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?
Where do you think state money comes from? Even if it’s the government that foots the bill for ICUs, in the end it will still be paid collectively by all of us regular people.
Where do you think the for-profit money goes? (HINT: it’s in the name.)
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…
This is a practical reality of the "we keep old people alive too long" category.
How old should people be allowed to get? Why are the old less valuable to you? A life is a life, is it not?
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…
They make like $250k. Specialists make like $500k and up. So the business model is for health networks to vacuum them up and then hire a bunch of nurse practitioners for $100k.
Some of these guys get laid off and end up working in dermatology offices getting commissions on expensive creams.
You still have the problem of writing a sufficiently detailed tree. I had a blood test last year and when I discussed the result with the doc, he asked me the clinic location where the blood was taken, because then he could estimate time between blood draw and lab test and interpret the result accordingly.
It’s your blood usually tested immediately? At least my hospital gives me results right away (well, say within 30 minutes).
It might be different where you live, but where I am, the vast majority of blood tests are not done at the hospital.
Family doctors and lab test centres do it.
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…
The author even mentions that a long term stay like their father’s is rare. A lot of the criticisms are about what is, and I apologize for the expression, an edge case.
If medical treatment was actually as formulaic and fully-solved as you imply, we wouldn't take the best students of every generation and make them spend ten years training to become doctors. We'd just have nurses, checklists, and diagnosis flowcharts.
General Practice medicine seems to come close enough. No differences in patient outcomes between physicians and nurse practitioners. > Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care > Results: Nurse practitioner consultations were significantly longer than those of the general practitioners (11.57 v 7.28 min; adjusted difference 4.20, 95% conf…
More tests isn’t a good things. The doctor was significantly quicker and could see 3 patients for every two the nurse saw.
I’m not sure where this leaves us, as the cheaper training cost for the nurse is a factor too.
Where do you think state money comes from? Even if it’s the government that foots the bill for ICUs, in the end it will still be paid collectively by all of us regular people.
Well good thing regular people don't ever need to use ICUs.
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…
In general for US healthcare providers there is little relationship between price and quality. They have to meet certain quality standards in order to operate at all, but outsides few limited areas they don't get paid more for delivering higher quality care. So quality (or lack thereof) tends to come down to organizational culture and management.