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Author Topic: What are doctors' qualifications, and is a public health service a good idea?  (Read 6112 times)

Offline Broca

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Honorary Fellowships and Memberships:

Royal College of Surgeons, England
Royal College of Surgeons of Edinburgh

Do these awards mean much in England, have you heard of them? If a doc boasted of these would you be impressed or not so much. They sound goodfor an amaerican surgeon   just wondering.
« Last Edit: 07/01/2010 04:33:01 by chris »


 

Offline rosy

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Not my area of expertise, but it looks to me like being an honorary fellow of the RCS is a pretty big deal, yes. The RCS is the main examining body for surgeons in England (possibly other bits of the UK), and see:

http://www.rcseng.ac.uk/surgical_awards_and_grants/membership-of-the-college/?searchterm=fellowship

I suspect you could find out in what way a given honorary fellow of the RCS has shown themselves to be particularly top-notch with minimal google-skill (and the name of the surgeon of interest...)

The RCSEd has a less informative website, and I hadn't previously heard of them, so I'm not sure what being an honorary-whatever there means, but I'd say the surgeon in question is probably pretty good at something...
« Last Edit: 02/01/2010 23:23:44 by rosy »
 

Offline chris

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The Royal Colleges (of medicine, surgery, pathology and so on) are the professional bodies reponsible for the certification of specialist members and for training and admittance of juniors into those specialties. The qualifications they confer - MRCP, MRCS, FRCPath indicate that a practitioner has fulfilled the professional (i.e. examination-based) standards required to be recognised as a member of the college. Without this higher specialist training, in the UK at least, a doctor may not practice (at least legally) as a specialist.

Having just completed the FRCPath Pt2 exam, I can honestly say that these qualifications are not easily acquired...(writing the £1000 cheque to take the exam is also quite hard...).

Chris
 

Offline Variola

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Do these awards mean much in England, have you heard of them? If a doc boasted of these would you be impressed or not so much. They sound goodfor an amaerican surgeon   just wondering.

If any Doc boasted of them I would not be impressed, good doctors don't need to boast...  ;) :D

Another way of 'gauging' a doctor is research portfolio, it isn't always applicable but it is another useful slant to use.
 

Offline chris

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Another way of 'gauging' a doctor is research portfolio, it isn't always applicable but it is another useful slant to use.

I'm sorry but that's not helpful.

Many hospital doctors and certainly most GPs are excellent clinicians but they certainly don't have time for research - because they are too busy seeing patients to play about with test tubes and publish scientific papers. This is the problem with the world these days; people have become so target obsessed that they have lost sight of the fact that being a good doctor and a nice person takes skill too.

At the same time, there are plenty of hopeless doctors who are geniuses in the lab. Research is not medicine, any more than medicine amounts to research. There are often overlaps, but they are two very different things requiring two very different skill sets.

And just for the record, there are many people who don't "boast" about their qualifications but do include them in their titles because then people know their credentials. That said, if you've worked your nuts off for a piece of paper, why not flaunt it? I certainly wouldn't disrespect someone for being well qualified...

Chris
 

Offline Variola

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I'm sorry but that's not helpful.
 

To whom? Please do explain Chris. Not everyone who is 'gauging' a doctor is interested only in how they practise medicine, their particular field of expertise can also be very relevant. I would be delighted to hear how you think this isn't helpful Chris.

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Many hospital doctors and certainly most GPs are excellent clinicians but they certainly don't have time for research - because they are too busy seeing patients to play about with test tubes and publish scientific papers. This is the problem with the world these days; people have become so target obsessed that they have lost sight of the fact that being a good doctor and a nice person takes skill too.

Yes I think the term there is hospital Doctors and GP's,I am sure you do realise that once qualified as medics, doctors do pursue other careers? Some retire, some leave active medicine to pursue a career researching, and publishing said papers that you refer to later on in your post. Ah, if only it was just a simple matter of playing about with test tubes Chris, without the years of back breaking research some of us do, there would be no medicine for Doctors to practise. Treating patients is a tad more difficult without drugs.
Yes indeed, being a decent and good person extends off the hospital wards and GP offices and into real life. That is why some teaching hospitals have started a scheme to give training medics extra support to develop people skills and deal with their own conflicts.IMHO not nearly enough of the medical degree is devoted to patient skills, simply because medic degrees are so intense and Uni's are under pressure to shorten the degrees as much as possible. The result is they churn out good, clinically excellent doctors without the people skills that are vital to their work.

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At the same time, there are plenty of hopeless doctors who are geniuses in the lab. Research is not medicine, any more than medicine amounts to research. There are often overlaps, but they are two very different things requiring two very different skill sets.

As I said above, without research there would be no medicine for doctors to practise. People have died, been discredited and made bankrupt for the sake of their research, Ignaz Semmelweis springs to mind (look him up if you don't already know}.


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That said, if you've worked your nuts off for a piece of paper, why not flaunt it? I certainly wouldn't disrespect someone for being well qualified...

But would you disrespect someone without knowing their quals or assuming they don't have any?
I don't have any nuts Chris, does that mean the papers I have published are less important? [:D}

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And just for the record, there are many people who don't "boast" about their qualifications but do include them in their titles because then people know their credentials.

Indeed. Variola the Pox, BACP FDAP BPS UKRCP








 

Offline Chemistry4me

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Variola the Pox, BACP FDAP BPS UKRCP
You? :o :D
 

Offline chris

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Let me lay my cards on the table so there's no conflict of interest here and then I can explain where I'm coming from.

I am a practising hospital doctor (I work at Addenbrooke's Hospital) and I am a clinical lecturer in virology at Cambridge University. I have a degree in neuroscience, a medical degree and a PhD in virology / gene therapy. My wife is a GP. I therefore have a broad and current understanding and insight into medical practise and also the scientific method.

Usually, most patients enter the healthcare system via a GP referral (excepting A/E presentations) to a specialist clinic for assessment. Such clinics are often run by registrars (now called specialty registrars), who are specialists in training. In difficult cases they may ask for advice from a consultant, but not necessarily.

Most registrars will do research at some point in their training, leading to the awarding of a higher degree (MD or PhD), but they certainly (in most circumstances) will not have done a huge body of work by this stage of their careers. GPs will have gone through a training programme involving placements on a number of medical subspecialties (usually 4-5 years post qualification) before undertaking a GP registrar year, passing MRCGP (now a requirement to complete training) and becoming an independent practitioner.

My point is that, for these reasons, attempting to use research track record as a guide to the quality of the the healthcare a patient will receive will, usually, not be helpful - a) because GPs, on the whole, don't do research because they are too busy dealing with government targets and b) because in clinic most patients often don't know who they're going to see until they walk into the waiting room.

However, and perhaps this is what you were getting at Variola, where research track records can be helpful is in cases involving unusual or rare conditions for which specialist knowledge is essential. But, bear in mind that a string of published papers does not say anything about that individual's ability to treat a patient, merely to do (good) science.

This is where the GMC, the Royal Colleges and the accreditation processes come in because they set a standard of practise to which all of their members must conform; these standards are established, verified and checked (at entry and multiple points through training) by examinations and, now, also by revalidation. The result is  a consistently high standard of medical care across the board.

I hope that makes clear the case I was trying to put forward.

Chris
 

Offline Variola

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Variola the Pox, BACP FDAP BPS UKRCP
You? :o :D

Yep 'fraid so C4M. I hope this doesn't make me any less gorgeous to you... ;D
Feisty redhead really is where it is at, the intelligent bit is a nasty rumor... ;)
 

Offline Variola

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However, and perhaps this is what you were getting at Variola, where research track records can be helpful is in cases involving unusual or rare conditions for which specialist knowledge is essential. But, bear in mind that a string of published papers does not say anything about that individual's ability to treat a patient, merely to do (good) science.

Actually my point was that not everyone is looking for a doctor to treat them medically. If a doctor has RSC after his name, as you point out he is trained, experienced checked and validated to ensure good medical practise. But if I want to seek a doctor, for whatever reason, who specialises say in neurosurgery, and then not just neurosurgery, surgery for PD, and then further still in DBS, I may well find research papers that he has published on it extremely useful.
That really was my original point anyway, that it is another slant that maybe useful depending on what people want. It really didn't require a big long discussion on whether it was helpful or not... ::)
Nevermind, it has given fold an insight into how doctors become qualified if nothing else.
 

Offline chris

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If a doctor has RSC after his name, as you point out he is trained, experienced checked and validated to ensure good medical practise.

Royal Society of Chemistry ? Must be a clinical pharmacologist ;)
 

Offline Variola

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If a doctor has RSC after his name, as you point out he is trained, experienced checked and validated to ensure good medical practise.

Royal Society of Chemistry ? Must be a clinical pharmacologist ;)

Nope 'tis the governing body of people who type abbreviations in the wrong order...!! :D
 

Offline litespeed

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In the US doctors can become "Board Certified" by meeting certain advanced requirements. It is not clear to me how important this is, however. For all I know, you can become Board Certified if you send in enough Corn Flake Box Tops.

I almost always prefer to see a Physicians Assistant (PA) instead of the actual doctor. In fact, I offered to pay $200 for an hour with the PA just to sit and talk shop. She had the latest hand held info gizmo, was not intimidated when I asked challenging questions, and was flattered I would pay that much.

She and her colleague left the practice and so now I see the doctor himself. He is just fine, but it is clear he wants me in and out on something like an assembly line basis. Also, you can hardly keep them from making an appointment for a similar revisit in the immediate future. And God help you if you have an elevated PSA or maybe some small gallstones.

The CAT SCAN gallstone guy had already made an appointment for me to see a surgeon, and the PSA guy was just hankering to stab twelve biopsy needles into my prostate. I forcefully challenged both of them to stop.  Of course the PSA test was high for other reasons, and tested very low the next time. And the itty bitty galstone issues was absolutely indefensibly when I brought it up. Not even a hint of an arguement otherwise. To them I was little more then a profit center waiting to be milked through my health insurance plan.

Yuck....



« Last Edit: 05/01/2010 21:02:25 by litespeed »
 

Offline litespeed

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FYI

WE in the US are now being tortured with 'Health Reform'. Lost in this discussion is that nobody, even illegal immigrants, are denied health care. I will give you two specific examples, and how they are financed. First, my un insured x-son-in-law cracked his back screwing about on a dirt track motor cycle. He spent five days at the local hospital at $$1,000 per day. I suppose they send him an occasional bill and should probably stop wasting money on the postage and paper.

I have excellent health coverage. Accordingly, when I inadvertently ended up at the emergency room with nothing wrong with me, they sat me in a corner for a couple of hours and charged my insurance company $3500 dollars. I believe there is a tacit but unspecified agreement among all concerned that this is the best way to keep the hospital from closing down. I don't really have an arguement against it.

Second, my old girlfriend who made $60,000 per year with excellent health care decided she wanted to become a New Age Healer instead. Shortly there after she was diagnosed with ovarian cancer and no health insurance. Still, she has become a statistical anomaly by surviving seven years. This is not by accident. She has had all the cutting edge therapy available, even at the Mayo Clinic.

The big problem is government run health care has no money. Everyone over 65 years of age is covered by the government. But the government reimbursement levels are so low medical facilities are now refusing to accept Medicare because it would put them out of business. Apparently, there are not enough guys like me with good private plans to milk for the difference.

I just hope when I reach age 65 the government will not prohibit me from purchasing a good health care plan. But I doubt it.
« Last Edit: 05/01/2010 22:03:17 by litespeed »
 

Offline chris

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It's a tricky one this but I can recommend "undercover economist" Tim Harford's take on it, which he sets out in the book "The Undercover Economist". The point he makes is that the burden of admin and bureaucracy that accompanies a private, insurance-supported system actually leads to enormous inefficiency and over-charging. Like you said, a brief sit in the casualty department accompanied by a cup of tea ends up costing thousands. Likewise, a 5 minute circumcision for a baby in the US is over a thousand dollars - in the UK it costs about £80 ($130) when done in a local clinic.

Indeed, just having a baby in the US costs ten thousand. The whole process is over-medicalised too because then doctors can charge money for old rope. Since it's the insurance company paying, they practise defensively, hence it's a doctor-driven service. Here, uncomplicated deliveries are done by midwives; the doctor only gets involved if things could or do cause concern (which they rarely do). The result is a dramatic saving - midwives are very good at delivering routine cases and they are also excellent value for money. What's driven their role and involvement is cost and cost saving.

A state-led healthcare system will actually most probably lead to an improvement in efficiency and a total cost saving; the money can merely be raised in taxes - workers will earn more because companies will pass the cash onto the workers instead of paying healthcare. In my view, the result will be a more efficient system that saves money but costs everyone no more than it presently does.

Chris



« Last Edit: 05/01/2010 23:21:25 by chris »
 

Offline Geezer

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Ahem! (puts feet up on desk and lights pipe - blows large amount of smoke into air - long pause for maximum effect - metaphorically anyway  :D)

Speaking as someone who has been on the receiving end of health care in both the UK and the US, I have to say, I'm totally confused!

I'm not really sure which works better. I did not like how, in the UK, you were made to feel as if your doctor was doing you a big favor by allowing you to see him/her in less than a week. And, if you had a condition that required surgery which was unlikely to terminate your life in the immediate future, you were put on a queue for months, and sometimes years, before you received attention.

In my experience, in the US you are actually treated with quite a bit more respect, perhaps because you are viewed more as a customer who has some options. This probably varies from location to location. We have moved around the US quite a bit though, and we've never had any problems. But then, we've been fortunate to have had good health insurance.

One good thing about the system in the UK is that it is free, and it can be very good. My mother-in-law had serious heart surgery in the UK when she was 85. It cost her nothing, and it has allowed her to continue to care for my father-in-law. I'm not confident she would have received the same level of care in the US, but that may not be a fair statement either.

Similarly, I was treated for seminoma in the US twenty-five years ago. Including the diagnostics, surgery, and radiation treatment, at the end of the whole thing, I was $5 out of pocket. It seems the treatment was successful, so I think it was $5 well spent.

Chris's comments about midwives are very appropriate too. Mrs G was a midwife in the UK, and a Health Visitor too (do they still have them?) The midwifes in the UK did a fantastic job, and probably saved the NHS a lot on money, although it was a bit of a pain for us when she got a call at 2:00 am. She would set off into the night, bottle of nitrous oxide in-hand, and return 14 hours later, totally exhausted!

I suspect those who claim to know all the answers on this subject are talking through their hats, but you can always get a second opinion.

« Last Edit: 06/01/2010 02:06:07 by Geezer »
 

Offline yor_on

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My view is that hospitals should be free for all, a Western country with a reasonably good economy can handle that easily on the taxpayers money. Those who want and need more preferential treatment have still the possibility to choose private hospitals.

I saw in a Swedish paper (Svenska Dagbladet) some months ago a big reportage about an organization that normally works outside the States bringing doctors and medicine to poor countries now doing the same inside USA.

If they have to do so there it must be an unbalance in the medical care, no matter if you can get emergency treatment 'for free'/pay later. I also read that if you don't have insurance, even if you are a acute patient needing immediate care, you might get referred to another, 'communal hospital', if I got that right?

I have no problems with giving through the tax. I like that better that the que where people stand, caps in their hand, thanking you for the 'hand out' a little like the church use(d?) to do. Food and the mass sort of.

It allows people a little more self respect when they find themselves losing their livelihood, insurance(s) etc. And I think there are a lot of people that are changing their position about 'privation' now that they themselves are in that position.

Things do happen, and no matter your current way of life there are no real guarantees.
 

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