Wednesday, May 2, 2012

Overtraining and Unnecessary Training

Before you watch the video I am proposing to support my very unsettling contention (and the video is more than unsettling in and of itself) I hope you will consider this personal anecdote of mine:

Nearly 10 years ago I came back from a horse back riding vacation with my older son. We rode hard everyday in the mountains of Colorado, and I came back with knee pain so bad I could do nothing beyond walking. I waited an hoped that it would heal on its on... and if it was healing it was not apparent to me, but my leg was atrophying, so... I went to see a highly recommended Orthopedist in my home town of Boca Raton. Nice guy, trained at Harvard.

During the exam the Doctor breaks out a replica of the human knee and starts in on his explanation of what is wrong and what my treatment options are. It occurs to me that what I am seeing is not a complicated problem... so I ask the Doc "In your years at Med school... how much time did the school devote to the human knee?" "Excuse me?" he kindly replied. So I said "Look, you had to study brain tissue, spinal columns, do a pysch rotation, liver diseases, and acne... so how much time did you spend on the human knee while in Med school? I would guess no more than 2 or 3 weeks. Tell you what, I don't know a thing about the human knee and I would like to speak with you about my knee intelligently and on equal footing... so I am going to leave here, head to the library and hit the web, I will be back in a couple of weeks... and I will know everything about the human knee that any recent Med School grad knows. Then, let's talk."

When I got back, we had a 20 minute discussion about sheering, lateral, impact, bending, and compression forces on the human knee and their impacts on the articular cartilage behind my knee cap and on the grove that it slides on at the bottom of my femur (among other things). "We" decided that surgery was a poor choice, that there were some activities people my size have liabilities with, that shock resistant shoes were very important, and that physical therapy was my best treatment option.

After we get done that, the Surgeon says to me: "I have been practicing for over 10 years (he was a young guy... at the time we were both in our early 40's) and I have never had a patient tell me that he would study a knee, shoulder, or elbow and then speak with me "as equals" (and he used his hands to gesture quotation marks).

The fact was this... had I worked at his elbow for a year or less, I feel I could have performed any of the surgeries he did on a human knee...and I told him that. I said, "its just carpentry, doc". To which he said that his profession was referred to as a "saw bones" and we had a good laugh.

So why does the system make this guy get an undergrad literature degree and then spend time doing dermatology and studying the human eye if his practice is entirely the surgical treatment of human joints? Because he is going to need to talk about those other areas of study with the referring physician?

The military puts medics on the field of battle with 16 weeks of training. We then trust him with field tracheotomy's (talk about delicate surgery under pressure) in a hostile environment/combat zone... we couldn't train him to do ACL repair in the confines of a sterile operating room absent the bullets and and shrapnel?

Look, physician M.D.'s LIKE the cache of being over-trained... and they want to be paid for it. OK with me. But they should not have a monopoly. If I don't want to pay for your 8 years of over training and under earning by going to a super specialist for my knee surgery (and I don't want to pay for someone else's neurosis, either, in the form of insurance... if you want this guy's particular training you should pay for it all by yourself) that should be my business.

So watch this video.... and tell me what you see....


Anonymous said...

Dude you can take classes at Harvard and MIT online for free. Online degrees may be coming. Knowledge is available you don't need to pay anyone 50K a year for that. The big universities don't make money from undergraduate tuition, they are primarily research oriented facilities. They want the next Nobel prize winner, the researcher who is going to uncover the next cancer cure. And you can get far better medical care at less than half the price in Canada, France, Thailand - any other country that has a national health care system because they are not slaves of the kleptocrats who run the American health insurance industry.

Anonymous said...

I'm not exactly jiggy with turd world medical care. I suppose they could move to more of an apprentice, journeyman, master type system; and to some respects they already do with PAs that either start out as nurses or paramedics. Then there are Nurse practicioners, etc. However there needs to be some standards, Autoclaves for instance. The first rule is do no further harm, not spread bloodborn pathogens with reckless abandon.

A big problem I see with that is it will eliminate cost shifting where simple routine cases are charged the standard rate even though it takes less than five minutes and that helps cover the physicians time he spends on complex cases, that also get charged the standard rate. you might argue that that shouldn't be; however the physicians you want pursuing the profession genuinely care about people and like the arrangement. Piss them off and they will leave.

Also, there is a synergy amongst fields. What you learn in one area applies to other areas as well, even if it isn't immediately obvious. Patterns tend to hold throughout the natural world.


Greg T. Jeffers said...

Dan: All true. Yet we, the AMerican people, are NOT paying for the "healthcare" we receive. We accomplish what we do through government spending.

I am not suggesting that I have the answers... only that I have some questions... and that we will have to do some things differently.

Greg T. Jeffers said...

Anon (Dude):

The top 5 Universities are in the circumstances that you speak of...

But let us speak in the aggregate:

Total student loan debt at this moment is nearly $900 Billion and less than 40% of this is actually have the balances paid down by the debtor/student.

Wrap your mind around that. Given that the $900 billion is not the total cost (students don't borrow 100%... government kicks in some, parents some, charities, etc...)... the return on TOTAL investment is, by mathematical necessity, worse than default rate on the debt.

This means, AGAIN BY MATHEMATICAL NECESSITY, that the costs are not supported by the outcome (the employment after graduation).

OK, "Dude"?

Greg T. Jeffers said...

And "Dude":

Harvard and MIT START with a pool of people that were the best of their class - near perfect and perfect SAT scores and IQ's north of 150 on average... hard to go wrong with those folks...

Then these universities concentrate this talent pool into an "association" with all of the unintended consequences that that entails.

There is a great deal to this that has not been openly debated.

Greg T. Jeffers said...

And Dan...

I hope to not be in a position to have to use the services of the street dentists of New Delhi... but that isn't the point.

The point is this: If these "dentists" were out-lawed, their patients would have ZERO access crowns, bridges, and dentures... is perfect the enemy of the good?

Anonymous said...

that is a tough one. you are certainly right that some service is better than no service. However without some sanitation they could easily do more harm than good. There is a reason the HIV kit in a first aid kit for travel to the third world consists of sterile syringes and sutures.

As far as the cost that is fairly easy to pin down. The largest culprit is the public/private nature of our system. If you are healthy you can buy health insurance, the private part. However if one is sick the government pays. Oh sure not until they go bankrupt but if they are sick and don't have insurance then it is all but inevitable. Even if they have insurance if they are truly sick they will loose their job or business, then shortly thereafter their savings and with it their insurance. At which point they are facing bankruptcy and the government will be picking up the tab on the medical bills. Unless we are going to send people home to die once they are broke, it's just another instance of private profit and public losses.


dennis said...

Most of our medical could be supplied by my veterinarian, and he does make house calls.

Anonymous said...

Anon May 2, 2012 5:35 PM,

The insurance industry takes the hit for all the ills in the healthcare system. This is another Big Lie of the left. The insurance industry is the payer of the bills. They take your premiums and distribute them to the providers. Now, don't get me wrong, there is lots of waste in the insurance system, but most problem is in the hospitals, medical supply and equipment companies, big pharma, etc. These guys go out and give campaign contributions to congressmen and senators. They are fairly agnostic about party affiliation, but really like the guys that want more regulations. (Democrats) They then supply pre-written bills for these jokers to introduce. These regulatory initiatives are always held up as being for the safety and protection of the consumer, but in reality they create a Byzantine maze of rules and procedures that make it essentially impossible for new entrants into the market. For every $7 cotton ball and $20 Tylenol there is a rule or a reg that ensures that the price is justified. Of course, the solution to the problem of over-regulation is always more regulation. And then, when the government runs the whole thing, everything will be better. Ever deal with the VA? HA!

Consider how our views are distorted by media propaganda. Everyone talks about prohibition against permitting Canadian drugs into the US, as if THAT were the problem. The problem is that the US market is so F**ked up and distorted that drugs cost twice as much here. As long as everyone takes the bait and bitches about no Canadian imports, the real problem will never be addressed. That's just what big pharma wants and that's why the lie exists.

There will be more innovative and cost effective treatments. But, they will be developed outside of the US. What a shame. Medical care will follow the same path as every other socialized institution. Inefficiency, stagnation, obsolescence, total destruction.

I've heard that you can get first class care in India or Thailand for less that 1/4 the price. I don't know anyone that has experienced it first hand. I do know quite a few people with first hand experience with healthcare in Canada, France and the UK. NO THANK YOU!!!!

Best Regards,

Coal Guy

tweell said...

What I see is the difference between the knowledge needed for a trade and the license needed for that same trade.

In the middle ages, the trade guilds were in control. To be in a trade, one had to apprentice oneself to a master for x years, get the master's approval, then work as a journeyman for x years before becoming a master and having apprentices. Minimum skills were required, but the guilds were all about protecting the guys already on top.

We now have that situation again, only with the government enforcing the status quo. Colleges provide licensing after you've paid them enough, suffered long enough, and demonstrated minimum competency. Without that licence to practice, you're going nowhere.

Anonymous said...


That is absolutely the case. I've met a few undegreed engineers over the years. They were abused no end. Lower pay and longer hours got them more low pay and long hours. In the job market, competency does not mean as much as the license.


Coal Guy

Anonymous said...

The point is that the knowledge is available online to anyone who wants it. Yes, going to Harvard can give you a lifelong list of contacts but if that's what you really want you can hang out in the social spots in Cambridge and get that. Many American colleges will go out of business in the coming years and decades because they are too expensive for what they offer. Some of the student loans will never be paid back, the government will take the loss. Eventually students will stop borrowing hundreds of thousands for a Us education. The natural laws of supply and demand will end this problem