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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

#311

Post by throwaway2037 »

heavyset_go wrote: post #191
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 this is a symptom of hospitals being understaffed, whether that's from a deliberate lack of hiring or an actual labor shortage. I feel like many of the problems in this aspect of healthcare could be solved if doctors, nurses, etc weren't run ragged with insanely long shifts and expected to care for a ton of patients.

I don't know how to respond to your post. I'll try: Money. Skilled people cost money, a lot of money. I disagree with both of these: > They are making do with the amount of money that is available. It would be wiser to focus on why healthcare is so expensive in the United States compared to other highly advanced countries -- France, Germany, Netherlands, Finland, Japan, etc.

Re: Things I've noticed while visiting the ICU

#312

Post by light_hue_1 »

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.

You would not. 5 doctors talking about your case wouldn't help much.

People really don't understand the dire and primitive state of current medicine.

We are in the dark ages. We don't know why most drugs work; we have some notional idea but it's often an after-the-fact fiction that we tell. We don't know what causes the majority of diseases. In many cases we don't have treatments for the underlying problems, we only have treatments for symptoms.

If you want to see House MD, then tell your congresspeople and senators to invest in funding medical research so we can one day maybe leave the dark ages.

Re: Things I've noticed while visiting the ICU

#313

Post by throwaway2037 »

Aeolun wrote: post #285
jillesvangurp wrote: post #240

Earlier quoted context omitted.

I have great respect for what people like you do. I've lived all over Europe and a have some first hand experience with care in different countries. Universally, nurses are heroes and it's just a very hard and often thankless job. Not to mention under paid in many places. But there's a big difference in what I would label as institutional stupidity between different countries. Some countries feature a lot of mismanag…

The only bad thing about Dutch healthcare is that, if you are not acutely in need, it can take months to get a spot.

I have heard similar complaints about UK and Canada. From a cost perspective, it makes sense to me. I also wonder: If you make people wait months, how many people skip/cancel the appointment? Probably many.

I have lived in two countries with very unfair healthcare systems. High income people get "health insurance" (whatever that term really means!) from their employer. They use it a LOT. Way too much. And their "health insurance" covers most of the cost. The number of times that I have seen high income people see a medical doctor for a runny nose (light head cold) stuns me. What an incredible waste of medical resources! As someone fortunate enough to have this "health insurance" at various times in my life, I am constantly saying "no" when doctors try to over-prescribe all manner of medicines. Obviously, they know my insurance will pay 100%!

The #1 duty of a public healthcare system absolutely must be "acute need". Everything else is second priority, else they go bankrupt. It's rough. I don't know a better solution.

Crazy idea: What if there was a kind of public auction system where people in the queue could set a price to sell their position? As long as it was fair and transparent, I might be OK with it.

Re: Things I've noticed while visiting the ICU

#314

Post by throwaway2037 »

etrautmann wrote: post #184
Ensorceled wrote: post #111

I noticed a lot of the same things when my dad was in the ICU. Some additional thoughts: 1. "Almost every patient has delusions and nightmares" I personally felt "off" when visiting my father. The sounds, smells, lights and constant buzz of activity all contributed to a feeling of being in a surreal dreamworld. Lack of sleep contributes. I can't imagine what my father experiencing. 2. Food was HORRIBLE. One meal was…

Yes - my wife is a physician and she routinely describes how well meaning family members make care harder for their loved ones by trying too hard in the wrong ways. Requesting more care doesn’t get you better care - “squeaky wheel gets the grease” doesn’t really apply in many situations.

I have heard an equal number of stories that are exactly opposite. Only through aggressive, pushy "squeaky wheel" behaviour was someone able to get the correct care.

Re: Things I've noticed while visiting the ICU

#315

Post by froggertoaster »

tomcam wrote: post #250
kingsloi wrote: post #95

Interesting take. I was in a paediatric cardiac ICU when my daughter battled with heart disease for 7 of her 8 month life. Another dad who we got close to in the ICU said the phrase "practising medicine says it all...". My experience is same same but different. It was during COVID, so we welcomed the nurse change, sad/happy to see one go and welcome another. Paediatric ICUs and their staff, I'd say are top tier in mo…

Cried a little reading that. What agony, losing a child in slow motion. My best to you and yours.

> What agony, losing a child in slow motion.

These words are both poetic and heart-wrenching.

Re: Things I've noticed while visiting the ICU

#316

Post by throwaway2037 »

duffpkg wrote: post #124

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…

I am going to repeat myself here.

Quick Google search for "icu beds per capita" finds: https://www.oecd.org/coronavirus/en/data-insights/intensive-...

US: 25.8 / 100K population

Germany: 33.9 / 100K

Re: Things I've noticed while visiting the ICU

#317

Post by froggertoaster »

theNJR wrote: post #57

My wife just gave birth and it was my first multi-night hospital stay. The midnight pokes and checks were infuriating. It also doesn’t help that dads aren’t the patient after a birth, so they aren’t fed or given a bed. Constant nurse changes were difficult too. On the plus side, I was surprised at the decent quality of food given to my wife. Steamed vegetables and mid grade proteins with every meal. After two nights…

Father of four here, had one two months ago.

> It also doesn’t help that dads aren’t the patient after a birth, so they aren’t fed or given a bed.

Yes, and? You're free to go to the cafeteria and buy food or leave and go buy food. And there's usually at least a chair. What do you expect, a Marriott?

Re: Things I've noticed while visiting the ICU

#318

Post by throwaway2037 »

haldujai wrote: post #234
_uvv0 wrote: post #204

Earlier quoted context omitted.

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…

It’s probably because we don’t have enough ICU (or step down beds) in Canadian hospitals than the fear of litigation in the US. Canada’s capacity is amongst the least in G20 nations. 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 u…

I am going to repeat myself here. You wrote: >

Not even close.

Quick Google search for "icu beds per capita" finds: https://www.oecd.org/coronavirus/en/data-insights/intensive-...

Canada: 12.9 / 100K population (slightly higher than OECD average)

For the record, it is usually better to quote "OECD" than "G20". G20 just means total GDP is large, but GDP per capita can be very low, like India, Indonesia, and China. OECD is always (democratic and) high-income -- high GDP per capita. For example: Nederlands, Norway, and Switzerland are all OECD, but none G20. All are very high income and high human development.

Re: Things I've noticed while visiting the ICU

#319

Post by throwaway2037 »

incone123 wrote: post #268
conductr wrote: post #236

Earlier quoted context omitted.

This is a practical reality of the "we keep old people alive too long" category.

I'm not old but I have an Advance Directive on my file that essentially says if I'm fucked then they should let me go. (And I'm in the UK where treatment is free at point of use).

Wow, this is a great post. I never knew about this NHS programme. I wish I had the same where I live.

https://www.nhs.uk/conditions/end-of-life-care/advance-decis...

https://www.nhs.uk/conditions/end-of-life-care/advance-state...

At the risk of sharing some PII, are you willing to share some of the conditions that you set?

Re: Things I've noticed while visiting the ICU

#320

Post by throwaway2037 »

hef19898 wrote: post #275
fedeb95 wrote: post #272

Earlier quoted context omitted.

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.

Related, interesting anecdote: I was recently talking to a co-worker. We are both "third-country", so we can compare and contrast our current healthcare system versus "home". My co-worker made an interesting point: In their home country, patients are much more involved in their care, and doctors are willing to engage with well-prepared, intelligent patients. As a point of comparison: Our current country, not at all.

My point of this anecdote vis-a-vis high-agency healthcare systems: I like when I can ask questions to a doctor about their diagnosis and proposed treatment. Yes, I understand they are busy and there is a reasonable limit. I am equally annoyed when this is viewed (in the extreme) as an assault on their authority!

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