As an outsider but with intimate knowledge of both systems, I agree with you that British system is better than US system for a large percentage of population.
This is true to a certain extent. Another major factor is unavailability of suitably qualified and experienced doctors. Especially in high stress/low prestige specialties like emergency medicine.
Some thoughts and observations by a practicing anesthesiologist:
1.Improving patient outcomes, improving patient satisfaction, reducing medical errors and curtailing costs etc are very hard problems. There are no easy answers. Doctors know about this( because this affects us also) , routinely discuss it, try to solve/amend whatever is in their power but the overall nature of these problems is such that without nation wide measures and policy changes no concrete improvement can be achieved.
2. Becoming somewhat emotionally detached/blunt etc is a requirement for the job. There is no survival without it. It happens to all doctors. It happens to family and friends of people who end up in hospitals for months. Even with the detachment adverse patient outcomes do affect the treating doctors and this emotional trauma piles up over the years.
3.Same for abrasive personalities. There is so much push and pull going on between doctors of different specialties, between doctors and nurses, between doctors and administration, between doctors and insurance companies, between doctors and patients and their relatives that anybody not strong/abrasive/assertive enough looses his ground which affects both the doctor and the patients under his care adversely.
4.Generally a lay person reading up things on his own doesn't bring anything useful to a discussion with the doctor. Sometimes there are real options in which even the doctor is not sure of benefit/risk ratio. The patients should take decisions in these cases. Same for major operations and interventions. But for majority of cases average lay person is better off following the advice of his doctor than relying something he read on internet.
5. A job of doctor will probably be one of the last jobs to be replaced fully by machines. Just like parenting.
6. Doctors are not against technology or threatened by it. For example a lot of lab tests that are automated now were performed by hand by pathologists.They are very happy to use these new technologies. Their role hasn't diminished. The lack of enthusiasm for health IT software is because most of it sucks.It adds to workload, doesn't provide any value, and adds another layer of responsibility/anxiety. Most doctors will run to anything that only marginally improves their ability to handle workload.
And the list can go on.
Some interventions that might work are:
Checklists. simple, easy to use and practical checklists .
Mandatory leave/ time away from patients. The more acute/emergency oriented/high stress specialty , the more the need. For example I think specialists in Anesthesia/critical care/emergency medicine/gynecology/neonatology etc should have 3 months of leave away from patient care every year to stay sane.
>fulfilled doctors make for more-satisfied patients. Tackling the problems of Kaiser Permanente’s Colorado medical group, he took the counter intuitive step of demoting “patient-centered care” as a goal, and elevated “preservation and enhancement of career” for doctors to first place. He restored to them the sense that their work is, as Barron Lerner’s old-fashioned father put it, a “rare privilege” to be pursued with a sense of responsibility, rather than harried accountability.
ABSOLUTELY TRUE!!
There is promise in healthcare analytics, predictive analytics and things like auto flagging of unusual events. Doctors are used to analytics and algorithms and will embrace any good solution to these.
Similarly, machine learning/AI can play important role in things like reducing medical errors and postmortem of adverse events. These should be combined with training for human factors.
Continued medical education in its present form is very ineffective. Continuing medical education and remedial training/retraining etc need to be customized and focused to meet specific objectives.
>The most interesting thing about Melatonin isn't that it makes you drowsy or helps you sleep, it's that it increases the _desire_ for sleep.
Exactly! After having tried almost all Hypnotics/Sedatives for a sleep disorder that has lasted better part of a decade, it was so refreshing to find something that:
Doesn't have any hangover,
Doesn't make you feel more crappy if you are unable to go to sleep after taking it. The headache/light-headedness that follows if you don't sleep after taking other sedatives/hypnotics is generally very annoying and sometimes even unbearable.
The quality of sleep is much better too. No nightmares as such. More dreaming, yes, but that may be just because of better sleep quality.
The reasons are related to anatomy of spinal column. In adults the spinal cord ends at lower level of second lumbar vertebra. The sheaths/coverings of spinal cord extend all the way down to cocyx. This creates a hollow tube filled only with cerebrospinal fluid from second lumbar vertebra down to end of spinal column. Most of the epidural anesthesia techniques and all of spinal anesthesia techniques use this space because there is no risk of damage to spinal cord. In epidural anesthesia, the catheter can only be advanced a few vertebra up and down from point of insertion. The regions on which surgery can be performed depend on reach of epidural catheter. So, with an epidural catheter in lumbar region, only lower limbs and lower abdomen can be anesthetized. With epidural cathetr in lower thoracic vertebra , approx. lower 2/3 of abdomen can be anesthetized. For chest surgeries you will need epidural catheter in mid thoracic vertebras. And so on. But the problem with thoracic epidural is risk of puncture of dural sheath and damage to spinal cord which will result in permanent paralysis of that area. Epidural anesthesia can be used for upper abdominal and chest surgeries but the risk will be more. Moreover, for extensive surgeries a lot more is needed just simple loss of sensation. for example, more granular control of heart rate, blood pressure, oxygenation etc ; all these manoeuvres are a lot easier in general anesthesia.
So for lower limbs to lower abdomen , spinal and epidural anesthesia are fine, even better compared to general anesthesia (especially in obstetrics). For the rest, depends on specific circumstances.
Hahaha . I'm actually not really a fan of cricket , my cousin is .
When he came home today , he asked me to open up cricinfo for the score and i thought it was really a stupidly tedious thing to do and so WHOOPA i wrote a script :P
