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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

#151

Post by ghufran_syed »

gowings97 wrote: post #105
rscho wrote: post #73

Earlier quoted context omitted.

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?

pretty much every patient in the intensive care unit - that’s kind of what the “intensive” is referring to.

If nothing else, you either take the blood pressure the normal way with a pressure cuff, which is going to wake you up. Or you put an intra arterial catheter, which reads continuously without bothering the patient, but has a small risk of damage to the vessel, infection etc

Re: Things I've noticed while visiting the ICU

#152

Post by warner25 »

jmhmd wrote: post #52
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…

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.

Yeah, that's what I mean by the medical system just not being set up to allow this. I generally see a different doctor every time I make an appointment, because I'm assigned to a team in a clinic with constant turnover, the appointments are 20 minutes long, and the doctor easily spends more time on boiler plate stuff in the computer system than examining and listening to me. I don't even think they have time to look over the basic medical history, let alone have a whiteboard session to consider all the pieces of the puzzle and brainstorm possible explanations.

Re: Things I've noticed while visiting the ICU

#153

Post by rednerrus »

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…

The AAMC should increase the number of students they admit. The average medical school is turning away 95% of applicants. The top 10 schools in America are excepting <2.5%.

Re: Things I've noticed while visiting the ICU

#154

Post by chromatin »

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…

Although I agree with you on a distaste for the foolishness of central planning, lLet me provide an alternative perspective.

A huge proportion of US physicians are already mediocre; a shocking number are bad. (Source: I am a physician.) Given this, I am concerned that further relaxation of standards in an effort to train more doctors won't lead to better outcomes.

Re: Things I've noticed while visiting the ICU

#155

Post by ghufran_syed »

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…

ability to afford the ICU is not relevant at all when the docs decide to put someone there or not, based on my 14 years practicing in the US. Do you have any experience to the contrary? I’m pretty sure that would be illegal in the US

Re: Things I've noticed while visiting the ICU

#156

Post by ghufran_syed »

ivraatiems wrote: post #69

My wife is a physician who works in a critical care setting. She did not read or approve this post; these are my thoughts as someone who hears a lot about the other side of this environment: For the most part this seems like a sensible and reasonable article communicating what must have been an extremely difficult situation for the author. In case the author reads this: I'm really glad your dad got better and I know…

It’s also impossible to infer the logical process from a superficial observation of the tests being done - that would be like inferring the code architecture from what’s displayed on an output device, in rare cases it might be possible, but usually not

Re: Things I've noticed while visiting the ICU

#157

Post by Der_Einzige »

Eleison23 wrote: post #98
questime wrote: post #25

Earlier quoted context omitted.

> 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.

Your human dignity is not predicated on how much pain you're in, how awake you are, or how able you are.

Uhh, yes it is to all three of those things.

If I'm in pain, am delirious, and am unable to operate in the world. I've lost my dignity.

Re: Things I've noticed while visiting the ICU

#158

Post by throwaway821909 »

notacoward wrote: post #34
Mezzie wrote: post #17

Earlier quoted context omitted.

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.

> I also pay taxes Do you really get nothing ? And who is paying for whose care? You mention taxes, but they've probably been paying taxes even longer. And why do you think health care is a strict quid pro quo anyway? Some of us believe care should be allocated where it's needed, not where it's paid for. Put another way: why is it a problem that they are getting care? Isn't it that you aren't ? This doesn't have to b…

More bluntly - if you're a greater-than-average user of healthcare resources, this seems like a dangerous line of questioning to bring up.

Re: Things I've noticed while visiting the ICU

#159

Post by rscho »

haldujai wrote: post #150
rscho wrote: post #139

Earlier quoted context omitted.

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%…

You're right that silencing alarms is strictly forbidden in anesthetic territory only, not ICU. I'm biased bc I'm in Switzerland, and here the coverage ratio is usually 1:1. The country is so rich, that many things are different here... they really are near the patient at all times. To give you an idea: the day COVID really hit, we received 180 shiny new Hamilton respirators complete with additional staff overnight, in an ICU that's usually ~30 beds. And you can't order "your nurses" around, because they've got a lot more power. Yes, in most places it's different and I should have mentioned that.

Re: Things I've noticed while visiting the ICU

#160

Post by coryrc »

croes wrote: post #53
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.

Where do you draw the line? At what age, what illness do you refuse to treat a patient even though he may not want to die? You could give a lot of people medical treatment with a proper healthcare and tax system. Why don't we try that first?

At some QALY/$.
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