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Things I've noticed while visiting the ICU

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Re: Things I've noticed while visiting the ICU

#21

Post by a_shovel »

I don't have much personal experience with hospitals, but there's a trend I've noticed across several articles now where the medical system is characterized by an unpredictable and frequent alternation between extreme competence and extreme incompetence.

The author's dad was being seen by a variety of highly trained specialists all working to treat him, but "people need to sleep" seems to be a recent discovery in the ICU world, and if his family hadn't been there to help, every new nurse would have tried to give him the same medication that gave him a bad reaction, over and over, just because there wasn't an established place to write that (obviously important) information down.

I've read that food with better nutrition than regular hospital food may reduce mortality rates by as much as half [0]. That's such a huge effect that it's shocking that hospital food is just expected to be bad. Everyone says nutrition is vital for health, but hospitals don't seem to care.

I think the root problem is cost-cutting. Management cuts costs until the brink of disaster, and tries to hold it there for as long as possible. This is not a system that strives for the best outcome for patients within reasonable limits of the resources available; this is a system that attempts to extract as much value as possible from the patients, and patient death is only prevented as a means to that ends.

[0] https://www.sciencedirect.com/science/article/pii/S073510972...

Re: Things I've noticed while visiting the ICU

#22

Post by polishdude20 »

anjc wrote: post #4

> the next time you have trouble booking a surgeon or even a gastroenterologist, you can remember that America’s supply of surgeons and gastroenterologists is being disproportionately used by the AARP crowd. What a horrible sentiment.

In a way I think this is ok though? Like, when I reach that age I sure as hell hope I'll have more access to doctors than younger people?

Re: Things I've noticed while visiting the ICU

#23

Post by bombcar »

parker_mountain wrote: post #3
tomcam wrote: post #2

Very well thought out article, but I promise your life will improve if all you do is read the caption on the first image.

This is not a picture of a real hospital. This is a picture of Mystic Falls hospital, from the CW show “The Vampire Diaries”. If I remember correctly, the guy on the left is an evil vampire hunter (the vampires in the show are mostly heroes, except when they’re evil and trying to take over the world), and the doctor on the right is maybe a vampire? Or she might just be friends with a vampire but not realize it. Or sh…

I suspect it IS a real hospital, depending on if the show was set in a hospital or not. If they only needed it for a few scenes, you just rent out a hospital or something that looks similar enough.

Re: Things I've noticed while visiting the ICU

#24

Post by notacoward »

anjc wrote: post #4

> the next time you have trouble booking a surgeon or even a gastroenterologist, you can remember that America’s supply of surgeons and gastroenterologists is being disproportionately used by the AARP crowd. What a horrible sentiment.

I had a strong reaction to that too. Of course we devote more health-care effort to people in the last 5-10 years of their life, which primarily (but not entirely) means older people. There is practically no world in which that wouldn't be the case, because everyone's health trajectory eventually trends downward. By the time someone reaches the ICU (other than as a result of trauma) not only the immediate problem but likely several others will have progressed to problematic levels. That's also where the most labor- and dollar-intensive treatments tend to be applicable. It's just basic statistics, really. Cars also cost more in maintenance late in their life cycles, and so do many other things. A flat age distribution in the ICU would be super weird and probably an even worse allocation of resources.

I don't think the author really meant that to come across as callous as it sounded. Probably just poor choice of words. I'm only addressing it because someone else reading it here might interpret it in more of an "older people stealing from younger ones again" kind of way for demographic or ideological reasons.

ETA: it already happened as I was writing this.

Re: Things I've noticed while visiting the ICU

#25

Post by questime »

wellareyousure wrote: post #11
questime wrote: post #5

It's politically toxic to discuss but a ton of money goes to keeping people not dead (not really alive either). You could give a lot more people medicare/medicaid if we let a 90 yr old with dementia/diatebetes/etc. pass with dignity.

Yes, certainly people in medicine are aware. > we let a 90 yr old with dementia/diatebetes/etc. pass with dignity. Often it's a 4 week old baby. For every 1 sophisticated family member, there are 19 unsophisticated ones, who toss a weighted coin and, if it's heads, they decide they want their dying, non-responsive relative - possibly their baby, possibly their mom, etc. - to be kept alive at all costs. I don't know i…

> Often it's a 4 week old baby.

You are stretching the word often, most people in the ICU are close to the end of their life. A lot of people don't realize but most of the time if you needed to spend weeks in an ICU you are probably not "living" in a dignified way. Almost all ICU doctors/nurses I've talked to would rather have a DNR in their old age than live like that.

Re: Things I've noticed while visiting the ICU

#26

Post by chiefalchemist »

questime wrote: post #5

It's politically toxic to discuss but a ton of money goes to keeping people not dead (not really alive either). You could give a lot more people medicare/medicaid if we let a 90 yr old with dementia/diatebetes/etc. pass with dignity.

Many of the top causes of death, per the CDC, are from diseases that can be prevented or naturally mitigated. We're all going to get old. We're all going to die. But carrying two or more "pre-existing conditions" into your later years is going to decrease your quality of life, as well as your use of healthcare.

My point is, what's not sociopolitically allowed is discussing how personal choice as well as normalized systematic issues (e.g., urban food deserts) are killing us, slowly. It's unfashionable to suggest someone's weight is (ultimately) unhealthy. But the USA wants to have its cake and eat it too, literally. That's not working out. It's not sustainable.

Finally, not to get off topic but over the last couple of weeks there's been a thread or two on HN based on acticles suggesting the GDP and similar "classics" economic metrics are hiding underlying social issues. That is, for example, healthcare care contributes to the GDP (or whatever) but that healthcare is for diabetes, opioids, faltering mental health, etc. We're falling apart but not to worry the economy is doing just fine.

It's complicated. But to your point, the fact that some important topics are ofc limits isn't helping. Until that changes the status quo will continue.

Re: Things I've noticed while visiting the ICU

#27

Post by ch4s3 »

questime wrote: post #5

It's politically toxic to discuss but a ton of money goes to keeping people not dead (not really alive either). You could give a lot more people medicare/medicaid if we let a 90 yr old with dementia/diatebetes/etc. pass with dignity.

It's pretty well know and often discussed that up to 1/3 of Medicare spending is wasted. Being fee for service doesn't help but neither does spending 13-25% of all medicare dollars on end of life care[1].

What's worse is how much of Medicare's wasted spending goes to harmful treatments.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/#:~:tex....

Re: Things I've noticed while visiting the ICU

#28

Post by MBCook »

anjc wrote: post #4

> the next time you have trouble booking a surgeon or even a gastroenterologist, you can remember that America’s supply of surgeons and gastroenterologists is being disproportionately used by the AARP crowd. What a horrible sentiment.

I didn’t read it as an indictment (why are we wasting all this money on people who are dead soon anyway?) but more of just a straight observation that makes sense if you think about it but probably isn’t what most people would expect if asked unprompted.

Re: Things I've noticed while visiting the ICU

#29

Post by colechristensen »

a_shovel wrote: post #21

I don't have much personal experience with hospitals, but there's a trend I've noticed across several articles now where the medical system is characterized by an unpredictable and frequent alternation between extreme competence and extreme incompetence. The author's dad was being seen by a variety of highly trained specialists all working to treat him, but "people need to sleep" seems to be a recent discovery in the…

>The author's dad was being seen by a variety of highly trained specialists all working to treat him

The training doesn't really matter. Context is very important as is caring about doing a good job. You'll find a severe lack of both in hospitals. You eventually have to stand up and defend yourself against bad healthcare... or search endlessly for good healthcare which is terribly difficult to find.

Re: Things I've noticed while visiting the ICU

#30

Post by gopher_space »

anjc wrote: post #4

> the next time you have trouble booking a surgeon or even a gastroenterologist, you can remember that America’s supply of surgeons and gastroenterologists is being disproportionately used by the AARP crowd. What a horrible sentiment.

It’s painfully easy to start thinking in numbers when you’re paying six thousand a month to warehouse your grandmother’s body.

The number of tests people want to run on someone we all hope dies tomorrow is insane.

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