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Comment by fsloth | Hacker News Reader

"Sure, in a modern office you won't come across many such people (amongst other esoteric examples). But there's a counter argument here - forcefully introducing additional bureaucracy by proxies is just as hurtful, if not more."

Who said anything about bureaucracy? It all could be lean and agile - but with tasks such that people could concentrate on the value adding tasks. It seems more efficient to hire less people to do n amount of tasks but what happens when the productivity of those people plunge?

As an extreme example, we in finland use the public health services a lot. Every time I go there, the doctor fiddles about on his computer doing this adminsterial task and that. It would be much more efficient if the doctor had some secretary who could manage the bureaucratic fiddly bits and let the doctor focus on medicine.

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The doctor example is great, but where do we draw the line exactly? Offloading some aspects of your work by utilising other people and their expertise is surely the way to go, but there's a balance to be kept. Sticking to your example, good secretaries (much like good engineers) are expensive, and are hard to come by - isn't that enough to explain why public health services skimp on those?

You could argue that in an ideal world/society, everyone would just do those few specific things they're really good at/love, and nothing else.

Calling out for highly trained secretaries to do the doctors typing is really a strawman.

As a patient I don't really care of the quality of the bureaucratic output if the case is one-shot - which most are. So in that instance they could have a drunk monkey punching the computer. What I do care about, is that the doctor could see more of these one-shot patients and just forget the damn computer.

The value the records add, is providing a long term storage for my current diagnostic case. Once the issue passes, the value of those records plunges to zero.

Calling whatever it is, 80/20 principle, tipping point management - not everything needs to have 0.999999 level of certainty. In the one-shot bureaucratic typist thingie 0.9 would suffice. Once the medical issue becomes more prolonged and difficult, added care in the papers section will start to add value (as patient information is logged and tracked, and so on).

On the other hand, since this is a medical setting and we insist training on the secretary, the secretary could add immense value, by just going through the checklists the doctor really does not remember to do. The constantly recurring problem when getting medication is the doctors checking for incompatibilities with the patients physical condition and other medication. From my experience, if there is any underlying condition they screw it up half the time. As an example is a relative of mine with nut allergy and some ongoing medication - the stuff this persons gets described half the time has bad outcomes when combined with either of them. So in this instance the only valuable outcome would have been applicable medicine, and since that was screwed up, the value of output is zero, and the amount of resources used is... non-trivial at least.

Hospitals have solved this by having nurses following in the doctors footsteps with procedure specific checklists - and this saves lives. http://www.who.int/bulletin/volumes/86/7/08-010708/en/

The secretary you just described is going to ask way more money and has a lot more employment options. Why would she/he take a job with zero autonomy, little social status, non-flexible hours and not expect money in exchange?

And once you pay her those money, is it overall saving money?

Note, I gave two versions of the secretary :) - the non-professional and the professional one.

The professional secretary I described is a nurse. Also, the non-professional would effectively be a nurse. They just have different duties where the latter would also check-list through the doctors remedies. Note that this potion is not that of non-autonomous robot. They have the right and duty to double check on the doctors performance.

First, costs. Where I'm from nurses are fairly well trained professionals, but have a really low salary. They seem to keep at it. I could imagine a worse gig than GP:s assistant.

In single payer healthcare one should look at the total cost/benefit for the entire economy, not just how to minimize the cost for the single health center.

The cost of bad diagnosis or faulty recipe can be that the time of the doctor visit was completely wasted. Hence, the time used for the visit by the patient was completely wasted. If they need the medicine they need to reschedule - thus the cost doubles not only for the doctor, but also to the patient. And the direct cost is not the only cost. As we are effectively doubling our resource use, now we are clogging the system, and delaying other patients.

And. I don't get it why this needs to cost more. They have plenty of nurses at the health centers, for one accident or the other. They could just change the routines that the secretary-duty nurse gets a call if she's needed at some other place.

Of course, this is me looking at the situation through the lense of the single payer social healthcare scheme. The logic of the situation is probably different elsewhere.

Nurses in low paid systems are aging and complain. It happens that young women don't want that job all that much. That job does not happen to have perk that would offer low salary - hours are inflexible. But also, those who won't be nurses because of caring or some similar general idea, are even more likely to leave if you turn the job into secretary.

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