231–240 of 387 posts
Earlier quoted context omitted.
> 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?
Personal intuition, feel free to dismiss.
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.
We don't need better outcomes. We will happily take the existing outcomes but cheaper.
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…
I get what you're saying, but I don't think more doctors is the answer. Hospitals will only hire the absolute minimum number of doctors they can possibly get away with, other than the ones who actually bring in new business. This is the reason: as soon as the medical industry has established a consensus price for some procedure or other item of care, the hospital administration starts to work on figuring out how to d…
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…
My impression as a Canadian resident was the bar seemed a lot lower to get into the ICU in the US. Unless they needed a tube to secure an airway, pressors, or CRRT we managed COPD with BiPAP, pretty profound hyponatremia, cirrhosis with& bleeds, DKA/HHS on the ward pretty regularly just as examples of repatriated patients I remember. I always figured it was due to an overly litigious culture and a money maker for the…
A lot of patients we manage on the ward or step downs (i.e. pressors on step down, I’m unaware of any ward that will let you run these, very few tolerate central lines) really should be in a full ICU, or at least a high level step down unit like D4ICU at KGH (rather than the hilariously awful AMA units at TOH).
Earlier quoted context omitted.
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?
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…
Earlier quoted context omitted.
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?
Earlier quoted context omitted.
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…
Maybe you don’t want creativity in the ICU, but as a patient with chronic health issues, I do want creative clinicians. Over and over my entire life, I’ve gone to doctors with health issuesand watched as they mentally plug my symptoms into a flowchart that they learned in medical school, then they find that the symptoms don’t match anything that a standard protocol can treat, then they shrug their shoulders and say t…
The only medical practitioners I've found willing to be more curious and to take a more holistic approach are naturopaths. I have had some notable improvements in my chronic health issues working with them, though I am a little uncomfortable with them given their general openness to things that seem pretty questionable to me (like homeopathy).
Earlier quoted context omitted.
> 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?
Personal intuition, feel free to dismiss.
It just strikes me as something that wouldn’t be particularly hard to answer with a detailed study, and probably is a pretty high value question to answer, so I wouldn’t be surprised if there was a study.
Maybe I’ll poke around this weekend
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…
My home country the Netherlands is very different. My father had a stroke quite recently and spent some time in a very modern hospital where they are applying some of the latest insights for patient care. So, he was obviously hooked up to lots of equipment and intensely monitored. However, this hospital has separate rooms for all patients. Reason: it's best for the patients and helps them recover more quickly. Basically, more privacy for the patients and less restless nights. There are no TVs in these rooms. Instead patients are issued ipads with entertainment options and access to various things like indicating dietary preferences. Nurses carry ipads as well. Everything is digital. There are no paper charts in sight anywhere.
The rooms were modern, clean, and clearly optimized for making patient handling easy and straightforward. What struck me was the attention to detail and level of pragmatism in this. For example, my father's room had wall mounted hangers for folding chairs. These are for visitors. And when they are folded they are not in the way. The room had a whiteboard and a locked cabinet for medication and supplies. The doors are sliding. So, it's easy to move things in and out. Like beds, wheel chairs, equipment, trolleys. Etc. And so on. Just a really well designed and thought through design and architecture. Well managed and efficient.
BTW. This is not a private hospital: my country has a mandatory private insurance system: they can't reject people, people must be insured, and they can switch insurer. So, insurers mainly compete on quality care. Miserable patients and inefficient hospitals are bad for business and they are working to fix any issues there with hospitals. Which is why everyone, rich or poor, gets the same quality treatment in this hospital. It's way better than the private insurance I pay for in Germany. Way cheaper too. My German insurance is about 5x the price. I've been in a hospital here a few times and they can learn a thing or two about efficiency there.