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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

#221

Post by civilized »

ler_ wrote: post #161

I'm a nurse and I find the 7th point on the post especially relevant. I will add a disclaimer that I never worked in the ICU so I can't speak for what happens in that type of unit. There is a serious issue with the flow of information in healthcare, (or at least in the U.S, I never worked elsewhere to know if it's any different). But If you find something during your shift which will be important to know later on, it…

I wonder if part of the issue is having to remember a bunch of random things about a bunch of different people so that you can apply the information at the relevant time. E.g. the left arm is easier to find a vein, but this information is only useful for 30 seconds a day during a blood draw, so it's hard for people to remember or even retrieve (how much notes do you have to read through to find this info?)

If the info were somehow magically there when needed, it would be used, right?

Re: Things I've noticed while visiting the ICU

#222

Post by toast0 »

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?

> Where do you draw the line? At what age

30? or 21, if you prefer the book ;p

Re: Things I've noticed while visiting the ICU

#223

Post by civilized »

giantg2 wrote: post #197
ler_ wrote: post #161

I'm a nurse and I find the 7th point on the post especially relevant. I will add a disclaimer that I never worked in the ICU so I can't speak for what happens in that type of unit. There is a serious issue with the flow of information in healthcare, (or at least in the U.S, I never worked elsewhere to know if it's any different). But If you find something during your shift which will be important to know later on, it…

Not lost, but I've had a lot of trouble with information being captured incorrectly. Things like date are pretty commonly messed up. I've also had doctors and nurses put their own, incorrect, interpretation on information I've given them when they repeat it to others. When I say "my child wasn't eating and drinking normally and had half of what they normally do throughout the day", it's incorrect to say "the patient…

I've noticed recently that there are people out there who simply can't accurately listen to others and repeat back what they say. It's not about being stressed for time, the skill is just not there. You say ABC, they write CBD, and they have no idea it's not the same thing.

Re: Things I've noticed while visiting the ICU

#224

Post by throwaway892238 »

ler_ wrote: post #161

I'm a nurse and I find the 7th point on the post especially relevant. I will add a disclaimer that I never worked in the ICU so I can't speak for what happens in that type of unit. There is a serious issue with the flow of information in healthcare, (or at least in the U.S, I never worked elsewhere to know if it's any different). But If you find something during your shift which will be important to know later on, it…

This is similar to problems that would often happen in car manufacturing. The person assembling the car the standard way finds a problem, but the problem doesn't get addressed, or information isn't disseminated correctly, so the cars go out with problems. Toyota developed a methodology whereby such problems are addressed immediately and fixes were disseminated immediately, and would not send a car out otherwise. That kind of obsessive attention to detail and "crazy" focus on quality is what made them the top automaker. But most businesses are led by management that refuse to believe that being slow or focusing on quality first will result in more profits. And none of their lower-level workers are trained on how to spot and fix quality issues, nor are they told to care.

Hospital systems are the same way. Moronic, scared management that is fine with these kinds of problems as long as the dough keeps coming in, ignorant of the fact that more dough would roll in (in addition to better health outcomes, which of course is not their first priority) if they would just focus on quality.

Re: Things I've noticed while visiting the ICU

#225

Post by cfu28 »

rednerrus wrote: post #153
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%.

Doing this would make the problem worse by increasing the amount of unemployable newly graduated doctors that can't practice because they can't match into a residency program. Medical schools have exploded in number the past few decades compared to the actual amount of residency spots that have been opened.

The limiting factor isn't medical school admissions, it's residency spots. We'd need to increase medicare funding if we want more residency spots.

Re: Things I've noticed while visiting the ICU

#226

Post by throwaway892238 »

duffpkg wrote: post #220
Blammar wrote: post #203

Earlier quoted context omitted.

Can you explain why one ICU room costs millions, and why they cost 10k a day even if no one is in them? Neither makes sense to me. I can imagine say 100k in monitoring equipment in a room. Maybe it's the hospital inflation applied to equipment?

An ICU unit isn't exactly a single room. There are different configurations but they typically involve some sort of centralized monitoring station and 5-20 ICU "beds". Total cost of that / number of beds. Everything in hospital construction is expensive, ICUs are at the extreme end of that. Huge power requirements, medical gas lines, fixturing and surfaces needs to be able to be disinfected, special air, special wate…

So, they're complicated, they're expensive, they're necessary... why don't we have the state pay for them? We spend 720 Billion dollars on the military. Would it be useful to send a couple of those billion to make ICUs less expensive?

Re: Things I've noticed while visiting the ICU

#227

Post by roxgib »

trynewideas wrote: post #144
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 wai…

Here in Australia to see a specialist your GP has to refer you. To us the idea of going straight to a specialist is odd, if you have a non-emergency medical issue of any kind you just see your GP. Not saying we don't have issues, but I honestly don't know have people manage their medical issues without a GP to coordinate.

Re: Things I've noticed while visiting the ICU

#228

Post by jasongi »

RE: the amount of people over 70. This isn’t just ICU, this is all of healthcare.

Both culturally and legally humanity seems incapable of accepting death. The threshold for the amount of intervention we’ll do for a human dying is way too much. Sure, you can say DNR, but voluntary euthanasia laws are restrictive and the default from the medical and broader community is almost always try to survive at all costs.

Re: Things I've noticed while visiting the ICU

#229

Post by triceratops »

cfu28 wrote: post #225
rednerrus wrote: post #153

Earlier quoted context omitted.

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%.

Doing this would make the problem worse by increasing the amount of unemployable newly graduated doctors that can't practice because they can't match into a residency program. Medical schools have exploded in number the past few decades compared to the actual amount of residency spots that have been opened. The limiting factor isn't medical school admissions, it's residency spots. We'd need to increase medicare fundi…

Why does medicare alone have to fund residency spots?

Re: Things I've noticed while visiting the ICU

#230

Post by roxgib »

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?

I assume we start by getting more information from patients about their wishes, and then following them accordingly. A large number of elderly people don't want hopeless and unpleasant medical interventions, but end up having them anyway because no one asked them.
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