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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

#271

Post by barry-cotter »

bombcar wrote: post #12
voz_ wrote: post #6

Great, well written article, I wish your father a speedy recovery. Anecdotally, when I was in the hospital (much more minor, at a much younger age), they kept waking me up at 3am to draw blood and clean and do god knows what, and the light outside my room was constantly on. It felt... at best annoying, at worst, downright jarring and disruptive. It certainly feels like the sleep and rest parts of recovery and care ne…

There was an interesting article that showed "state of the art delivery rooms" from the 1950s - and they were ALL oriented around the doctor and nurse's convenience. Now we've moved back toward "birthing centers" which focus on the mother and the baby; perhaps it is time for something similar to grow across all aspects of care.

> There was an interesting article that showed "state of the art delivery rooms" from the 1950s - and they were ALL oriented around the doctor and nurse's convenience.

And women are still giving birth lying down, fighting gravity, for the doctor’s convenience.

Re: Things I've noticed while visiting the ICU

#272

Post by fedeb95 »

hef19898 wrote: post #265

Wow, that first paragraph is as cynical as it gets: " The ICU is filled with old people." It ends with people now knowing why it tales so long to get doctors appointments, and saying the author is not sure whether ir nit this is a good thing, that we (the articlee is about the US but is pretty much the same everywhere) spend so much of our health care resources on the old. While his dad, also not in his twenties, was…

Exactly my thoughts. I don't know anything about medicine, so my ultimate opinion is "I don't know". If I were to guess, the article just describes a well functioning medical structure and the author has some problem with people paying taxes.

Re: Things I've noticed while visiting the ICU

#273

Post by fedeb95 »

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…

Yes talking about scientific method and citing a TV show. Logic

Re: Things I've noticed while visiting the ICU

#274

Post by barry-cotter »

oaktrout wrote: post #174
kudu wrote: post #128

Earlier quoted context omitted.

> 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…

If you've spent on average ~200K for medical school, how willing will you be to pay to work for 3 to 8 more years before you get a paycheck? Resident doctors already make less than nurses with 4 year undergraduate degrees.

So? People really, really want the prestige that goes with being a doctor. If they could pay for it they would. Physician compensation is heavily weighted towards middle and late career as it is and that hasn’t stopped people beating down the doors to get into medical school. Half the people who currently apply to medical school could look at how crap it is and decide not to and there would still be intense competition.

The below article on how awful medicine and medical school are was written a decade ago and nothing has gotten better. People really like social status.

https://jakeseliger.com/2012/10/20/why-you-should-become-a-n...

Re: Things I've noticed while visiting the ICU

#275

Post by hef19898 »

fedeb95 wrote: post #272
hef19898 wrote: post #265

Wow, that first paragraph is as cynical as it gets: " The ICU is filled with old people." It ends with people now knowing why it tales so long to get doctors appointments, and saying the author is not sure whether ir nit this is a good thing, that we (the articlee is about the US but is pretty much the same everywhere) spend so much of our health care resources on the old. While his dad, also not in his twenties, was…

Exactly my thoughts. I don't know anything about medicine, so my ultimate opinion is "I don't know". If I were to guess, the article just describes a well functioning medical structure and the author has some problem with people paying taxes.

I really wished "I don't know" would be the default position of otherwise smart, educated and exeperienced people once they step out of their fileds of expertiece. There is only so much that easily transfers from one domain to another, or from one industry to another.

Re: Things I've noticed while visiting the ICU

#276

Post by Aeolun »

watersb wrote: post #200
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 think it would be much better for both patients and healthcare staff alike if there was a greater emphasis placed on focusing on the series of successes and failures that happen over the course of someone's care, not just seeing it as a single shift or a single problem happening in some isolated point in time. I once had a week as a patient at the Mayo Clinic in Scottsdale AZ. There were many remarkable aspects o…

For someone that hasn’t heard of they Mayo Clinic other than through webite articles describing medical conditions, are they that desired/high-quality?

Re: Things I've noticed while visiting the ICU

#277

Post by Aeolun »

throwaway892238 wrote: post #224
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…

> Moronic, scared management that is fine with these kinds of problems as long as the dough keeps coming in

That sounds like it’s the same in any sector? Especially IT.

Re: Things I've noticed while visiting the ICU

#278

Post by rscho »

joenot443 wrote: post #264
rscho wrote: post #259

Earlier quoted context omitted.

not all of us live in the US

I don’t either but fully agree GP’s assessment, you chose a strange character to use there.

It's the default on my keyboard, and the commonly accepted symbol in my language. Next time, I'll choose something else.

Re: Things I've noticed while visiting the ICU

#279

Post by newsclues »

hef19898 wrote: post #265

Wow, that first paragraph is as cynical as it gets: " The ICU is filled with old people." It ends with people now knowing why it tales so long to get doctors appointments, and saying the author is not sure whether ir nit this is a good thing, that we (the articlee is about the US but is pretty much the same everywhere) spend so much of our health care resources on the old. While his dad, also not in his twenties, was…

The observations of the comment about old people does however match the demographic data, and it shouldn't be simply dismissed this context is important and was not made clear during the COVID-19 pandemic.

Re: Things I've noticed while visiting the ICU

#280

Post by gus_massa »

haldujai wrote: post #201
gundmc wrote: post #167

Earlier quoted context omitted.

This comes up every once in a while when discussing the crazy 24+ hour shifts that doctors in residency are often assigned. One argument in favor of keeping the hours is that continuity of care is by far the factor most strongly correlated with good patient outcomes. So the argument goes that a change in caregiver is more detrimental to the patient than continued care from one doctor even if that doctor is sleep depr…

As a physician, shift length is honestly a red herring. As much as I hated doing 24-28 hour shifts on inpatient services, continuity of care does matter and errors do occur in handover. You have to keep in mind that medicine between 12am and 6am is what we call “keep people alive.” 6am to 12pm after an overnight is for handover. You’re not trying to diagnose a new illness overnight or make changes in management, your…

> As a physician, shift length is honestly a red herring.

This is how the Stockholm syndrome feels. I manage a few T.A. in the university, and they barely can think after a 6 hours of teaching (two consecutive classrooms, with like half an hour of rest in each one for the students, and perhaps another informal half an hour in the middle). Sometimes they have to speak in the blackboard, sometime grade informal take home exercises, sometimes reply questions on the spot, and they get very tired. So we have a strict 6 hours per day rule. And if they make a mistake, nobody dies!

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