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

Things I've noticed while visiting the ICU

trevorklee.substack.com

Post reply on HN
Print view View original

141–150 of 387 posts

Re: Things I've noticed while visiting the ICU

#141

Post by fernly »

> 1. The ICU is filled with old people... Pretty much all these patients are on Medicare, which means your taxpayers dollars are making this happen.

This ignores the (I think) very strong possibility that the old people are preferentially selected by the system because, thanks to Medicare, they can _afford_ the ICU. Many people aged less than 65 cannot. Consider the idea that if we had something like "Medicare for all", the population of the ICU would better reflect normal demographics.

That said, as a beneficiary of Medicare I can only be grateful. I had several days in a top-quality hospital and a procedure by a top-quality surgeon, and after all the EOBs had come in, I ended paying out of pocket... nothing at all.

Re: Things I've noticed while visiting the ICU

#142

Post by ericmcer »

fernly wrote: post #141

> 1. The ICU is filled with old people... Pretty much all these patients are on Medicare, which means your taxpayers dollars are making this happen. This ignores the (I think) very strong possibility that the old people are preferentially selected by the system because, thanks to Medicare, they can _afford_ the ICU. Many people aged less than 65 cannot. Consider the idea that if we had something like "Medicare for al…

Old people having more health issues is not really a crazy observation to make. I would be blown away if medical care needed was equal across all ages.

Re: Things I've noticed while visiting the ICU

#143

Post by mhalle »

As a person who has spent plenty of time in ICUs or other hospital floors in my life as a patient, I can add some more background to the mental health / delirium aspect. First, it definitely isn't just ICUs, just most common there. High stress environment, powerful medicines, poor sleep, and just sickness. Next, a fair number of patients in hospitals may already be predisposed to psychiatric conditions, or at least be mentally fragile. Some abuse substances. That adds to the whole environment, and hardens staff. I experienced hepatic encephalopathy because of liver failure, which really impacted my mental state, and at least some of the staff bundled me in with the crazies. Empathy would have gone a long way to reduce the stress for me. On the other hand, I am empathetic to them. The job is tough.

But most importantly though, given these mental stresses and challenges for vulnerable people, there is almost no psychiatric support for patients, staff, or families. That's shocking to me considering how many people experience "ICU delirium". There is almost no backup for staff to help with otherwise normal patients who, say, might think you are a monster trying to kill them.

If there was one thing I would fix, that's it. Psychiatric support on floors, helping staff ease the mental challenges of extremely vulnerable patients.

Re: Things I've noticed while visiting the ICU

#144

Post by trynewideas »

Spooky23 wrote: post #122

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 th…

> 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.

Man. Maybe this is a tangent, but remember primary care physicians? I can barely remember that as a concept. I waited so long to find a PCP taking patients at my last job that I quit before it happened.

Was that a role they ever filled? It kind of feels like it should be considering the title, but being a US citizen I've never experienced it.

Re: Things I've noticed while visiting the ICU

#145

Post by smileysteve »

coding123 wrote: post #74
jmhmd wrote: post #52

Earlier quoted context omitted.

The main thing that House MD has, that no other doctor in the world has, is not so much his superior intellect. It's that he and five other doctors spend 100% of their time on a single case, and can sit around all day discussing it, trying different things. If real world doctors had even a fraction of that luxury, you would see a lot more of what you describe.

Jeez, no kidding. I imagine if they made a realistic doctor show they'd be constantly showing the doctor at the bar (on days off) trying to make money on side gigs like health startups. Stumbling in a hangover to appointments on "work days" and giving everyone the same diagnosis as the last (and likely whatever sickness they themselves had recently). Also giving everyone fluids and an ativan so the patient says - "i…

You should check out The Resident. The first several seasons are about the doctor invested in a device that is a fraud, a private equity group buying the hospital, it eventually failing.

Chicago MD has some of the aspects you mention, especially overloaded, drug abuse, blame, police interactions.

New Amsterdam attacks it by the main character trying to solve the problems and running into bureaucracy.

Re: Things I've noticed while visiting the ICU

#146

Post by gowings97 »

rscho wrote: post #139
gowings97 wrote: post #135

Earlier quoted context omitted.

With all the focus on EHR and billing, they can't have all the machines taking vitals hooked up and in a ready only state thats sent to the nursing station? This is the type of stuff I have a gripe with. Sinecure and fiefdoms of power.

Silencing monitors is actually forbidden by law in many places. Staff is supposed to be near the patient at all times => monitors beeping. That's certainly a bad state of things, but not a "fiefdom of power". It's so ingrained in our education that most staff don't even think about it but would certainly agree if asked whether the patient would sleep better without it.

Not saying monitors should be silenced. You can monitor someone without waking them up.

Fiefdoms of power - nursing union not wanting to give up the night shift premium pay when the job description changes to monitoring a screen and half the physical workload vs. day shift.

Re: Things I've noticed while visiting the ICU

#147

Post by lofatdairy »

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.

I would argue that having onerous tests are not a great proxy. Not only do they not necessarily measure how good a physician a student would be, but it also encourages undergraduates to intentionally enter easier/less rigorous coursework to focus more on the exam aspect (though GPA plays a large role as well). I'm sure a psych major may make a fine physician, but I don't want doctors to only be educated in a rather dubious field. If undergraduate education is only a stepping stone towards medicine, then just integrate medical education with undergraduate studies, rather than adding a ritualized acquisition of a bachelor's degree.

Re: Things I've noticed while visiting the ICU

#149

Post by jmt_ »

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…

It's kind of amazing anyone chooses to go into healthcare having to work like this. It's the absolute last field I would ever want to go into, even as an engineer who wouldn't need to actually practice medicine. Seems like you need to practically give up your life to save countless others. Your wife, and those like her, are truly performing an innately critical job at an absurd cost to themselves - God bless.

Re: Things I've noticed while visiting the ICU

#150

Post by haldujai »

rscho wrote: post #139
gowings97 wrote: post #135

Earlier quoted context omitted.

With all the focus on EHR and billing, they can't have all the machines taking vitals hooked up and in a ready only state thats sent to the nursing station? This is the type of stuff I have a gripe with. Sinecure and fiefdoms of power.

Silencing monitors is actually forbidden by law in many places. Staff is supposed to be near the patient at all times => monitors beeping. That's certainly a bad state of things, but not a "fiefdom of power". It's so ingrained in our education that most staff don't even think about it but would certainly agree if asked whether the patient would sleep better without it.

I’m not sure where you’re getting this from. I / my nurses silence alarms at literally every hospital I’ve ever worked at (granted they’re temporary silences by design so you have to hit silence q1h/q30mins depending on the alarm).

Stanford Healthcare recently installed a system where all alarms/notifications get sent to a hospital assigned device the nurse carries rather blasting in the sleeping patients room as 90%+ are false alarms (aka IV or SpO2 sensors).

The real issue is that hospital technology is outdated and most places don’t have the option for this level of telemetry.

I’ve never been told / instructed my staff to “be near the patient at all times”.

In fact, most places have 1:8 nursing coverage on the ward…

Post reply on HN