Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Doctors, Revolt

nytimes.com

Post reply on HN
Print view View original

161–170 of 178 posts

Re: Doctors, Revolt

#161

Post by creep »

ScottBurson wrote: post #160
creep wrote: post #159

Earlier quoted context omitted.

Do you know why she had a clean urine sample? Mistakes happen, but my experience as a whole in the hospital that night lends emphasis to the mistake. It is not just that the infection was missed accidentally, it was that the management of my diagnosis and my stay seemed so ill-informed and counter-intuitive to my needs.

She had been drinking a lot of cranberry juice -- the folk remedy for a UTI. That may have had something to do with her clean sample, though this is just speculation. Most of the times that she's had these infections, her samples have had detectable bacteria, so this was an unusual case even for her. BTW, she had so many of these infections that her doctor eventually referred her to a urologist, who put her on a dail…

The cranberry juice thing is inconclusive, but I still drink a lot of it as well!

>Quite the contrary: doctors should know that that can happen.

Okay, thanks for clarifying. This is how I felt. It was silly to me that I could have all the symptoms of a UTI, only to have everything written off because of a clean urine sample. I think it was hopeful thinking on the doctor's part-- she just wanted me out of the bed so she could clear the waiting room.

How recurrent were your wife's UTIs, if you don't mind?

Re: Doctors, Revolt

#162

Post by ScottBurson »

creep wrote: post #161
ScottBurson wrote: post #160

Earlier quoted context omitted.

She had been drinking a lot of cranberry juice -- the folk remedy for a UTI. That may have had something to do with her clean sample, though this is just speculation. Most of the times that she's had these infections, her samples have had detectable bacteria, so this was an unusual case even for her. BTW, she had so many of these infections that her doctor eventually referred her to a urologist, who put her on a dail…

The cranberry juice thing is inconclusive, but I still drink a lot of it as well! >Quite the contrary: doctors should know that that can happen. Okay, thanks for clarifying. This is how I felt. It was silly to me that I could have all the symptoms of a UTI, only to have everything written off because of a clean urine sample. I think it was hopeful thinking on the doctor's part-- she just wanted me out of the bed so s…

This is from memory, but it seemed like there was the better part of a year when it wouldn't be more than two or three weeks after she was over one that she'd get another one.

Really, she should have been referred to the urologist a lot sooner.

Re: Doctors, Revolt

#163

Post by ScottBurson »

creep wrote: post #161
ScottBurson wrote: post #160

Earlier quoted context omitted.

She had been drinking a lot of cranberry juice -- the folk remedy for a UTI. That may have had something to do with her clean sample, though this is just speculation. Most of the times that she's had these infections, her samples have had detectable bacteria, so this was an unusual case even for her. BTW, she had so many of these infections that her doctor eventually referred her to a urologist, who put her on a dail…

The cranberry juice thing is inconclusive, but I still drink a lot of it as well! >Quite the contrary: doctors should know that that can happen. Okay, thanks for clarifying. This is how I felt. It was silly to me that I could have all the symptoms of a UTI, only to have everything written off because of a clean urine sample. I think it was hopeful thinking on the doctor's part-- she just wanted me out of the bed so s…

>> doctors should know that that can happen

In fairness, I guess it really doesn't happen very often — the ER doc in my wife's situation commented that she had never seen it before. On the other hand, pulled muscles don't cause fever. I understand a little bit of reluctance to offer antibiotics, as they have been overused, but geez, you have a patient with a fever and in terrible pain, indeed with all the other symptoms of a kidney infection, what's really the downside to going ahead and starting the antibiotic to see what happens? That's how I see it, anyway; I'm not a doctor.

Re: Doctors, Revolt

#164

Post by andreygrehov »

robbiep wrote: post #152
andreygrehov wrote: post #142

Earlier quoted context omitted.

In this case gastroenterologist goes to a patient and asks questions he is interested in. The point is that a patient doesn't have to tell the same story over and over again. The problem is that gastroenterologist would now have to have its own video, which would probably be time-consuming for the third doc.

Patients report higher satisfaction with their medical care the longer that they spend engaging with clinicians. Even if this was a practical solution, by deploying cameras and ensuring that the resulting files were accessible and categorised simply and easily (no easy IT solution!) it doesn't change the fact that by reducing the amount of time a doctor (any doctor) spends with patients is going to worsen their outoc…

> Patients report higher satisfaction with their medical care the longer that they spend engaging with clinicians.

Agreed. But that is because doctors are not easily accessible. You can't simply call doctor's cell phone or text him a message. Instead, you call the office, leave a message and wait for God knows how long. Some doctors do not even bother to call you back if they're not in the office.

> And how is this any different from reading a 'transcript' of the last interaction a patient had with a Doctor

You don't want to cancel the transcript-based approach. I was talking about improving existing processes, not replacing them altogether. Knowing that you're being recorded makes you more responsible for every note you take, it improves the kind of information doctors write down.

I'm sure you are aware that there are a ton of things to improve in the healthcare industry. It's just a matter of wise execution, which is the most complicated part.

Re: Doctors, Revolt

#165

Post by Griffinsauce »

robbiep wrote: post #95
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 patie…

This is a perfect example of the problem with uneducated opinions about healthcare. Everybody has them, has never even tried to confirm their assumptions with a doctor and will continue to propose all sorts of fixes (see sibling comments) that make zero practical sense and will actually drastically reduce the quality of care.

My SO is a doctor, even here in Europe there are many flaws, but what I have learned over the years is that this system is way, way more complex and effective than people think. If you want to improve it, great! Step one: go talk to a doctor about your ideas. If you haven't done that, don't spread your unfounded assumptions, it only leads to more demonization of staff and systems and doesn't help anybody.

Re: Doctors, Revolt

#166

Post by microcolonel »

creep wrote: post #149
microcolonel wrote: post #141

Earlier quoted context omitted.

Can confirm that basic details frequently get misrecorded (here in Toronto). At a recent visit, the surgical staff received such a broken telephone version of my original reports and activity in the hospital, that when I overheard the surgeon discussing with the students prior to the procedure I literally burst out laughing (despite having an appendicitis waiting to be removed). This is just how records like this wor…

I was at the hospital with a kidney infection last month. I get these regularly. I knew it was a kidney infection. I described my symptoms and the intake nurse agreed it sounded like a kidney infection. I told them my heart rate was faster than normal-- it's usually at 73, but it was now at 100. They took my vitals, which showed a fast heart rate (110) but I watched the nurse record a normal heart rate. Okay, whateve…

Yeah, despite this being the first serious thing requiring medical attention in my life, I knew it was appendicitis from literally the moment I felt it; it just took them seven hours to first, listen, and second, confirm the diagnosis. They spent hours sending me to tests that were ultimately pointless and inconclusive. Then when I collapsed spontaneously and went into a cold sweat for the third time since arriving, the people dealing with me seemed genuinely surprised that I had collapsed and went into a cold sweat!

They sent me home with like... "16 hours worth" of ultra-low-dose hydromorphone (I couldn't find any dosing guidelines which even reference 1mg tablets) and left me to choose which hours of pain I wanted them for; I missed my followup because the front desk folks couldn't send me where the surgeon's note said I should go.

The best part was the ambulance ride, which only cost me fifty bucks and was conducted excellently; the surgery itself also went well, as far as I can tell, though for an appendectomy that's nothing to write home about (not to downplay the work involved, but like flying in airplanes, it has become routine).

Likely not a coincidence, the ambulance ride is the one thing I had choice in as a patient, and the one thing I paid for out of pocket (although non-emergency rides somewhat subsidize emergency ones, by policy).

Re: Doctors, Revolt

#167

Post by OliverJones »

pishpash wrote: post #75
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…

> ... gets an extraordinary result from a collection of ordinary people Of course doctors are ordinary people. The ones that become doctors these days aren't even the brightest in school -- those go into STEM or, god forbid, finance. But if they are ordinary people why are they paid like the superhuman healers that they aren't and still hold themselves as such?

Many doctors I know opt to work for a practice association and draw a salary, typically in the very low six figures. Why? Their association handles all the huge pain in the neck CYA stuff like electronic medical records, triage, insurance and Medicare billing, malpractice risk management, scheduling.

From the practioners' point of view, especially for those who care for people over 65, socialized medicine has already arrived in the US. The rules around care and reimbursement are rigid.

You'll get an occasional congresscritter who used to be an obstetrician or dentist claiming it isn't so. But those specialties don't have to try to get paid by Medicare.

Re: Doctors, Revolt

#168

Post by dominotw »

PeterisP wrote: post #145
dominotw wrote: post #136

Earlier quoted context omitted.

> Hospitals should post prices of their procedures in the lobby. A surgeon gets $500 to repair a hernia and the hospital pulls in $5k for the ancillary services Cost for repairing hernia is not exactly the same for every patient though. Depends on the severity, general health of the patient and a million other things. Not sure if its even possible to put an upfront price. Even if they did, how do patients know before…

The same reasons would apply elsewhere, they're not USA-specific, so they don't explain why it's not possible to do the same thing that's successfully done elsewhere. Sure, there's some inherent variance always - the same thing happens in many industries and doesn't prevent them from offering fixed quotes; the service provider is the one best qualified to estimate the expected variance in their costs and offer approp…

> The same reasons would apply elsewhere, they're not USA-specific, so they don't explain why it's not possible to do the same thing that's successfully done elsewhere.

I 've never seen a chart with prices for hernia in the lobby , anywhere that I've lived( I am not from USA).

Where has it been successfully done?

Re: Doctors, Revolt

#169

Post by OliverJones »

paulcole wrote: post #91
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 dat…

If a patient is stable enough that the taking of regular vital signs is nothing but a nuisance, maybe it's time for the patient to leave the acute care hospital and go home or to a rehabilitation facility. Nobody wants patients who don't need acute care services in acute care hospitals.

Maybe DNR / palliative-care patients should get a break on the four-hour vital sign gathering. But people start yelling "death panels" when this sort of thing comes up in hospital policy.

Re: Doctors, Revolt

#170

Post by PeterisP »

dominotw wrote: post #168
PeterisP wrote: post #145

Earlier quoted context omitted.

The same reasons would apply elsewhere, they're not USA-specific, so they don't explain why it's not possible to do the same thing that's successfully done elsewhere. Sure, there's some inherent variance always - the same thing happens in many industries and doesn't prevent them from offering fixed quotes; the service provider is the one best qualified to estimate the expected variance in their costs and offer approp…

> The same reasons would apply elsewhere, they're not USA-specific, so they don't explain why it's not possible to do the same thing that's successfully done elsewhere. I 've never seen a chart with prices for hernia in the lobby , anywhere that I've lived( I am not from USA). Where has it been successfully done?

Well, it's not literally placed in the lobby (since the price chart is big and different locations/types/severities of e.g. hernia mean different types of operations, and the choice of which type of operation should be chosen is generally not made by you but by the consulting doctor) but it's conceptually the same in that the price list is publicly available and you know beforehand about what exactly you're going to be charged.

E.g. a link to a random local (to me) hospital's pricelist (not in English, sorry) https://www.aslimnica.lv/lv/content/neirokirurgijas-operacij... starts with two different procedures for herniated spinal disc repair. That's it, if your doctor recommends to do this operation, then if it's not covered by your insurance this is what you'll pay for the procedure followed by a standard per-day inpatient fee for however you're required to stay during recovery. It's up to the hospital how to split the amount among all the involved specialists labor, equipment, drugs and supplies required.

As far as I've seen when traveling, the same (i.e. once it's clear what you want to be done, there's a price known beforehand) applies in most European and Asian countries, but it's hard to provide online examples as you must look for the local non-english (the english-speaking market, USA+UK+UK dominions, seems quite different from the rest of the world) services since English websites tend to be oriented for "medical tourism" services which is different from how the locals handle their healthcare, and there's a significant language barrier.

How does pricing of elective surgeries work in your area?

Post reply on HN