be eliminated, rather than allowed to thrive.
You’re exactly right. As I tell people, your doctors chose their careers and livelihood over their sacred oath to guard your life. You’re no longer patients. You’re a cash register.
I made a point to set myself up so that I would never be held in a career position where I would have to make those choices, but in many other fields, doctors are forced to either advocate for their patient or be safe with their employer and its often very hard to do both because doctors have a lot less power than they used to compared to corporate health care systems.
It's disappointing, although not in the least surprising, that doctors don't have an organization that has advocated for their ability to practice as so many would prefer. Instead, they've passively allowed the entire system to degrade and along with it their autonomy and ability to truly serve patients. If there is such an organization it's so ineffective as to be invisible. I will never forget when, as a young teen in the 60's I asked my mom why we weren't stopping by the cashier to pay as we left the clinic. When she explained "oh, nobody pays, everybody has insurance that pays" I knew instantly what that meant - the system would inevitably be taken over by the very worst individuals, and become a corrupt mess. Why most people can't understand how a system with every incentive to raise prices and no incentive toward efficiency must fail is beyond me. High prices benefit insurance companies, that should be obvious but apparently is not.
Great comment.
"Why most people can't understand how a system with every incentive to raise prices and no incentive toward efficiency must fail is beyond me. High prices benefit insurance companies, that should be obvious but apparently is not."
The fact that we're forced to buy health insurance is another clue that supports what you wrote there.
There are few incentives for delivering quality care either. In fact, it often works just the opposite as we can now clearly appreciate.
Also, the freedom from liability seems to encourage sloppy or harmful work and not only that, but government funding obviously encourages a race for the bucks and the short cuts that typically entails.
The object is to do just enough to get the handouts with little regard for the results. I have a brother, an engineer, who went to Bosnia after the war, with USAID. He was (naively )concerned about quality until a superior took him aside one day and told him that the object was just to spend money. Reminds me of the shocking scandals that took place when the railroads were being built in the USA 150 years ago. Apparently the situation regarding government favoritsm, spending, and graft has only worsened since.
If we cannot abolish monster government, then we should at least abolish corporations, but I doubt that'll ever happen.
Tragically, most doctors today function as little more than hired hands but that goes as well for anyone employed by large corporations. You are smart for seeing the trap and having the guts to avoid it.
It's really sad to think of how many years and how much effort docs have invested to secure their own slavery.
Just as the military seems to be finding it difficult to find good people, medicine will increasingly find that to be true as well. Part of the problem is that the quality of our journalists and politicians has been in a tailspin for decades too.
they get kick backs from pharma. Either in the form of vacations, parties or free fancy dinners. I know this.
So, if you are a doc in a "group", you might be able to decide how to treat your patients conservatively, or you might give in to the pressure of offering a new med that is horribly expensive but "we can give you a coupon". pharma needs people taking meds, Not old meds, new meds
By design. Saw it coming when managed care took hold.
You cite a good example of where it's useful to know about basic psychology: A rational person will tend to choose his own well-being, loyalty to family, friends, tribe, religion, nation, etc. over those of outsiders. There are many other ways that could be phrased: A rational person tends to act in his own self-interest. Sure, there are cases where a person will act altruistically and sacrifice himself for others or for a group, for an ideal he believes in. But that's rare. In other words, you are a fool if you put yourself into a position where you hope someone will put his own interests aside. Hoping that someone will risk his own ass just for you is not a smart way to bet. Note that none of the foregoing says a person so acting is "evil." Yes, surely the would-be beneficiary would be expected to feel that way. Yet the impartial observer would say no, the would be benefactor is merely acting in his own self-interest, and the "victim" is in the wrong, expecting others to act against self-interest.
That's why some knowledge of pop psychology is helpful. For example, consider an economic transaction (and seeing your doctor is one). How is the other party compensated? Complications like the risk of fraud always exist, but a lot can be inferred by knowing actual or likely potential conflicts of interest. Of course it depend upon the situation. For example, in court, plaintiff and defendant optimally want a lawyer who represents their interest only. The judge should be impartial, having no conflicts of interest either way. Alas, the real world is rarely so clear-cut. Oftentimes, the best one can do is to be aware of the actual or probable conflicts of interest and manage how they may influence the other party's behavior.
A final comment: I NEVER was taught anything remotely like the above in school, and I've got a BS STEM degree and a MA in a liberal art. The closest I came to moral insights might have been in various religion teaching I received. Yet the psychology or morality I outlined above is basic stuff. I learned it from articles, independent reading, even from economics texts.
Common sense wins out over the ivory tower morons all the time.
Almost no one truly gives a shit about your problems unless it affects them directly.
Most, yes.
Excellent comment.