Are these really the people that should be required to work so much? Isn’t their job about handling life and death daily? Wouldn’t we want exactly these people to come fully rested to work every single day and be fully staffed?
I don’t know if there are jobs with similar stakes that are so carelessly staffed and disgustingly paid.
Who’s we? I’m certainly not okay with it
Yea, “we” the people are not okay with it. “We” the profit driven corporate vampires are okay with it because “profits”.
Momentum is hard to overcome and it’s been done this way for many many years
The guy who is largely attributed to making the medical residency system so punishingly difficult in terms of hours was coke addict btw. William Stewart Halsted. That was like 1890 and residents didn’t have their hours limited until 2003 (and even then, barely)
Yeah, I saw that they were “limited” to 80 fucking hours a week (in the US). Quite the limit.
This is actually an interesting question.
They experimented with “office hours” for doctors and patients were dying more than double/triple shift.
This because the information lost during handoff was more valuable than doctors being more tired (and by consequence doing more mistakes).
This is a textbook example of the risks of lost context
I’d like to see those numbers. I’m not finding clear numbers on shift-length mortality. This meta review (Systematic Review of the Impact of Physician Work Schedules on Patient Safety with Meta-Analyses of Mortality Risk, 2023, DOI: 10.1016/j.jcjq.2023.06.014 ) says
Limiting all resident physicians to 80-hour work weeks and 28-hour shifts in 2003 was associated with an 11% reduction in mortality (p < 0.001). Limited shift durations and shorter work weeks were also associated with improved patient safety in clinical trials and observational studies not specifically tied to policy changes.
I think we can all agree that a 28 hour shift is fucking insane and that anybody doing such a long shift will not be of sound capacity.
And if hand-offs are killing more people than work hours, then that just means that the hand-off procedures are terrible. I’d want to see what kind of hand-offs are being compared and if hand-off methods have different patient events.
I mean, did they increase staff numbers proportionally to hour reduction or did they just have people go home? Because if it’s the latter, then duh.
I fully agree with this as far as why they do extended shifts of 12 hours or more. But, OP did say double and triple shifts so they might not be just referencing the longer shifts. In that case it is corporate greed.
I’ve also heard that and it makes sense, but if it’s a statistic already at this point, can’t it serve as a way to improve information storing and handover? I have nothing in common with the medical industry, this is just an outside observation.
A lot of people have alluded to this already, but I’ll simplify.
“We” are not OK with it. “We” are not the ones making the decisions
Hospitals and such are fine with it because they’re a business now and not as much involved in the health of the public beyond making sure they can still pay them.
No we’re not. But generally governments everywhere want to starve the medical industry to make it generate profit for the wealthy. The US is their role model.
Glares at Doug Ford
Glares at Tim Houston
Tries to glare at Tim Hortons but it is not available in my region
I mean they deserve it too…
Right in the Tim bits.
ಠ_ಠ
Honestly, I don’t think it’s even about profit everywhere.
I obviously don’t know what it’s like in Canada, but in my country, we also have socialized healthcare (like Canada), we have a shortage of some specialty doctors because they’re expensive to train and expensive to hire, and many go to other, richer countries instead (Finland in particular, as it’s close by). But nobody works huge amounts of overtime usually. Nurses work double or triple shifts, but mostly overtime is voluntary, and the only reason they work 16 or 24 hours in a row is because of stupid traditions and the slight risk of information going missing with the shift change.
The one upside is that they get a bunch of days off after each shift since you only need 2 shifts a week, and actually get to skip one shift every now and then if you don’t want to do overtime.
they kinda are doing that, by UNDERSTAFFING everywhere, replacing expensive MDs for NP/ or even nurses, and PAs. PAs are useful if they can spend time with your medical history like 30min+, anything less than that they are only slighty better than NP/nurses.
We’re not. But, just like AI, executives with the ideology of rapists don’t care about our consent.
Who would’ve thought that running every industry and business like mini dictatorships would backfire? Thanks capitalism!
More like the ideology of slave masters, which includes rapists plus oh so much more.
The greatest fear of capitalist administrators is that there might be a slow night in the hospital and a few employees have some down time to take a breath where no “production” is taking place. The shareholders would not be amused. That’s why they staff hospitals with the bare minimum, paying them as little as possible and using them as much as possible.
Because the alternative is the rich paying more in taxes, and we can’t have that obviously.
Not really.
Universal healthcare could be more than paid for just with what we pay in insurance.
It’s still money, but in this case it’s that profit healthcare is tied to employment causing employers across all industries to want less employees, which means a lot of overtime.
The real solution was shortening the work week to spread the labor around while keeping salaries high.
That seems very US specific. In Europe, we have universal healthcare, but it’s chronically underfunded.
sounds like a billionaire problem
It damn well is, no doubt about it.
always is. Universal healthcare is a reality. We just have a billionaire problem
I don’t understand why people aren’t voting for the uber-rich to pay their fair share. Billionaires pay less tax percentage-wise than any worker out there and it’s all because we focus so much on income tax. The uberrich don’t have income - the have wealth, which isn’t taxed.
Mods, jail.
the rich hospital admins, they skimp out on hiring more mds to rotate the burnouts.
I’m not okay with it but it’s the type of problem that can only be solved by them. They have to go on strike and protest.
In a vacuum, yes. The problem is that when, say, chip fabricators go on strike, orders for microchips don’t get fulfilled on time and the company loses money. When SAG goes on strike for months, movies get delayed, and people usually cheer them on in solidarity. When MEDICAL professionals go on strike en mass, people will die… Quickly, in some cases. People say they support us, and I get a free breakfast once a year at Denny’s during Nurse’s Week, but nobody’s going to cheer on the picket line outside when their dad or grandmother is INSIDE, sitting in their own poop, or not being fed, or having respiratory distress.
You don’t go into nursing for the money or easy work. You don’t even do it because it’s “just a job to pay the bills” because there’s way easier ways to make this little money. You do it to because you’re the kind of person who is more fulfilled by helping a stranger than by helping yourself, and those people are not ok with risking the life and safety of their patients over a shift differential. A LOT of nurses would cross the line to help them anyway, which would negate the whole effort… It sucks, but that’s it.
I’ve been a nurse for about 10 years now after getting out of the military, so I have some perspective on this, but I don’t know what the way forward is without letting a couple of vulnerable people die to catalyze change in the field.
I understand, but you guys are setting yourselves on fire to keep society warm.
In Japan when bus drivers go on strike they don’t stop the buses, but they stop taking bus fare from riders so the company doesn’t get paid. Maybe something involving medical notes so they can’t get billing codes.
That would be the perfect balance, but we’re not the ones taking the money like the bus drivers. Even if we were, they can always send a bill later. Messing with the notes would be falsifying medical records, which is one of the Cardinals sins of healthcare… and is also a crime.
Hey, regarding false medical notes, I’ve got a recently discovered whopper of falsehood. I’m going to keep this vague.
Patient suddenly can’t walk/stand, has very limited sensation in lower limbs. Goes to ER, spinal cord compression protocol clears and they are admitted. Long weekend of no progress. Patient leaves in a wheel chair, almost no change in symptoms.
Years later, they are collecting medical records for new doc and discover the notes from that stay in the hospital saying that all the symptoms spontaneously resolved before discharge. Wtf
Miracled! I wonder why they would lie about it, unless money?
Nurses can and do strike. People support them because organized nurses who can enforce collective decisions provide the best care.
There was just a victory in New York:
https://www.ajmc.com/view/historic-nyc-nursing-strike-ends-with-3-year-contract-wins
I’m aware this has happened a few times, but I don’t fully understand how. I keep meaning to look into it further, but I’ve never seen a detailed explanation of who was caring for people while this was going on. Maybe it’s buried in one of those articles somewhere, but I don’t have time to read through them right now.
Nurses strike all the time.
Here is a list of some strikes in US only. 2026: https://nurse.org/articles/nurse-strikes-list/, 2025: https://www.beckershospitalreview.com/hr/7-healthcare-strikes-in-2025/
Sometimes they maintain minimum care. There is advance notice provided. Nurses can also do things like provide care but not chart it in the correct way to get “counted” by their funding model. So the employer loses money while patient care is if anything improved.
We have to vote. They can’t be left alone.
We vote, but it’s not enough.
Do you? Do we? We currently consistently have about 20-50% of the population in Europe voting for far-right to conservative - parties that don’t give 2 shits about medical staff unless they require treatment. And even then, some of them don’t care about them because “do your job and stop whining”.
And that’s just the people that vote. At municipal level the voter participation is abysmal.
It’s the same situation in the US. My own mother votes for the most vile Republicans against our interests because she’s been so stuffed with hate and tribalism from Fox news all she cares about is that dopamine hit from “my team is winning”. No amount of reasoning will overcome that addictive hit of dopamine.
It’s a carefully manufactured propaganda machine funded by people with power we could only dream about reaching out from here to the EU.
Even the youth here in the south vote against their interests because abortion and immigrants bad jesus good. Education has been dismantled and even if they knew what was going on our districts are so gerrymandered it probably wouldn’t matter.
People need to be inoculated against billionaire propoganda, but how do you do that when they control the media and schools?
We’re not going to get anything done done within the system because they control the system. Strikes and violence or extremely disruptive protesting are going to have to happen.
‘How does capitalism keep the unemployed on hand?’ you ask.
Simply by compelling you to work long hours and as hard as possible, so as to produce the greatest amount. All the modern schemes of ‘efficiency’, the Taylor and other systems of ‘economy’ and ‘rationalization’ serve only to squeeze greater profits out of the worker. It is economy in the interest of the employer only. But as concerns you, the worker, this ‘economy’ spells the greatest expenditure of your effort and energy, a fatal waste of your vitality.
It pays the employer to use up and exploit your strength and ability at the highest tension. True, it ruins your health and breaks down your nervous system, makes you a prey to illness and disease (there are even special proletarian diseases), cripples you and brings you to an early grave — but what does your boss care? Are there not thousands of unemployed waiting for your job and ready to take it the moment you are disabled or dead?
That is why it is to the profit of the capitalist to keep an army of unemployed ready at hand. It is part and parcel of the wage system, a necessary and inevitable characteristic of it.
It is in the interest of the people that there should be no unemployed, that all should have an opportunity to work and earn their living; that all should help, each according to his ability and strength, to increase the wealth of the country, so that each should be able to have a greater share of it.
But capitalism is not interested in the welfare of the people. Capitalism, as I have shown before, is interested only in profits. By employing less people and working them long hours larger profits can be made than by giving work to more people at shorter hours. That is why it is to the interest of your employer, for instance, to have 100 people work 10 hours daily rather than to employ 200 at 5 hours. He would need more room for 200 than for 100 persons — a larger factory, more tools and machinery, and so on. That is, he would require a greater investment of capital. The employment of a larger force at less hours would bring less profits, and that is why your boss will not run his factory or shop on such a plan. Which means that a system of profit-making is not compatible with considerations of humanity and the well-being of the workers. On the contrary, the harder and more ‘efficiently’ you work and the longer hours you stay at it, the better for your employer and the greater his profits.
You can therefore see that capitalism is not interested in employing all those who want and are able to work. On the contrary: a minimum of ‘hands’ and a maximum of effort is the principle and the profit of the capitalist system. This is the whole secret of all ‘rationalization’ schemes. And that is why you will find thousands of people in every capitalist country willing and anxious to work, yet unable to get employment. This army of unemployed is a constant threat to your standard of living. They are ready to take your place at lower pay, because necessity compels them to it. That is, of course, very advantageous to the boss: it is a whip in his hands constantly held over you, so you will slave hard for him and ‘behave’ yourself.
from Now and After by Alexander Berkman, Chapter 5: Unemployment. Available to read for free here.
Even in countries where healthcare is socialised, they are run “efficiently” like a capitalist business by administrators who care not for healthcare but for finances, “balancing the books”, and bean counting.
Wait until they find out about pilots
this is bad
this is just as bad
I think we agree
Or public transport operators
my gf is a nurse and it is absolutely bonkers how the healthcare system works at all, shit is very run down and society as a whole needs a lot of shifting for how taxation affects the health care system. tax the fucking rich and make them pay their fair share and siphon that into healthcare.
gop states are poorly funded i assume, since they have on or few large hospitals that accomadate your needs
We aren’t. But it’s generally better for patient care. It’s the same nurse/doctor seeing through more of the care of a patient with less handovers.
Handovers are where minor details or context can be forgotten, dropped or misunderstood - especially after a really tough shift.
Patients also get to see the same faces more often, which makes them feel like they are being taken care of - as opposed to a part being made in a machine.But it’s wrong. It would be better to have 8 hour shifts with 2-4 hour overlaps between shifts. So it’s not a handover, it’s an actual rounds, it’s actually servicing patients and so on.
But that is likely very intrusive for patients, and 4-8 hours of the shift is with someone else (who you might not like or agree with) and communicating (which can be tiring).So yeh, it’s not great. Understaffing doesn’t help, especially since these are people that genuinely care about their work. It’s pure exploitation, because it is cheaper and hospital administration can justify it and get away with it (or whatever is higher that hospital admin in the case of free healthcare).
In some cases, it’s budget and exploitation. And it’s bullshit.
But there is a genuine argument that a doctor who is fully informed and tired is better than a doctor who is fresh and oblivious.I’m always slightly skeptical of this answer just because residency pretty much intentionally gaslights doctors into thinking that exhausted decision making is normal and unavoidable… All because the guy who started medical residencies had a massive cocaine addiction and it was 1900.
I’d be curious to see a study with data on patient outcome, wait time, use of resources etc, that measures exhausted double shifted doctors, vs fresh doctors with more context switching, vs fresh doctors + appropriate overlap to avoid context switching.
They’ve done those studies and context switching has historically been where the most problems occur. Whether they’ve repeated them with modern electronic medical records and systems, I don’t know. I think most people agree there’s probably a better middle ground between 8 hr shifts (3 handoffs a day) and the standards set by a dude who liked to experiment with coke and meth.
One of the big issues that I feel like doesn’t get touched on as much is longer shifts allow less doctors, which reinforces the artificially low doctor graduation rates. The national board in the US pegs the graduation at X thousand new doctors every year and that number is mostly tradition / vibes. No we don’t want to compromise on the ability of new doctors, but “gestures vaguely to US healthcare” good lord do we need more of them. Much the same could be said for nurses.
And all of that circles back around to not wanting to dilute traditionally higher paying job markets with more practitioners because the for-profit system will try to wring out every cent they can.
There are probably many more minds that could hack being a good doctor, but are smart enough to go into a field where the work-life balance hasn’t been a terrible trope since 1900. I think I could have been a good doctor but from a very young age I remember it seeming like the time wasn’t worth it.
That being said, I did end up becoming an RN, and I’ll say that my program is probably not unlike others in the US where sacrifice and fucking martyrdom reign supreme. Like wouldn’t you do anything to help your patient? Lose sleep, skip breaks, skip meals? If you don’t, whooo wiiiiilll???
There are probably many more minds that could hack being a good doctor, but are smart enough to go into a field where the work-life balance hasn’t been a terrible trope since 1900.
This was me. Studied for and did well on the required exams, interviewed at a couple of schools, and in between my interviews and acceptance letter I talked to a couple of people in residency at my university. The descriptions of their work-life balance was so atrocious, and the altruism of the profession so stomped out of their mentality that I decided I could probably help people in other ways.
As I watched a couple of my close friends battle depression all through medical school and residency with very little institutional or mentor support, I decided I absolutely made the right choice. I really respect you for staying within the system and becoming an RN, because you guys also have it just as rough, along with the added disrespect of “But you’re not a DOCTOR.”
I don’t know why medicine is so gatekeepy in it’s processes. Being strict in education and procedures I understand. But the heirarchy, egoism, and political games to grind down all these young trainees is quite archaic.
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Yeh, same. Which is why I said ideally there would be 100% overlap with shifts. Always 2 doctors, offset by half a shift.
Like, that is the fix. Peer review of decisions, easy conference/council/whatever-the-word-is, context can be handed over better (outgoings doc/nurse briefs incoming doc/nurse while remaining doc/nurse listens & supplements)But I have also been on gigs (I work in events) where there is a rig crew, a show crew and a derig crew.
When everything is meticulously planned out and everything goes according to plan with all the communications in advance, it works. It does. (As a tech, I’d rather set up the kit I’m using). If I know it has been set up according to pre-communicated spec then I can work it. If it deviates and I have been in the loop, I can work with it. But if it turn up and it doesn’t make immediate sense then it is many times harder. If I am rigging kit without a clear concrete plan, then I am guessing what the tech wants.
And I also know 2 lampies can’t co-light a gig unless they take turns.
Someone has to be incharge, someone has to take responsibility.But I don’t think (and from what I have read, and I’m sure I have been somewhat misinformed) that applies directly to healthcare. Meticulous plans don’t exist. Every patient is different. Something minor reported and expected to go away on the last visit of the leaving doc that is then reported as slightly-more on the new docs visit… That could be significant. And a few extra hours on a shift could save a life, because of that easily dismissed/forgotten context/knowledge during a handover.
2 doctors at all times is the fix. Or, actually, a voice-to-text and an LLM… Likely a decent usage of an LLM.
It doesn’t need to know who/what the patient is. It doesn’t need to know co-morbidities, existing conditions, medications, treatmens etc. Just that the doctor is interacting with patient A, and here is a summary.
Patent A is the same patient that a nurse interacts with.
Helps with hangovers and context.
Patient A is still in the hospital? Patient A still has a transcribed record that can be quickly summarised by a local (or onsite) LLM.
Using onsite LLMs is no different than using a database. And it doesn’t have to be massive. 30m before a shift change, there can be a “notes after this time will not be summarised during handover so previous context can be summarised”. So doctors only have to remember the last 30m during a handover, and the rest of the context (even transcripts) are provided to prompt their memory for a better handover. It’s an information tool for doctors, not a crutch.
And now I sound like an AI shill.Sorry for the wall of text. I’ve been drinking. I hate the “just use LLMs bro”, but think they have genuine utility when applied safely and locally.
And I want doctors and nurses and janitors/cleaners/sterilisers/techs of hospitals to be treated like the fucking heros they are.That does seem like a reasonable use for an LLM, but it’s very important to realize that an LLM is not a database. You don’t necessarily get out what you put in. LLMs can lose context, they can hallucinate, and they can make all sorts of weird decisions that might compromise the quality of your data. There’s no workaround for actually checking on that information when the stakes are high.
An automated system that isn’t an LLM would be more reliable.
I’m going to disagree with you on the “better for patient care”, as the study I saw was not good. I remember the study being put forward by a party that had a significant interest in having people work longer shifts, which amused me when that’s exactly what they found was better. Your study might be a different one that has actual methodology done after the one we liked to make fun of because it was a shit study with a conflict of interest (even if it may have shown something that may be true that I disagree with, I haven’t gotten around to granting that I’m wrong yet I still have two full paragraphs of bullshit in me).
Aside from becoming a valuable piece of medical evidence I’ve done a fair amount of MD education and worked in the office side. I know my own icd 9, 10, and 11. To give my credentials without doxxing myself (I could just show my famous anatomical abnormalities, the ones that got photos sent around to every medical schools in the world, but like then EVERYONE would know who I am. I might have just doxxed myself just saying that I haven’t had privacy for a while)
This is what I feel is the
gold[ew that feels wrong now.] prime bean standard of hospital care: the lead doctor needs to be able to explain to the patient and the nurses what is going on in their care such that they understaffed it. You have handoff happen in front of the patient and have the patient explain (as concisely as possible. Under 30 seconds if you can, you have all day to practice) their upcoming routine medications/appointments/therapies/allergies/dreams/hopes/eyeshadow/steam engine kebab designs and then the nurse/aide explains any additional procedures/steam engine kebab design competitions that have been scheduled during the shift. If there’s anything else that you need to cover during handoff, like the location of the nearest Turkish or Afghan restaurant and a handy menu, that’s easy enough to cover.Your downvotes are all nurse administrators and bed control. Bullies. Because who else would argue that hospital staff is not exploited, honestly.
I wonder if less workdays alongside higher staffing would be a better way of reducing burnout while preventing handovers
No one does this outside of the USA. It is not at all normal, just like being stuck with the imperial system of measurements.
What are you talking about? I live in Europe and this is standard. I know midwives, nurses, and doctors and they have the worst work schedules. I think in France health workers can even be prohibited from striking. The government declared it an “essential” job and when there aren’t enough workers, striking isn’t allowed. THey are always understaffed, so they aren’t allowed to strike. GReat eh?
En France vous avez des lois qui limitent le maximum des heures travaillés par semaine. Oui dans des cas éxtraordinaire c’est possible de les ignorer, mais c’est une grande difference en comparaison avec les états-unis, où ils travaillent pendant 24h sans pause comme c’est une chôse normal
Not really true. At least in Germany, the health workers are also extremely overworked. From nurses to surgeons. It’s a big problem
Source: family and friends who work there
How many hospital administrators making 7 figures are working 24hr shifts?
In Deutschland gibt es eine gesetzliche wöchentliche Höchstarbeitszeit. Ja die kann in Notfällen undso überschritten werden, aber die Leute arbeiten nicht oft 24h am Stück ohne Pause als wäre das etwas völlig normales
In theory, absolutely. Sadly, not always followed
I’ve worked with surgeons in US and Europe. It is definitely worse in the US but surgical culture is also like this in Europe just to a slightly lesser degree.
It’s deeply rooted in medical / surgical culture and much of it comes from not wanting to pay for more of these highly trained workers when you can just squeeze more out of a smaller cohort. Issues with handoffs for patient care are real with shift type work, but this could be improved if it became more standard.
Gen Z is a bit more concerned about these kinds of issues so some changes may be happening soon, but ultimately this will not likely ever self regulate and only legislative changes would effectively change this culture.
It is simply the law.
For example, in Switzerland, no employee may work more than 45 hours per week in the normal case (there are exceptions). Even if the employee and employer agree to ignore this, the employer will get absolutely rekt by the (mandatory) insurance if anything happens to the employee - even an accident in the employee’s free time.
It’s not the same, but similar, in other European countries.
Surprise! Everybody in the world is stuck with imperial system. Got a car that’s all metric? Wheels and tires are in inches. (Yes metric tires are still using inch rim measurements) Every tool on planet earth weather the sockets are sae or metric? All turned by a 1/4, 3/8ths or 1/2 in ratchet. Clearance too tight on ur bottom end bearings? Measured in thousandths of inch. I could go on, but it is incredible what imperial leftovers there are all over the planet that persist through time!
There’s a not-so-small difference between weird and annoying leftovers in specific areas and going all in with it in everyday life and still teaching it to every child.
Right, I was just highlighting the fact that globally we ARE still stuck with imperial system for shit that gets used daily! I can’t fathom why we haven’t moved to centimeters for rim measurements, and why so much machining is still done in thousandths of inch. There’s also no good excuse as to why every lathe and CNC machine on planet earth has 1/2 in chuck keys instead of 13 mm, why ratchets use a 3/8ths drive instead of 10mm. It’s just instilled from decades of use and nobody does anything about getting away from it in automotive or tooling! I’m sure there’s lots of other weird leftovers in other fields, just naming the ones I work with on a daily basis. At least nobody is producing shit with whitworth standards anymore, although I do occasionally have the misfortune of having to work with that as well.
A combination of a few things.
First, the founder of modern medical teaching was a man who loved cocaine and created a fairly aggressive education program which fed into a profession without work-life balance. The profession hasn’t self-reformed while cases where skilled labor has massive overtime is generally more regulated.
Second, the cost of education is enormous. Medical training for a doctor costs north of half a million dollars, so there is a high cost to training an additional doctor. Because of that, it is more cost effective to add additional shifts to existing doctors and nurses.
Third, a lot of doctors have a god complex and don’t want to admit they are fallible people. Because of this, they resist a lot of best practices other industries; checklists for operations are a 21st century “medical technology”. There isn’t a push within the industry to study how people fail like there is in other industries.
Because of this, they resist a lot of best practices other industries; checklists for operations are a 21st century “medical technology”.
When I was an electronics technician in the Air Force, ‘tool accountability’ was huge. All toolboxes were arranged with individual foam cutouts for every individual tool, no matter how small, so it would be quickly and easily obvious from a mere glance if a tool was missing from the toolbox, leaving an empty cutout behind. (Like this.) Paperwork was required to check tools out of and into tool boxes. At the end of every job, the toolbox had to be checked – both the paperwork and visually – to ensure no tools were missing. (And if tools were missing, the job wasn’t done until those tools were found and accounted for.)
And that’s because aircraft in general – and jet engines in particular – really don’t like lost tools banging around loose inside. I didn’t even work on engines, or even on aircraft, but the Air Force had adopted these policies service-wide to prevent accidents resulting from lost tools left inside engines.
Which is why it baffles me that surgeons can sometimes accidentally leave a tool inside a patient. Working on a real human body is way more important than anything I worked on … and human bodies don’t like foreign objects left behind any more than jet engines do. Plus, those surgeons are getting paid so much more than I did, and they even have assistants in the room to handle the tools for them. How the fuck have they not managed to have a similar system of tool accountability, preventing them from leaving tools behind inside patients?
Surgeons are considered money makers in hospitals, literally “the talent.” If a surgeon punches a nurse, the nurse will be the one fired. If a surgeon sexually harasses a tech, even rapes a tech, the tech will be fired. If a surgeon makes life difficult for everyone in his department, they will work around him like a missing stair. If the surgeon comes in drunk or impaired, this “working around” gets tripled into direct coverup, where no one sees anything and no one knows anything. Reports are rote fabrications, as are incident reports; Joint Commission visits are scheduled in advance and prepared for (and their results kept non-public); when an incident occurs family members are routinely bullied; and god help you if you are an employee and you have a problem with any of this: whatever keeps the money coming.
Hospital HR departments are set up to maintain exactly this situation, to the point that even the internal complaint process is rigged, for example in a situation where per the employee handbook you as an employee must submit ALL your evidence up front, and no evidence added later will be considered. You might think, “Well, that’s harmless enough, right?” No. What this does is game any complaint from the start: you as an employee generally can’t sue successfully unless you have tried internal solutions first, and this way the hospital gets to see everything you have upfront, create a defense and/or coverup tailored to your proof, and then counter-accuse you with bullshit you cannot rebut because you never saw it coming and are not allowed to submit anything further. So you either have to sue, or accept being fired at some point, if you’re not fired outright with whatever fabricated misconduct you get charged with as a result of bringing the complaint. Or you can just drop it and try to get on with your career somewhere else.
I have more, but you get the idea. These true experiences come straight from a very large hospital in the southeast US, one that would be considered “award-winning” in a major combined metropolitan area and is considered a “great place to work” based on salary rates. But inside those walls, people who work there usually and very quietly go to the smaller hospital across town when they need their own surgical healthcare. There are many, many great people that work there who are every bit people you would want on your own healthcare team should you need it. But in many departments, the ones that demonstrably aren’t great are not the ones who get fired.
I’m sure other hospitals are better, but many are even worse. The very rare surgeon who does lose their job for cause anywhere in the US is out only because after a years-long road of internal complaints and related witness/complainant firings and employee harassment, one person, at great cost to their own career, doesn’t back down, OR by a stroke of circumstance a patient who is harmed has the right connections to make some kind of justice happen, and then the surgeon moves to another hospital in another state. But that’s rare.
And it’s all about the money: surgeons bring in lots of cash, like oncologists and cardiologists do, and elective surgeries bring in even more. Who pays for all that cushy hospital administration? Surgeons, specifically, among others. You’re 100% right that surgical mistakes can be eliminated, but not in a healthcare system that prioritizes profit over all else. If that surgeon has a pulse and can get to the hospital without getting arrested for DUI, guess who’s doing your surgery? Hospital HR departments protect “the talent,” simple as, and state licensing boards aren’t any guarantee either: they’re staffed with MDs who all went to the same schools as the people whose professional conduct they are entrusted with overseeing.
specifically elective surgeries is the money maker, like cosmetic or minor reasons, not a serious condition.
Gallbladders would like a word. Those things are made of gold.
But pee is stored in the balls
on the third point the it was the anesthiesa professional group which made the push for the much more rigorous process that greatly improved outcomes. So there is some precedence for the profession realizing it needs to improve processes.
Yes, and it is important that those doctors advocated for better patient care and that the desire to develop procedures are somewhat there. However, the medical profession as a whole seems to be less focused on procedures than others.
Solid post. #2 stings extra, extra hard when you learn that in the USA doctors spend on average somewhere between a quarter and half their time (studies vary) with insurance nonsense. We could potentially DOUBLE (or, low end, increase by 1/3 which is still insane) the number of useful doctor hours tomorrow, but we don’t. U$A
i assume you meant the residency program, yea that is such an abusive program that should be revised decades ago. i wonder if the medical admissions remain constant to med school or it declined. i know some people try different ways to get into the MD industry in AMERICA, EITHER AS foreigner/immigrant MD, or go to a questionable foreign medical school, apparently its tougher if you come from a foreign country as an MD.
