The Home Doctor - Practical Medicine for Every Household - is a 304 page doctor written and approved guide on how to manage most health situations when help is not on the way. I’m a surgeon. I’d like to think that I’m resilient and well adjusted, having gone through medical school and rigorous surgical training. I’ve been a doctor for 13 years and much of that period has been spent training to be as good a surgeon as I could ever be. I have great family support, a physician wife who understands my work and I’ve never been diagnosed with a mental illness.
I think the root of the problem is having medicine being controlled by for-profit corporations. My local hospital was purchased by a for-profit corporation. Since then its been obvious that staffing has been cut to the point that things don't function well. Every time I had a problem there, it touched on a department or service that either had layoffs or was overbooked. Its like running a car engine without oil.
Capitalism and a free market is just not a good fit for endeavors where quality matters more than profit. I believe that the profit motive for medical insurance is at the root of the problem. They capture the profit and squeeze the hospitals and medical practices to the edge of sustainability.
And this drives the pain and suffering for the doctors and other professionals who try to work in the system and the patients who know that the time with our physician is rationed.
Its how medicine is funded that has to change. Some European countries are doing this much better than we are in the US.
US doctor on last year of residency training and going to fellowship. Even in my formative years as a physician we can clearly see the direction of medicine. Even as protected as we are in residency, we find it is still violated by non physicians who want to dictate what we do and how we do it. The thought of leaving the profession altogether has crossed my mind many times, especially on those days we have to fight insurance or the system. I know now that anyone that has gone through residency can endure a lot. The only question is how much and at what cost.... we just hope we are left standing at the end of the day most days(which frankly in itself is a very low bar). Like anyone else I am afraid of falling out of love with a universe I love
> What other “Dark Side of Doctoring” issues can you think of?
As a physician in the U.S. you have to report to the medical board any time you had to get mental health counseling or if you are taking psychoactive meds, like antidepressants. Therefore many just endure mental health struggles. This article (https://www.kevinmd.com/2016/01/physicians-anxiety-shouldnt-suffer-silence.html) resonated with me.
And the news media seem to delight in reporting any incident where a physician gets into legal trouble, and I've seen a few of my colleagues get reported for domestic disputes or legal accusations for which they may or may not have been guilty. I've seen a physician targeted for a lawsuit by a crazy patient who wanted money, only because he had the deepest pockets. Patients can accuse you of anything publicly, and you can only say "no comment" because saying anything more can be an expensive HIPAA violation. Most doctors are no longer in their own private practice, and are now employees of hospitals, or some other larger healthcare group. Thus, most doctors don't have much control over their workload, or the ancillary help they get, or their payscale. This is probably the cause of much burnout in the profession.
This is so sad.. the way I see it what's happening is the same thing that happens to every single industry. It eventually gets taken over and run by profit maximizing business parasites and a bloated admin staff at the expense of the actual workers. Same thing in colleges or software or any sufficiently large organization. From an MBA perspective, your autonomy and judgement is just unpredictability and low efficiency - they would much rather have a line of mid-level instruction following and interchangeable drones than great people with agency.
The only answer I see is basically leaving the institutions that do that and building new ones owned by the workers. Like private practices or small clinics that are substantially owned by the doctors not admins or PE firms or wall street. But that's much easier said than done..
This speaks to me so much. The practice I’m in was bought out by a PE-backed group and the issues you’ve run into in the hospital have crept their way into outpatient medicine too. Increasing loss of control of aspects of my practice and an unrelenting push for increased productivity despite rapidly approaching the point of being simply too damn busy to provide the quality of care I personally intend to provide to my patients. And metrics. Endless metrics. Productivity targets that make it clear they really don’t want me to take my vacation time. Corporate leadership that doesn’t in the slightest bit understand how the practice of medicine actually works, because to them it’s about money, money, and money. It’s maddening.
I 100% resonate with this. I am a nurse, not a doctor but nursing is in a similar state. Lots of nurses leaving the profession all together. Too much burnout and too much administrative nonsense. I don't really know what to do about it but the situation is too stressful for me to work full time anymore. I've stepped back considerably. The saddest part is the loss of meaning, like you said. I came into nursing because I wanted to help people. Instead I feel like I'm herding cattle. The moral injury is the worst part. It's the worst feeling to have to leave a dementia patient who is reaching out to me for help because I have a patient tanking in the next room. And so she's left alone because she is not the priority and there are not enough staff to help. But she is someone's mom, sister, grandmother. And I can't help her. And when I finally do get to her I have to rush through care because I have gazillion other things to do. It's insane. This is just a tiny example of the struggles of health care professionals. It's an insane work environment. It's not fit for either staff or patients.
Thank you for having the courage to share this. More of us need to be sharing stories like this. It's important that patients know what's going on because it's totally unsafe the way things are.
Capitalism. When society going to realise that there no country in the world that successfully implemented capitalism. 100 years, it’s as bad or even worse. Can’t have healthcare on commercial basis, it’s madness.
As an OBGYN who has observed the tightening of the top down tyrannical vice intensify over the last 30 years, I feel there is only one two part solution: state constitutional convention term limits amendment to sever the ties between the so call representatives and the powerful entities such as the american hospital association ( the worst ) AMA which sold Doctors out long ago, Big pharm esp the ripoffs of generic cost manipulations and more.
Zero change will occur without this severance package.
The second part of the solution is to form a new organization the PNP National Society. ( Physicians-yes physicians, not “PCPs”, Nurses and Patients. Patients are being horribly treated both economically as well as clinically by the current unsustainable monster called “ the health care system”.
Together only will we be able to reassert our primary roles. The inclusion of patients is the key because our duty is to them. You have more than convincingly written a thesis that shows how what is bad for us is bad for them. One third of the cost of medicine could be lopped off in short order-especially by targeting hospitals outrageous hostile takeover of the system.
Thank you for expressing your intense pain. Be on the lookout for other options n the meantime. I have nightmares about scenarios less brutal than yours.
Above all trust in God who knows our unjust sufferings, and remember to value yourself and be your own best friend, confidante and guide.
Thank you for sharing this. Thank you for your courage to being open. I worked as a hospital supplies clerk where I interacted with doctors and nurses seeing behind the scenes and being part of the administration I emphatized with them. I also saw many areas to improve conditions. However, even in a public hospital budgeting is prioritized over people.
"Sending heartfelt condolences to Dr. Bryant's family. My wife recently retired from her 40-year healthcare career, starting in NYC hospitals and ending in northern NJ. She was part of the CIR movement early on. Today, many share challenging experiences that reflect the people's struggles, but it's crucial to consider the broader impact. If you read industry reports like Beckers ASC Review for insights into how healthcare trends, the rise of administrators and AI is nothing new. Let's face it, modern Taylorism has been reshaping medicine for decades. If you have ever read any of the fundamental works of Fred Taylor, every one of his "innovations" in time and motion studies, incentives or efficiency are ripped directly from his works on maximizing profits in the INDUSTRIAL settings like steel mills or shipyards. While these changes are widely recognized, their full impact can be hard to grasp. Perhaps it's time, despite the status quo, to advocate more actively for shorter work periods etc., akin to CIR's past activism. Without action, expect more of the same challenges.
A very interesting post. I now understand why I end up always waiting so long at every doctors clinic.
Curious to know though why some of the tedious paper work cannot be delegated to an assistant. Seems like the obvious answer, but I guess I’m missing something.
It's insane to see what's being demanded of our doctors, though it seems like you guys have been pressed by the same systemic daemon that is affecting all professionals (to the most extreme of course).
But what is happening? Why are people working harder yet systems collapsing faster? Where is the glut going? Is it because of the Rich? The managerial class? The inverted population pyramid?
Honestly, I know doctoring schedules were set by a coke addict - but why is there such pressure to perform right up until the point of suicide? And why does it seem like theres no one to point of finger at.
I am the wife of a complex neuro patient with mystery symptoms. There is never enough time to relay my husband's health history to a new specialist, and the end result is another wasted effort, first to find the knowledgeable doctors, then to get an appt., then to make my husband's sacrifice of strength and energy to get to the consult, and then to convey the right data without taking up valuable time conveying the unnecessary data. I understand why doctors are leaving their practices for concierge medicine. Not that a surgeon has that option; you have my deepest sympathy. Our daughter opted to become an EM physician so that she could leave her job behind her at the end of her shift.
As a Christian expecting the Rapture at any minute, I am able to let "failure to diagnose" happen, because my husband and I will get new imperishable bodies without pain or sorrow to trouble us any longer. These bodies are temporary dwellings (tumbledown shacks after 6 decades!). But I do wonder how patients as well as overworked doctors and other medical staff without this faith get through a single day, I truly do. God bless you for speaking the truth about the tyranny of the computer invading the practice of medicine to its destruction. A last word...if you don't believe in Jesus (yet), at least be brave enough to refuse the Mark...
I admire doctors like you, I work within IT Industry and I have on-call at times, it's noway near the frustration you going through and if I make mistake during wee times, that will cost a company money not a person's life, I wish people high up can understand the pain of you and other doctors who are over worked. I kept on showing my partner this article while reading it, it has touched me and I feel something needs to be done, to protect you and other doctors from burning-out which would be catastrophic to your patience and people you are trying to help while exhausted. Keep up the good work.
I always admired how the doctors sacrifice their life for their job. I know well what happen to person when got no sleep, So thinking doctors being awake for days still doing their job in those critical situations that blows my mind, really it is unbelievable thing. I am always ready to support the doctors to work with normal hours, to save their lives literally. Probably you may say well there are plenty of patients need our help, what is your idea to how we organize the patients? I would say as a patient, yes large number of patients is a problem. but another main problem is health system, beside with capitalism. I don't understand how medical industry evolved to this from Luqman to Doctor who just giving prescription for symptoms. i don't understand why i am in pain because the source of disease still there while my doctor giving me medicine to solve symptoms superficially. i really hate this. I have really huge admiration to doctors (real ones) who really want to help other humans. But system is failing, healthcare should not be affected by capitalism.
I think the root of the problem is having medicine being controlled by for-profit corporations. My local hospital was purchased by a for-profit corporation. Since then its been obvious that staffing has been cut to the point that things don't function well. Every time I had a problem there, it touched on a department or service that either had layoffs or was overbooked. Its like running a car engine without oil.
Capitalism and a free market is just not a good fit for endeavors where quality matters more than profit. I believe that the profit motive for medical insurance is at the root of the problem. They capture the profit and squeeze the hospitals and medical practices to the edge of sustainability.
And this drives the pain and suffering for the doctors and other professionals who try to work in the system and the patients who know that the time with our physician is rationed.
Its how medicine is funded that has to change. Some European countries are doing this much better than we are in the US.
US doctor on last year of residency training and going to fellowship. Even in my formative years as a physician we can clearly see the direction of medicine. Even as protected as we are in residency, we find it is still violated by non physicians who want to dictate what we do and how we do it. The thought of leaving the profession altogether has crossed my mind many times, especially on those days we have to fight insurance or the system. I know now that anyone that has gone through residency can endure a lot. The only question is how much and at what cost.... we just hope we are left standing at the end of the day most days(which frankly in itself is a very low bar). Like anyone else I am afraid of falling out of love with a universe I love
> What other “Dark Side of Doctoring” issues can you think of?
As a physician in the U.S. you have to report to the medical board any time you had to get mental health counseling or if you are taking psychoactive meds, like antidepressants. Therefore many just endure mental health struggles. This article (https://www.kevinmd.com/2016/01/physicians-anxiety-shouldnt-suffer-silence.html) resonated with me.
And the news media seem to delight in reporting any incident where a physician gets into legal trouble, and I've seen a few of my colleagues get reported for domestic disputes or legal accusations for which they may or may not have been guilty. I've seen a physician targeted for a lawsuit by a crazy patient who wanted money, only because he had the deepest pockets. Patients can accuse you of anything publicly, and you can only say "no comment" because saying anything more can be an expensive HIPAA violation. Most doctors are no longer in their own private practice, and are now employees of hospitals, or some other larger healthcare group. Thus, most doctors don't have much control over their workload, or the ancillary help they get, or their payscale. This is probably the cause of much burnout in the profession.
This is so sad.. the way I see it what's happening is the same thing that happens to every single industry. It eventually gets taken over and run by profit maximizing business parasites and a bloated admin staff at the expense of the actual workers. Same thing in colleges or software or any sufficiently large organization. From an MBA perspective, your autonomy and judgement is just unpredictability and low efficiency - they would much rather have a line of mid-level instruction following and interchangeable drones than great people with agency.
The only answer I see is basically leaving the institutions that do that and building new ones owned by the workers. Like private practices or small clinics that are substantially owned by the doctors not admins or PE firms or wall street. But that's much easier said than done..
This speaks to me so much. The practice I’m in was bought out by a PE-backed group and the issues you’ve run into in the hospital have crept their way into outpatient medicine too. Increasing loss of control of aspects of my practice and an unrelenting push for increased productivity despite rapidly approaching the point of being simply too damn busy to provide the quality of care I personally intend to provide to my patients. And metrics. Endless metrics. Productivity targets that make it clear they really don’t want me to take my vacation time. Corporate leadership that doesn’t in the slightest bit understand how the practice of medicine actually works, because to them it’s about money, money, and money. It’s maddening.
I 100% resonate with this. I am a nurse, not a doctor but nursing is in a similar state. Lots of nurses leaving the profession all together. Too much burnout and too much administrative nonsense. I don't really know what to do about it but the situation is too stressful for me to work full time anymore. I've stepped back considerably. The saddest part is the loss of meaning, like you said. I came into nursing because I wanted to help people. Instead I feel like I'm herding cattle. The moral injury is the worst part. It's the worst feeling to have to leave a dementia patient who is reaching out to me for help because I have a patient tanking in the next room. And so she's left alone because she is not the priority and there are not enough staff to help. But she is someone's mom, sister, grandmother. And I can't help her. And when I finally do get to her I have to rush through care because I have gazillion other things to do. It's insane. This is just a tiny example of the struggles of health care professionals. It's an insane work environment. It's not fit for either staff or patients.
Thank you for having the courage to share this. More of us need to be sharing stories like this. It's important that patients know what's going on because it's totally unsafe the way things are.
What do?
Sincerely.
I am a generalist in computer world but also deal a lot with humans and politics.
Can you tell us what the propably biggest lever is to remove friction from the actual doing medicine?
European here. Seems a little less fucked up in here but not by far.
internet-ramblings-59202@gheddo.biz
Capitalism. When society going to realise that there no country in the world that successfully implemented capitalism. 100 years, it’s as bad or even worse. Can’t have healthcare on commercial basis, it’s madness.
As an OBGYN who has observed the tightening of the top down tyrannical vice intensify over the last 30 years, I feel there is only one two part solution: state constitutional convention term limits amendment to sever the ties between the so call representatives and the powerful entities such as the american hospital association ( the worst ) AMA which sold Doctors out long ago, Big pharm esp the ripoffs of generic cost manipulations and more.
Zero change will occur without this severance package.
The second part of the solution is to form a new organization the PNP National Society. ( Physicians-yes physicians, not “PCPs”, Nurses and Patients. Patients are being horribly treated both economically as well as clinically by the current unsustainable monster called “ the health care system”.
Together only will we be able to reassert our primary roles. The inclusion of patients is the key because our duty is to them. You have more than convincingly written a thesis that shows how what is bad for us is bad for them. One third of the cost of medicine could be lopped off in short order-especially by targeting hospitals outrageous hostile takeover of the system.
Thank you for expressing your intense pain. Be on the lookout for other options n the meantime. I have nightmares about scenarios less brutal than yours.
Above all trust in God who knows our unjust sufferings, and remember to value yourself and be your own best friend, confidante and guide.
Mark Berry MD
Hammond La
Thank you for sharing this. Thank you for your courage to being open. I worked as a hospital supplies clerk where I interacted with doctors and nurses seeing behind the scenes and being part of the administration I emphatized with them. I also saw many areas to improve conditions. However, even in a public hospital budgeting is prioritized over people.
"Sending heartfelt condolences to Dr. Bryant's family. My wife recently retired from her 40-year healthcare career, starting in NYC hospitals and ending in northern NJ. She was part of the CIR movement early on. Today, many share challenging experiences that reflect the people's struggles, but it's crucial to consider the broader impact. If you read industry reports like Beckers ASC Review for insights into how healthcare trends, the rise of administrators and AI is nothing new. Let's face it, modern Taylorism has been reshaping medicine for decades. If you have ever read any of the fundamental works of Fred Taylor, every one of his "innovations" in time and motion studies, incentives or efficiency are ripped directly from his works on maximizing profits in the INDUSTRIAL settings like steel mills or shipyards. While these changes are widely recognized, their full impact can be hard to grasp. Perhaps it's time, despite the status quo, to advocate more actively for shorter work periods etc., akin to CIR's past activism. Without action, expect more of the same challenges.
A very interesting post. I now understand why I end up always waiting so long at every doctors clinic.
Curious to know though why some of the tedious paper work cannot be delegated to an assistant. Seems like the obvious answer, but I guess I’m missing something.
Well said!
It's insane to see what's being demanded of our doctors, though it seems like you guys have been pressed by the same systemic daemon that is affecting all professionals (to the most extreme of course).
But what is happening? Why are people working harder yet systems collapsing faster? Where is the glut going? Is it because of the Rich? The managerial class? The inverted population pyramid?
Honestly, I know doctoring schedules were set by a coke addict - but why is there such pressure to perform right up until the point of suicide? And why does it seem like theres no one to point of finger at.
It's the odd zeitgeist of our time.
I am the wife of a complex neuro patient with mystery symptoms. There is never enough time to relay my husband's health history to a new specialist, and the end result is another wasted effort, first to find the knowledgeable doctors, then to get an appt., then to make my husband's sacrifice of strength and energy to get to the consult, and then to convey the right data without taking up valuable time conveying the unnecessary data. I understand why doctors are leaving their practices for concierge medicine. Not that a surgeon has that option; you have my deepest sympathy. Our daughter opted to become an EM physician so that she could leave her job behind her at the end of her shift.
As a Christian expecting the Rapture at any minute, I am able to let "failure to diagnose" happen, because my husband and I will get new imperishable bodies without pain or sorrow to trouble us any longer. These bodies are temporary dwellings (tumbledown shacks after 6 decades!). But I do wonder how patients as well as overworked doctors and other medical staff without this faith get through a single day, I truly do. God bless you for speaking the truth about the tyranny of the computer invading the practice of medicine to its destruction. A last word...if you don't believe in Jesus (yet), at least be brave enough to refuse the Mark...
I admire doctors like you, I work within IT Industry and I have on-call at times, it's noway near the frustration you going through and if I make mistake during wee times, that will cost a company money not a person's life, I wish people high up can understand the pain of you and other doctors who are over worked. I kept on showing my partner this article while reading it, it has touched me and I feel something needs to be done, to protect you and other doctors from burning-out which would be catastrophic to your patience and people you are trying to help while exhausted. Keep up the good work.
I always admired how the doctors sacrifice their life for their job. I know well what happen to person when got no sleep, So thinking doctors being awake for days still doing their job in those critical situations that blows my mind, really it is unbelievable thing. I am always ready to support the doctors to work with normal hours, to save their lives literally. Probably you may say well there are plenty of patients need our help, what is your idea to how we organize the patients? I would say as a patient, yes large number of patients is a problem. but another main problem is health system, beside with capitalism. I don't understand how medical industry evolved to this from Luqman to Doctor who just giving prescription for symptoms. i don't understand why i am in pain because the source of disease still there while my doctor giving me medicine to solve symptoms superficially. i really hate this. I have really huge admiration to doctors (real ones) who really want to help other humans. But system is failing, healthcare should not be affected by capitalism.