TIL Ishikawa fishbone root cause analysis
https://en.wikipedia.org/wiki/Ishikawa_diagram
Of course I've seen them before but was struck by the interesting name.
Why do patients leave against medical advice?
11–20 of 85 posts
Re: Why do patients leave against medical advice?
#12I left AMA once because I was fine but the hospital wanted my perfect insurance in Yuma, Arizona where most of the patients are uninsured immigrants. I understand that they need to money to survive but three weeks was just outrageous.
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It clearly did happen so those people are obviously wrong.
Re: Why do patients leave against medical advice?
#13people want to be back in their own homes. i was in hospital a year ago (nhs, fractured ankle) and the guys in the whole ward i was on were literally desperate to get out of the place (which wasn't horrible, and i think the nhs is brilliant). it took me probably an extra week to get discharged that it needn't have done. but there is a lot of arse-covering going on.
Re: Why do patients leave against medical advice?
#14I left on day 4 of 6 combatting a MRSA infection. I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd. Turns out I was right in my estimations that the course of IV would suffice and also that the remaining days would not be covered. I feel like I 'survived' the hospital system, not MRSA.
As a physician probably my single most feared infection is a MRSA (or any Staph.) bloodstream infection. It’s a sticky bacterium that likes to destroy heart valves and joints. I’m personally a bit of a medical nihilist but antibiotics often work to treat it and I would not be eager to do the n=1 trial of the shortest effective duration.
Re: Why do patients leave against medical advice?
#15I left AMA once because I was fine but the hospital wanted my perfect insurance in Yuma, Arizona where most of the patients are uninsured immigrants. I understand that they need to money to survive but three weeks was just outrageous.
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Re: Why do patients leave against medical advice?
#16I left on day 4 of 6 combatting a MRSA infection. I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd. Turns out I was right in my estimations that the course of IV would suffice and also that the remaining days would not be covered. I feel like I 'survived' the hospital system, not MRSA.
Couldn’t you have enrolled in a plan that would have covered your treatment after the fact? I think you have 30 days to do so after losing coverage. I agree that the current system in the US is insane, but what was your plan originally for when you lost coverage?
GP could be referring to treatment being covered under the prior year deductible or max out of pocket.
I have a friend who was hospitalized on December 30th and released on January 2nd. And that's how they hit their max out of pocket two times over the course of 4 days.
It's an awful edge case. If they'd gotten terrible vertigo a couple days earlier or later, it would have cost them half as much.
Re: Why do patients leave against medical advice?
#17I left on day 4 of 6 combatting a MRSA infection. I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd. Turns out I was right in my estimations that the course of IV would suffice and also that the remaining days would not be covered. I feel like I 'survived' the hospital system, not MRSA.
> I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd. For future reference, asking the hospital what your insurance covers will always result in a "we don't know" answer because they don't speak for your insurance. They can't risk saying "yes" when they aren't the ones deciding. In these cases, call the insurance company. The reps deal wit…
This is good advice, but I can just feel the egregious hold times, insufferable IVR (our choices have changed!), and explaining the same thing to 5 different people until you get an answer that winds up being incorrect but good luck proving that in Small Claims because smartphones are very good at preventing you from recording conversations for your own records.
I understand the reasons why we structure our world using adversarial systems but geez, sometimes it really shows.
Re: Why do patients leave against medical advice?
#18I left on day 4 of 6 combatting a MRSA infection. I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd. Turns out I was right in my estimations that the course of IV would suffice and also that the remaining days would not be covered. I feel like I 'survived' the hospital system, not MRSA.
> I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd. For future reference, asking the hospital what your insurance covers will always result in a "we don't know" answer because they don't speak for your insurance. They can't risk saying "yes" when they aren't the ones deciding. In these cases, call the insurance company. The reps deal wit…
Yes, but the point is that it's insane that your advice is the correct advice. There should be borderline zero "barrier to entry" for knowing what monetary burden you are about to submit to, especially considering the state you are probably in, and the time-sensitive nature of health issues.
Re: Why do patients leave against medical advice?
#19Earlier quoted context omitted.
Couldn’t you have enrolled in a plan that would have covered your treatment after the fact? I think you have 30 days to do so after losing coverage. I agree that the current system in the US is insane, but what was your plan originally for when you lost coverage?
GP could be referring to treatment being covered under the prior year deductible or max out of pocket. I have a friend who was hospitalized on December 30th and released on January 2nd. And that's how they hit their max out of pocket two times over the course of 4 days. It's an awful edge case. If they'd gotten terrible vertigo a couple days earlier or later, it would have cost them half as much.
doing this on an annual basis is such an obviously inefficient system (on both sides) that you'd think somebody would've developed a basic mathematical approach by now to disrupt the market.
but of course in practice, most US healthcare consumers don't really have an actual choice about who they buy their healthcare from.
Re: Why do patients leave against medical advice?
#20people want to be back in their own homes. i was in hospital a year ago (nhs, fractured ankle) and the guys in the whole ward i was on were literally desperate to get out of the place (which wasn't horrible, and i think the nhs is brilliant). it took me probably an extra week to get discharged that it needn't have done. but there is a lot of arse-covering going on.
> people want to be back in their own homes
Seriously why are "bad food" and "noisy nurses" not on the list of reasons? People want to eat and sleep and if they feel like their acute medical problem is manageable I can see why they'd want to leave.