I'm a psychiatrist, and there are a few things to consider about this story: 1. The bulk of people in a psychiatric hospital are there voluntarily. They can walk out the door at any time. 2. When a patient is in a hospital involuntarily, their stay is subject to state laws about involuntary hospitalization. This, as far as I know, universally requires 2 independent professional opinions that a patient is actively sui…
I wonder if there is a way to setup the system so that a corrupt doctor that has lost their way is still mainly incentivized to work for the interests of the patient.
Even in medical situations where patients do not face involuntary confinement, they are mostly left wondering if the doctors are working for them or working to bill them (I guess the outcome based payment schemes address this).
I don't know of anywhere that has average stays anywhere near a month. Please provide a citation.
Could you possibly do the same for your numbers: "less than 4 days"? I trust that you're a psychiatrist but you could be spewing old or incorrect numbers just as easily as anyone else who may unknowingly make a mistake.
Correction: psychiatric stays are generally very short with private insurance, and months long with state insurance. May vary with the level of corruption in your area.
I don't know of anywhere that has average stays anywhere near a month. Please provide a citation.
Well how about the article in question? It doesn't say a month but the gist of the article is that profit is motivating at least one chain to make patients stay too long. Which is the essence of the point you are responding to.
My wife is an inpatient psychiatrist. She gets a monthly productivity report. Her pay is based on the productivity. In her system she gets more money on the day of admission than for subsequent days. This gives her an economic incentive to get patients out the door. She hasn't yet succumbed to the pressure to release them early but it's foolhardy to think that economic forces don't or can't play a role. There are lots of examples of doctors doing very bad things for profit.
I'm a psychiatrist, and there are a few things to consider about this story: 1. The bulk of people in a psychiatric hospital are there voluntarily. They can walk out the door at any time. 2. When a patient is in a hospital involuntarily, their stay is subject to state laws about involuntary hospitalization. This, as far as I know, universally requires 2 independent professional opinions that a patient is actively sui…
Firstly, it must be incredibly difficult to work with severely mentally ill populations, so I commend and thank you for taking on that responsibility. It troubles me, however, to to give a government the capability to detain citizens based on the (forgive the scare quotes) "medical" expertise of a psychiatrist. This has been abused [1] and I find significant issues with the credence given to testimony by psychiatrist…
> I'm not sure the answer here.
Has anyone started making lots (like tens of thousands) high-resolution, 3D, video (i.e., not still snapshots, but over time and ideally during episodic moments) MRI and CAT scans of diagnosed psychiatric patients, pointed a deep learning system at the scans, and see if patterns can be detected? If the deep learning systems can pick up patterns we didn't notice before, then that could be a valuable empirical tool to add.
I once met a mural artist who told me a very memorable story of his peculiar time at the cuckoo's nest, how he got there and how he left. It was the 1960s-70s and all had been reasonably normal in his life, until his attendance at a certain party. Though he was untroubled in the company of recreational drug fiends, he didn't participate, at least not deliberately. However, someone had surreptitiously spiked the punchbowl with LSD. Being a gentle and kind sort of creature, he unwittingly embarked on a profound psychedelic odyssey. Still under the effects of the punch and yet unable to rationalize the situation, he called his sister for help, who persuaded him against his better judgment to check in to a psychiatric hospital. Shortly after, his state of mind returned to normal where he was able to assess the cause, but the talons of the ward took hold and would not let him go. They'd already begun to medicate him heavily with tranquilizers which clouded his mind and dulled his resolve. His pleas for understanding were ignored and he soon realized that he'd become a prisoner. In this situation his only assets were his art and good character. In a sanctioned stupor he devised a plan; he would begin "cheeking" his medicine in the presence of the nurses and spitting it out in their absence. He was permitted art supplies, the results of which quickly earned him respect among the staff. He'd use this to eventually obtain permission to paint outside in the courtyard, where he'd scan every possible vector for a way out. His fear had began to impel him after seeing inmates which were previously articulate and sociable become zombies after what he presumed were lobotomies. He suspected he was on the list for the same. Once he gained the trust of the staff, he finally sprang for freedom. He got it and never returned. He carried on with his art, remaining perfectly sane, innocuous and successful in his trade.
I'm a psychiatrist, and there are a few things to consider about this story: 1. The bulk of people in a psychiatric hospital are there voluntarily. They can walk out the door at any time. 2. When a patient is in a hospital involuntarily, their stay is subject to state laws about involuntary hospitalization. This, as far as I know, universally requires 2 independent professional opinions that a patient is actively sui…
Firstly, it must be incredibly difficult to work with severely mentally ill populations, so I commend and thank you for taking on that responsibility. It troubles me, however, to to give a government the capability to detain citizens based on the (forgive the scare quotes) "medical" expertise of a psychiatrist. This has been abused [1] and I find significant issues with the credence given to testimony by psychiatrist…
I understand your points, and there have been many appropriate checks and balances introduced to avoid past abuses (which were very real).
That said, I have a hard time feeling that allowing a person to go untreated and end up in jail or prison is in their best interest.
And if you want to see examples of how government run healthcare (or anything else) can fail, just look at the history of atrocities of public psychiatric hospitals.
Or visit emergency in most any Canadian hospital.
I live in Toronto. I've been to the ER here. We were seen promptly, given the right care, and paid no bill.
The efficiencies gained by not wasting time on unneeded treatments, not having a billing department and not paying million dollar CEO compensations, these outweigh, in my opinion and experience, any gains we might have via privatization.
This is an appropriate article to comment with the Rosenhan Experiment. From Wikipedia: The study involved the use of healthy associates or "pseudopatients" who briefly feigned auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the…
That's an interesting experiment, but what was the expected outcome? The deliberately feigned illness to get in and then reverted to completely normal. That's not a class of patient that is ever expected to show up. How would someone expect those cases to be handled and why?
A great example of how for-profit healthcare (or anything else) can fail. Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits. They do not have a prerogative to benefit society, or help human beings apart from what they choose to do. Every country has to decide whether the benefits of privatisation of the various services outweighs the societal costs caused…
>Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits... I love how people generally agree upon this, but when it comes to specific topics, they seem to have a blind spot for this. For ex. Vaccines and how people seem to blindly believe what ever the authority tells them... I mean. Look at this thread. https://www.reddit.com/r/worldnews/comments/6c5k10/italy…
You're coming to hacker news to argue that vaccines are actually a conspiracy?
A great example of how for-profit healthcare (or anything else) can fail. Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits. They do not have a prerogative to benefit society, or help human beings apart from what they choose to do. Every country has to decide whether the benefits of privatisation of the various services outweighs the societal costs caused…
This is a problem localized to psychiatric care, general healthcare has obligations and quality controls, and it doesn't fail in the ways you describe. The fact that medical practitioners take out enormous malpractice insurance policies proves that there is accountability, at least if you're considered sane enough to press charges. For psychiatric care specifically, the problem is that the patient has no agency by de…
Nearly everything you have written is incorrect.
It's rare to find a psychiatric hospital, public or private, that's not accredited by JCHO. This group has the same standards for general and psychiatric hospitals about patient rights, and due process for any hands-on or involuntary interventions.
Psychiatric patients can, and do, complain. The assumption is that they are making a genuine report until proven otherwise.