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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

#81

Post by spfzero »

maxerickson wrote: post #13

The solution to difficulty booking doctors isn't to pontificate on how to allocate their time, the solution to difficulty booking doctors is to make more doctors. There's lots of levers that could be pulled in the US. Cut down on undergraduate requirements, incentivize large health systems to fund more training (people like to complain that the federal government only funds a fixed number of residency slots, as if a…

I get what you're saying, but I don't think more doctors is the answer. Hospitals will only hire the absolute minimum number of doctors they can possibly get away with, other than the ones who actually bring in new business.

This is the reason: as soon as the medical industry has established a consensus price for some procedure or other item of care, the hospital administration starts to work on figuring out how to do it for the least possible cost. The price has been set in stone, no need for further justification. Medicare or whoever WILL pay that much. The price is fixed so the only knob left to turn is cost, and cost will be reduced all the way down, until service is just above a level so poor that patients would decide to stay home.

Re: Things I've noticed while visiting the ICU

#82

Post by DoingIsLearning »

> So, when it comes to prescribing (...) Giving psychiatric medicine “as needed”? Go wild.

This implies a lack of duty of care which is painfully unfair.

As a counter story to this I have a friend of mine who is a _former_ ICU nurse with a gigantic scar on her forearm.

I much later in our relation found out that the scar is from a patient who basically ripped her forearm biting down on it while she was trying to stop him from tearing out a central line in his own neck.

It's ironic that in trying to stop a patient from having a massive central line bleeding she ended up bleeding herself.

Outside hospitals we fail to realize how disoriented and irrational patients can get when coming out of anesthesia or with certain diseases.

So yeah 'as needed' is absolutely right because everyone is entitled to work in a safe environment.

Re: Things I've noticed while visiting the ICU

#83

Post by HEmanZ »

thfuran wrote: post #66
HEmanZ wrote: post #60

These threads always have lots of people jumping on doctors and their decisions/callousness/lack-of-reason/etc.etc.etc. My wife is a physician (OBGYN) at a major city hospital that primarily serves a very poor population. I'd like to share her schedule, and see if you think what kind of care you could perform under these circumstances: Monday - Friday - Wake up at 4:30 AM - Get to hospital by 5AM to start rounding on…

That sounds illegal.

Nope, not where we live.

I have seen administration do some blatantly illegal shit around physicians with COVID, but I don't want to write that up here.

Re: Things I've noticed while visiting the ICU

#84

Post by chki »

notacoward wrote: post #63
chki wrote: post #51

Earlier quoted context omitted.

I think a more generous reading of the comment you are replying to could be (and probably is reasonable): It is hard to pay a lot of money for somebody that is living in agony with no chance of getting better, where death might be a good option for them personally. I would not understand the comment to criticize supporting people living in relative comfort.

"Warehousing her body" suggests otherwise. When people talk about someone as a "body" they usually mean insensate IMX. People whose loved ones are in pain tend to use different, even more colorful, language. I know I did, when that was the case.

> People whose loved ones are in pain tend to use different, even more colorful, language.

The human experience varies wildly and I would not make such assumptions. Caring for somebody without the hope of improvement for years can make you bitter or even resent the person that no longer resembles the one you loved.

Re: Things I've noticed while visiting the ICU

#85

Post by jewayne »

Mezzie wrote: post #17
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.

What's terrible about it? I'm a younger (34) person with substantial healthcare needs (I have MS). Everything is always oriented towards the old, and I also pay taxes that are used to support them while getting nothing in return despite having similar needs.

No post body was provided.

Re: Things I've noticed while visiting the ICU

#86

Post by blue039 »

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…

No post body was provided.

Re: Things I've noticed while visiting the ICU

#87

Post by bombcar »

b112 wrote: post #67
bombcar wrote: post #23

Earlier quoted context omitted.

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.

No, it's a real hospital, and a real scene, but they're all reverse vampires.

Isn't a reverse vampire just a blood infusion doctor?

Re: Things I've noticed while visiting the ICU

#88

Post by rscho »

warner25 wrote: post #37

> There’s no sense of a scientific method, reasoning from first principles, or even reasoning from similar cases though. It’s all shooting in the dark, and most of the time I felt like I could have done just as good a job on these longterm issues... This articulates very well what I've usually felt when dealing with doctors. It's like the story of a programmer finding that his code outputs 5 when it should be 4, and…

I'm sorry but curiosity and creativity are certainly the n°1 enemy of the patient, especially in ICU settings. Curiosity and creativity are grandpa's medicine, and a total antithesis to evidence-based modern medicine, that attempts (and largely fails) to be an application of science instead of the whims of the decision-makers.

What you should want is curious and creative _researchers_, but precise and totally unimaginative clinical staff. Those are often the same person. See the problem? You want protocols applied down to the last detail. You want nothing left out of standard operating procedure. That's what kills patients in practice.

You might mean creativity in the sense of "let's have guys who think about the right things, and search for rare diagnoses and analyze stuff to see what could work, like Dr House". But that simply can't be done in practice. You can't be testing for every rare thing, because the tail of low probability diagnoses is much too long! And believe me, you _really_ don't want creative doctors around...

Re: Things I've noticed while visiting the ICU

#90

Post by mberning »

I think people expect that things could go significantly better, if the “system” were better. I disagree. In most cases, by the time they hit the ICU, you have a patient that is circling the drain from old age and chronic conditions and all you can do is manage it. No amount or quality of care is changing the outcome.
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