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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

#121

Post by neonate »

rscho wrote: post #107
neonate wrote: post #93

Earlier quoted context omitted.

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.

> The social isolation of old age is the same everywhere

That is certainly not true. Traditional societies and non-western societies have far different ways of relating to elders than we do, and even among western societies there are variations.

Re: Things I've noticed while visiting the ICU

#122

Post by Spooky23 »

My mom was the nurse empress of a large ICU (at least tactically). The biggest issue is there’s no “product manager” for your care. Each specialist doctor has an incentive to do as little as possible as often as possible to avoid having a death on their record, but to be able to bill. So the nurses usually are the most incentivized people to actually take care of you.

From her point of view, the management ensured that the best care for patients happened when family was present, especially on irregular intervals, and for prisoners, who had a CO always watching and sometimes logging what happened.

Her other big thing was hatred of EMRs. The loss of the clipboard made situational awareness tough.

Re: Things I've noticed while visiting the ICU

#123

Post by ncallaway »

j-bos wrote: post #113
NegativeLatency wrote: post #80

Earlier quoted context omitted.

Just getting accepted to a medical school is pretty hard unless you’re amazing/very good at the tests. Had a cousin and a friend (both I would characterize as smart and hard working) take several years after undergrad and eventually “settle” for physicians assistant schools.

I personally want my doctors to be amazing and very good. For now tests are a fair proxy, it's the 8 years that seem ridiculous, esp when looking at non US countries.

> For now tests a a fair proxy for that

Is it? Is there a study demonstrating the correlation to pre med test scores to patient outcomes?

Re: Things I've noticed while visiting the ICU

#124

Post by duffpkg »

Author of Hacking Health for O'Reilly, managed operating companies for hundreds of hospital facilities, etc...

One widely under realized aspect to healthcare costs in the US (there are many) is the very high number of ICU beds per capita, ~35 per 100,000 people. While it gets a little complicated to compare apples to apples, a reasonable person could say we have 30% more than germany which is the only european contry that is close and double to triple most other nations we are typically compared against like the UK and Canada.

ICU beds are extremely expensive to both build and operate. Also for the lay person the term "bed" has a specific regulatory meaning and does not refer to just the physical existence of the room and bed but means that it is operational with highly regulated amounts of staffing, services and equipment. Each "bed" has costs in the millions to build and equip and operating costs are typically in the neighbood of $10k to $40k per "bed" per day, occupied or not, a large portion being labor.

Re: Things I've noticed while visiting the ICU

#125

Post by HEmanZ »

chips_n_fries wrote: post #117
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…

And she is not a resident or in a training/certification program?

Not anymore, but she’s only two years out. Her hours are actually worse than most of residency these last two years.

Re: Things I've noticed while visiting the ICU

#126

Post by [deleted] »

z3rgl1ng wrote: post #20
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.

This is an oft-repeated piece of received wisdom that is empirically untrue. https://www.statnews.com/2018/06/28/end-of-life-health-spend...

[deleted]

Re: Things I've noticed while visiting the ICU

#127

Post by Sevii »

dheera wrote: post #43
Wonnk13 wrote: post #39

For context see my comment here https://news.ycombinator.com/item?id=33625584#33647770 One thing that this article touches on, but I think needs to be emphasized even more is that the stark reality is that the only advocate for the patient is the patient themselves, or perhaps a caretaker. The burden is on me to ask questions about fertility and sperm banking because my oncologist is well... an oncologist not a ferti…

I was in an ICU for a week after a cardiac arrest. I don't remember much of it other than a lot of hallicunations. I had family there to advocate for me, but there's no way in hell I would have been able to advocate for myself. I was literally seeing things around me in the ICU room that didn't exist. My family were probably the only ones that realized that that wasn't the real me. The hallucinations stopped happenin…

Hallucinations are one of the most common symptoms of sleep deprivation.

Re: Things I've noticed while visiting the ICU

#128

Post by kudu »

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…

> people like to complain that the federal government only funds a fixed number of residency slots, as if a trillion dollar industry is just absolutely helpless to do anything

Agreed, but I would go further and say that if demand by students for the training provided by residency exceeds the demand by hospitals for the work provided by residents, I don't see why residents couldn't pay for their training just as they do for medical school. The whole "residency funding" thing seems like a red herring as an explanation.

To be clear, I'm not saying that medical graduates should have to take on more debt to pay for residency, but rather that the reason this doesn't happen is not obvious according to typical economic reasoning.

Re: Things I've noticed while visiting the ICU

#129

Post by steve76 »

chiefalchemist wrote: post #26
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 sy…

No post body was provided.

Re: Things I've noticed while visiting the ICU

#130

Post by [deleted] »

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…

[deleted]
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