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Things I've noticed while visiting the ICU

trevorklee.substack.com

101–110 of 387 posts

Re: Things I've noticed while visiting the ICU

#101

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…

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Re: Things I've noticed while visiting the ICU

#102
I’m fresh off of spending 24 hours in the ICU and I can say the OP is right. It’s impossible to actually “recover” there at all. My singular goal while there was simply to get home to my bed, even if it meant I could potentially die. I didn’t care. I wanted out.

Re: Things I've noticed while visiting the ICU

#103

> 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…

[deleted]

Re: Things I've noticed while visiting the ICU

#104
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.

Any form of euthanasia runs into the legal and moral problem of who decides? And why?

You might think everyone wants to act in the best interests of their relatives, but of course that's not true. Some people will want to speed the natural process along because that inheritance looks really appealing, and no one is really going to miss the old guy/gal anyway.

Besides, that's not really the problem. The problem is profiteering by insurance companies and the hospitals they (effectively) run for profit, with patient wellbeing as a regrettable requirement they have to put some effort into.

Re: Things I've noticed while visiting the ICU

#105
post #73

Earlier quoted context omitted.

I don’t think the problem is cost cutting. I think the problem is just the same problem that every human enterprise has. Most people just don’t give a shit outside thier immediate responsibility. Looking at the global view and actually making changes that require persuading other people is a hard and often thankless task. Many people who do give a shit get this crushed out of them early in their career by the negativ…

I work in a hospital, and occasionally in ICUs. You're wrong. Most workers are very much jaded, but they do care. Problem is, the system crushes you to death if you don't set pretty harsh limits to protect yourself. In a lot of cases, that means de-humanizing your work, put your feelings aside and work like a machine. Good little machines are just what management wants, right? Now higher management... wow, those peop…

What percent of patients have a medical need to be woken up every few hours then?

Re: Things I've noticed while visiting the ICU

#106

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…

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It's not illegal for other entities to fund residencies!

I anticipated your argument in my other comment...

Re: Things I've noticed while visiting the ICU

#107
post #93
post #46

Earlier quoted context omitted.

> We fear death In the US. It's perhaps the most striking difference that hit me during my stay overseas. In the Old World we occasionally get people completely panicking about their own death. In the US, seemingly _everyone_ is like that.

I'd like to hear how elders are treated in these societies that don't fear death as much.

I'd wager: not very differently. But not out of fear. The social isolation of old age is the same everywhere. Young people have their own lives to live.

Re: Things I've noticed while visiting the ICU

#108
post #99
post #94

Earlier quoted context omitted.

The treasury department’s website[1]. I wonder if your link is rolling in the VA? I can’t quite tell. [1] https://fiscaldata.treasury.gov/americas-finance-guide/feder...

>Department of Defense--Military Programs I wonder if that means they're subtracting portions of the DoD budget that aren't technically military operations.

As with many of these categories it can be hard to pin down accurate numbers.

Re: Things I've noticed while visiting the ICU

#109

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…

Totally agree. Also, let people open more medical care facilities. Right now "Certificate of Need" legislation is killing lots of viable options for care _outside_ hospitals.

Re: Things I've noticed while visiting the ICU

#110
post #88

> 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 unimagi…

If medical treatment was actually as formulaic and fully-solved as you imply, we wouldn't take the best students of every generation and make them spend ten years training to become doctors. We'd just have nurses, checklists, and diagnosis flowcharts.
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