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Doctors, Revolt

nytimes.com

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Re: Doctors, Revolt

#91

Post by paulcole »

OliverJones wrote: post #21

Let's be careful about nostalgia for the "good old days" of medical practice. Keep in mind that standardizing medical care process has done more to get physicians to WASH THEIR HANDS than all kinds of exhortations about relationships, partnerships, and healing. And washing hands has, since Semmelweis's discoveries 150 years ago, been known as the easiest way to promote healing that medical people don't do. Why do the…

>Why do the overnight shift of nurses take vital signs every four hours? So they catch rapid unexpected changes in patient conditions more quickly.

The first sentence of the second paragraph of the article you seemed to have avoided reading says:

“Checking things like temperature, blood pressure and respiratory rate every four hours on hospitalized patients has been the standard of care since the 1890s, yet scant data indicates that it helps.”

Re: Doctors, Revolt

#92

Post by Floegipoky »

araes wrote: post #22
WhatIsDukkha wrote: post #14

Earlier quoted context omitted.

The doctors individually spending 5 quiet minutes reviewing the case files of the patients they were about to treat BEFORE they arrived. That's not modern reality and its shameful.

This was the desired behavior. Its not that they reviewed existing info to check for changes, its that they knew nothing. Like the last 30 minutes of questions and chart didn't exist. On the side of the patient, this does not inspire confidence. It projects a sense of confusion and disorganization.

To play devil's advocate, patient handoffs are incredibly risky and one of the biggest causes of medical error. Retaking patient history is one of the best ways to reduce that risk.

Think of it like talking to a project's stakeholders yourself rather than relying on requirements gathered by somebody else.

Re: Doctors, Revolt

#93

Post by hiram112 »

kbenson wrote: post #10
araes wrote: post #6

Health care and education are IMO the next two major car wrecks coming for America. Both are like patients with similar symptoms (indicative of the general disease of America.) - They treat the customers like replaceable widgets - Costs are spiraling out of control. ($2-3000/day hospital, $3.4 TRILLION in total health spending [this equals the entire federal budget]) - Doctors / teachers often don't seem to communica…

> Friend's mother was recently in hospital, multiple doctors thru a single day, each one had to completely relearn what was going on. What's the alternative? 24 hour shifts for the doctor and the new doctor each day needs to relearn everything? Having to relearn everything might be a problem, depending on what it actually means, but as long as we want a normal human being as a doctor, they will cycle over time as peo…

Gracefully dying?

Re: Doctors, Revolt

#94

Post by djrogers »

pishpash wrote: post #72
kbenson wrote: post #10

Earlier quoted context omitted.

> Friend's mother was recently in hospital, multiple doctors thru a single day, each one had to completely relearn what was going on. What's the alternative? 24 hour shifts for the doctor and the new doctor each day needs to relearn everything? Having to relearn everything might be a problem, depending on what it actually means, but as long as we want a normal human being as a doctor, they will cycle over time as peo…

The alternative? How about not artificially restricting the number of doctors in the system so the ones in it don't play musical chairs and ones aspiring to don't do 28-hour shifts?

Artificially restricting? Could you elaborate? I was under the impression that the only restriction on the number of doctors is the ability for people to get through med school.

Re: Doctors, Revolt

#95

Post by robbiep »

araes wrote: post #6

Health care and education are IMO the next two major car wrecks coming for America. Both are like patients with similar symptoms (indicative of the general disease of America.) - They treat the customers like replaceable widgets - Costs are spiraling out of control. ($2-3000/day hospital, $3.4 TRILLION in total health spending [this equals the entire federal budget]) - Doctors / teachers often don't seem to communica…

It’s not relearning but making sure you get the facts from a primary source. The ICU motto is ‘trust no bastard’ - if you rely on what is written down without asking the patient directly, can you be sure that it is correct? I have personally come across many instances where what has been recorded is inaccurate or misses important details that careful questioning elicits.

I will always take my own history from a patient, but I use the previous records as corroborating records - I know what the general gist has been, but what might they have missed/what might the patient have told them?

It is a critical part of good patient care, despite its inefficiencies

Re: Doctors, Revolt

#96

Post by gregw134 »

adventured wrote: post #84
savanaly wrote: post #81

Earlier quoted context omitted.

It's not like hospitals are wildly profitable to run though? I think the inflated costs are due to the little understood phenomenon of "cost disease" rather than owners of hospitals extracting outrageous rent for themselves as I think you are implying.

You're correct about the spread of cost disease, it has essentially reached every corner of US healthcare. The part that hospitals are particularly guilty of, is unnecessary admin expense inflation. The US education system has seen an almost identical problem. Building buildings that aren't needed, hiring 10x the admin staff that the system had 30 or 40 years ago, etc. It's the system rewarding itself, bureaucrats hi…

Last time I was out the hospital they had robots running around to just to pick up towels. Robots are great and all, but that's a symptom of not managing costs.

Re: Doctors, Revolt

#97

Post by maxerickson »

djrogers wrote: post #94
pishpash wrote: post #72

Earlier quoted context omitted.

The alternative? How about not artificially restricting the number of doctors in the system so the ones in it don't play musical chairs and ones aspiring to don't do 28-hour shifts?

Artificially restricting? Could you elaborate? I was under the impression that the only restriction on the number of doctors is the ability for people to get through med school.

There's a fixed number of seats in medical schools and a fixed number of residency slots. When you add foreign doctors that would like to practice in the US to medical school graduates, there's less residency slots than doctors that would like to take them.

Most residencies are paid for by Medicare. Big hospital systems just can't seem to find the funds to train doctors on their own.

Re: Doctors, Revolt

#98

Post by ardualabs »

As a survivor of stage IV cancer, I can say my experience strongly mirrors that. I would go further to say that the assembly/widget mentality in a health care setting made it difficult for some of the staff to see me as a human. Abuse or care-full neglect (is that a thing? working on the words) is, in my experience at least, common.

It's not to say I don't appreciate being alive, but we can do better for those suffering.

Re: Doctors, Revolt

#99

Post by ardualabs »

mikecsh wrote: post #13
kbenson wrote: post #10

Earlier quoted context omitted.

> Friend's mother was recently in hospital, multiple doctors thru a single day, each one had to completely relearn what was going on. What's the alternative? 24 hour shifts for the doctor and the new doctor each day needs to relearn everything? Having to relearn everything might be a problem, depending on what it actually means, but as long as we want a normal human being as a doctor, they will cycle over time as peo…

In addition to this, many doctors want to re-take the history from the patients and re-examine them for themselves, rather than rely on a brief handover or potentially sub-optimal notes from another doctor. Clinical signs can be subtle, as can points in a patient's history that may point to a diagnosis. I see patients often frustrated at being asked the same questions by each doctor they see, but most of the time thi…

It's tough, and I get that. I also know that as a person with neurological trauma that makes speech difficult at best, having to recall what amounts now to 50+ pages of chart every 4 hours is... BS. You might as well be telling someone with a broken ankle to run up and down a flight of stairs every so often while they try to recover.

There is also an argument that, unless there is some sort of ongoing peer review (they did this during my Oncological Adventure(tm)), you're increasing the number of moving parts, and thus the chances of a breakdown. Charting errors are a significant source of medical mistakes.

The problem as I see it is not the intent of the procedure, it's the while (1) do x; mentality. There should be some "ifs" and mitigating functions instead of a hardcoded 1

Re: Doctors, Revolt

#100

Post by waffle_ss »

WhatIsDukkha wrote: post #14
kbenson wrote: post #10

Earlier quoted context omitted.

> Friend's mother was recently in hospital, multiple doctors thru a single day, each one had to completely relearn what was going on. What's the alternative? 24 hour shifts for the doctor and the new doctor each day needs to relearn everything? Having to relearn everything might be a problem, depending on what it actually means, but as long as we want a normal human being as a doctor, they will cycle over time as peo…

The doctors individually spending 5 quiet minutes reviewing the case files of the patients they were about to treat BEFORE they arrived. That's not modern reality and its shameful.

That's not modern reality according to whom?

My spouse is an MD and she spends a minimum of 45 minutes before her shift reviewing her patients' charts. After work, at home she tidies up patient notes to ensure the next person gets an efficient summary of the patient. Then after dinner she's answering a bunch of instant messages from patients on the hospital's patient portal and doing any prep necessary for the next day.

Programmers would be collectively rending our garments if we had to do anywhere near the amount of unpaid / off-the-clock work as doctors do.

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