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Old 05-29-2013, 10:54 AM   #41
sir_pudding
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Mathulhu View Post
Physician 12 (TL 7) is not as good as Physician 12 (TL 8)
For the gaming perspective there has to be a sharp cut off, but in reality it would be a smooth-ish transition between the two.
Isn't this what Variations Within a Tech Level p. B511 is for?
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Old 05-29-2013, 10:56 AM   #42
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Or he'd just have more complications... eh? I've done expeditionary medicine- it's a compromise.
Indeed. I was thinking of someone who could work under "war zone" conditions while retaining the same success rate as the "average professional", which may be veering into cinematic territory.

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So, not too long ago, the standards for being a doctor were, um, lower. Who has skill 12? The GP era doctor, or the post-GP era doctor? Or even the pre-Flexner report doctor? Massive, massive differences in doctor quality (even after adjusting for TL), but all are "professionals".
I wouldn't get the game's rules too tangled up in the legal criteria for real-world professions, medical or not. Skill-12 is defined as a "professional" level of skill because, as we already saw, someone with that level of skill will very rarely fail in a routine situation. Regardless of any legal barriers the setting might impose, someone with skill-12 could practice that skill for a living. While those legal barriers could certainly be seen as "elevating the standard" so that licensed professionals in the setting need a higher skill, it could also be seen as keeping the skill-7 quacks out of the profession.
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Old 05-29-2013, 11:03 AM   #43
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Fred Brackin View Post
So if that "average" surgeon has a Skill level of 14 and takes a -3 but then gets a +4 that's a net 15 which is what the average adjusted Skill level for at least that operation appears to be.
He also has another +2 from using TL8 surgical equipment, so you could achieve 95% reliability with Surgery-12 :).
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Old 05-29-2013, 11:14 AM   #44
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Bira View Post
He also has another +2 from using TL8 surgical equipment, .
I don't think so, that's a an Equipment Bonus and so's the +4 for Specialized Operating Theater. The specialized version replaces rather than stacking with the Basic equipment.
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Old 05-29-2013, 11:32 AM   #45
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Bira View Post
...Skill-12 is defined as a "professional" level of skill because, as we already saw, someone with that level of skill will very rarely fail in a routine situation. ...
There is a reason staff our hospitals with very expensive doctors in addition to (still not cheap) nurses. Dealing with routine situations is easy. Nurses can cope with routine medical problems (quite well, even). Doctors are there, in a very large part, to deal with the unusual problems. Remember, doctors see huge numbers of patients. They get "weird" outliers reasonably often, and need to be able to treat them. Medical standards aren't designed to handle the easy/standard 80-95% of the cases. They are there to deal with the 5-20% hard cases. A doctor who needs a +4 TDM to cope is a malpractice lawsuit waiting to happen.

So: if skill 12 is a good level to very rarely fail in routine situations, and nurses can handle most routine medical problems, then (starting) nurses might actually be reasonable candidates for Skill 12 (and they are, very much are, medical professionals). But that puts the "doctor" level significantly higher.
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Old 05-29-2013, 11:32 AM   #46
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I don't think so, that's a an Equipment Bonus and so's the +4 for Specialized Operating Theater. The specialized version replaces rather than stacking with the Basic equipment.
According to High-Tech p.223, surgical tools give an "intrinsic", TL-dependent bonus to skill that explicitly stacks with any quality bonus. So a TL8 specialized operating theater gives a +4 (quality) bonus, plus the +2 bonus from simply being TL8, for a total of +6.

If it was a TL 6 theather (the TL of its introduction), it'd give only a +3 quality bonus, because TL6 surgical gear gives no "intrinsic" bonus.
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Old 05-29-2013, 11:40 AM   #47
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Bira View Post
According to High-Tech p.223, surgical tools give an "intrinsic", TL-dependent bonus to skill that explicitly stacks with any quality bonus. So a TL8 specialized operating theater gives a +4 (quality) bonus, plus the +2 bonus from simply being TL8, for a total of +6.
Maybe. Still looks like double-dipping to me.

A Standard Operating Theater only gives a +2 and I don't know that I was in a Specialized one. That would take you back to 14 - 3 + 4 = 15.
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Old 05-29-2013, 12:06 PM   #48
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Default Re: What level Physician skill should an MD have?

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Jesus, Kromm (MYLF), do Canadian FPs really get 40 minute appointment slots?
There are many variables. When I was ill with complicated cholecystitis (threatening liver, pancreas, colon, bile duct), I got 30- to 40-minute consults. On average, I get 20-30 minutes for my annual checkup, and my current doctor is considered overworked and only took me on because she was treating my wife. Before her, I was getting 10- to 15-minute slots at a university clinic. And before that, my old family doctor gave me up to an hour, and made house calls. So I'd say 20 minutes is fair and 40 minutes isn't impossible.

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Also assumed a Ph.D. very often means skill-14.
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I mean, we're talking about people with doctorates, here- the equivalent of a PHD.
With due respect to our MDs here, an MD is not a PhD. The two differ significantly, in many ways. In sheer years, a PhD is typically more educated. In Canada, the MD is actually considered an undergraduate degree, awarded 3-4 years after an optional BSc, also earned in 3-4 years; the mean age of graduation is 25-26, depending on region. The PhD is a graduate degree earned after 3-4 years at the bachelor's level and 2-3 years at the master's level, and takes on average 5 years in itself; the mean age of graduation is >30, and 36 in the sciences most closely related to medicine. In sheer hours-to-skill-points terms, a PhD has 10 years on and higher skill levels than a green, unspecialized MD.

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This is why I think skill-12 is pretty low for someone in a stressful, chaotic occupation with very high expectations.
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I think it's telling that in articles that talk about medics for mercenaries, the writers preferred ER doctors, Nurses or paramedics over general practitioners.
I agree re: skill levels. However, the average MD isn't a surgeon, an ER physician, or a medic in a warzone. For the sorts of doctors (or equivalent) likely to be PCs in action-adventure campaigns, I totally agree that skill 12 is far too low and you shouldn't bother asking for the job with less than skill 14.

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Yeah- remember, in the U.S. a GP is someone who has finished medical school and done a one-year internship, but they have not done a residency. An FP, on the other hand, has finished a three-year residency, as has an internist.
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Anyway, most of you are mis-using the term GP or "general practitioner." You're using GP as a synonym for "primary care", and it is not. At least in U.S. vernacular a GP is a doctor who graduated from medical school and then went into practice- full-stop. Most significantly, he has not completed a residency (though most have done a 1-year internship somewhere). They are not board-certified, nor even board-eligible.
This is not the same in Canada. Here, a GP is an accredited specialist who has followed up her four-year MD with a two- to three-year residency in a family medicine program and then passed a special examination. She is what the U.S.A. would call an FP. She is still in no way qualified to work an ER, ride in an ambulance, or do anything in an OR. A significant fraction of the training is in the psychology of the job.

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And the more I think about it the more annoyed I get at the thought that someone might try to deny me my Surgery-14 after I did that five-year residency! Come and say that to my face, brother! What's a guy gotta do to get a freakin 14 around here? That was five years of 100+ hour work weeks! You're lucky I'm not asking for 16!
See above – I think that 14-16 is justified for many, even most surgeons. My answer was about MDs, who as a baseline are graduates of a four-year undergraduate program. They are as skilled at medicine as the graduates of any four-year entry-level program are at anything. Saying that they get more out of their four years than other people strikes me as hopeful. I had plenty of pre-med and med students visit my office (and attend the same parties . . .) when I was running physics courses, and they were not more impressive or more diligent students than the people majoring in physical education, sociology, chemistry, commerce, etc.; they were just other undergraduates.

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So, what is something like removing a gallbladder in GURPS terms? Easy?
My surgeon claimed it was, relative to her normal work, which is breast-cancer surgery and medical research. YMMV.

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Originally Posted by Kraydak View Post

I really, really dislike the "professional skill level=12". Among the many problems it has is: what happens when the professional skill standards change?
Answer: The meaning of the skill changes at a level below the abstraction of the game system. Ignore it, or at most treat it as a -2 for unfamiliarity with new methods and equipment until current skill users catch up on their reading, whereupon they no longer have that -2 eating into the bonuses for the new stuff. It would be completely wrong to say that as standards advance, skills increase. For fixed years of study, skill levels are fixed as well. What changes are the bonuses for developments in the field and, ultimately, the TL.
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Old 05-29-2013, 12:15 PM   #49
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Kromm View Post
...
Answer: The meaning of the skill changes at a level below the abstraction of the game system. Ignore it, or at most treat it as a -2 for unfamiliarity with new methods and equipment until current skill users catch up on their reading, whereupon they no longer have that -2 eating into the bonuses for the new stuff. It would be completely wrong to say that as standards advance, skills increase. For fixed years of study, skill levels are fixed as well. What changes are the bonuses for developments in the field and, ultimately, the TL.
But the pre-post (US term) GP-era difference is, explicitly, a difference in years of study (years of residency). If I am reading you right, pre-post (US term) GP-era doctors should have different skill levels.....
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Old 05-29-2013, 12:27 PM   #50
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Default Re: What level Physician skill should an MD have?

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But the pre-post (US term) GP-era difference is, explicitly, a difference in years of study (years of residency). If I am reading you right, pre-post (US term) GP-era doctors should have different skill levels.....
At the current intensity of undergraduate education and work terms/residencies, I'd go with about 2 points/year, total, in associated skills, techniques, and perks. Someone who has a flat four-year MD has 8 points to distribute; someone who does another four years of specialization has 16 points to distribute. Spend them as you like. The contrast between {Diagnosis (H) IQ [4], Physician (H) IQ [4]} and {Diagnosis (Optional Specialty) (A) IQ+2 [8], Physician (Optional Specialty) (A) IQ+2 [8]} is huge, and the latter person may also have access to perks like Cutting-Edge Training, Efficient, and Hyper-Specialization that aren't taught below the specialist level.
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