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How Doctors Die (2011)

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Re: How Doctors Die (2011)

#31

Post by meaty »

elemeno wrote: post #6
afterburner wrote: post #5

"someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right)" Is that always necessarily true...?

Not always, but very often. Guidelines in the US and Europe recommend compressions which are four or five cm deep, and that's a pretty significant percentage of the distance from your sternum to your back. Remember of course that one of the things that your rib cage is supposed to protect against is blows to your heart and lungs, so it shouldn't be too much of a surprise that a procedure that is supposed to compress…

Yes this happened to my father. I remember the crunching sound of his ribs to this day. This was at waterloo station in London in 1993. He just keeled over. Fortunately for him, someone had just got stabbed 100 yards away so people were already on hand. The paramedic didn't even blink. Everyone else shit a brick.

He survived though and after a bypass op is fine to this day.

Re: How Doctors Die (2011)

#32

Post by elemeno »

meaty wrote: post #31
elemeno wrote: post #6

Earlier quoted context omitted.

Not always, but very often. Guidelines in the US and Europe recommend compressions which are four or five cm deep, and that's a pretty significant percentage of the distance from your sternum to your back. Remember of course that one of the things that your rib cage is supposed to protect against is blows to your heart and lungs, so it shouldn't be too much of a surprise that a procedure that is supposed to compress…

Yes this happened to my father. I remember the crunching sound of his ribs to this day. This was at waterloo station in London in 1993. He just keeled over. Fortunately for him, someone had just got stabbed 100 yards away so people were already on hand. The paramedic didn't even blink. Everyone else shit a brick. He survived though and after a bypass op is fine to this day.

It probably helped as well that St Thomas's is literally within a few hundred yards of Waterloo Station.

The speed with which you can be in specialist care is absolutely critical when it comes to cardiac problems - which is a large part of the reason why survival rates are far higher in places like Central London where you've got both fast response time for paramedics (for London as a whole, ~75% of 'immediately life-threatening' calls have a response time of under eight minutes) and multiple world class Hospitals with specialist cardiac centres.

Even so, that's one hell of a lucky break your father had and fantastic that he both survived and is fine still!

Re: How Doctors Die (2011)

#33

Post by akiselev »

bstewartny wrote: post #30

I dont know. Its one thing when you are 65 and all your kids are grown up. Its a whole other thing when you are 50 and have young children at home. I have a friend with 4 young kids. He has stage 4 cancer requiring constant chemo and pain, but he is going to fight it with everything they have in order to be there as long as possible with his kids - and maybe beat it.

Even that issue isn't that simple. There is no right answer to the debate between being there as long as you can for them and not wanting to have them experience their parents withering away and dying, entirely helpless. I have been fortunate not to be in this position but I can't imagine the latter being very healthy for the children. It's up to every parent and family to decide this in their own way.

I've known two people in the medical field in this position, late stage cancer with young children at home. Both chose to fight with drug cocktails and experimental treatments (such as sipuleucel-T when it was in trials) but stopped short of life debilitating treatments like chemo, although one was lucky enough to get laser based irradiation therapy (I forgot the technical term, but it uses an accelerator to irradiate a tumor without harming surrounding tissue as much as chemo: http://www.protons.com/protons/index.page). I never asked but I'm guessing that they've seen all too often what the family goes through with a loved one dying from terminal cancer and don't think it's worth the pain or suffering, for the family or for them.

Re: How Doctors Die (2011)

#34

Post by javert »

drcube wrote: post #16
javert wrote: post #7

As a 26 year old American, my experiences with the US hospital system have been so abysmal that I would consider not even seeking treatment for many serious conditions unless I knew the solution would be straightforward. Abysmal in terms of having good medical outcomes, and being treated respectfully by hospital staff (who tend to be extremely overworked). Plus, it's degrading to have no control over how much you wil…

I agree, and it's not just end of life treatment. I often tell people, half joking but half serious, that I would rather die than go to the hospital. Even the simplest visit is an excruciatingly long, bureaucratic, kafkaesque nightmare where your bank account is drained, and the patient has little if any input or control over how they're treated. Hospitals just suck.

A "kafkaesque nightmare" perfectly describes my thinking.

Re: How Doctors Die (2011)

#35

Post by Someone »

nialo wrote: post #20
robbiep wrote: post #19

Earlier quoted context omitted.

You can make your wishes explicitly known, it's called 'advanced directives' however most people either don't know about this or don't want to have to think about it because it involves facing their own mortality. IF you really don't want CPR, or heroic measures to be taken on you, then get a DO NOT RECUSSITATE' or DNR tattoo on your chest or side, where the defib pads go (just in case) and carry around a copy of you…

The previous HN thread claimed that it's better to have a bracelet or necklace or similar than a tattoo, and in particular that tattoos may not actually be followed as consistently as bracelets etc. I'm not interested in the debate as to why this is, just trying to inform people.

For those wondering: https://news.ycombinator.com/item?id=3313928? Main reasons are:

- a tattoo may be a strong indication that, some time ago, you had an opinion, but it isn't any kind of indication that you still are of that opinion (including a timestamp in your tattoo is an option, but impractical). A signed statement in a bracelet, on the other hand, can be updated regularly, and even if it is not updated, the fact that you still are wearing it can be seen as confirmation that your opinion hasn't changed.

- regulations.

Re: How Doctors Die (2011)

#36

Post by javert »

purplelobster wrote: post #15
javert wrote: post #7

As a 26 year old American, my experiences with the US hospital system have been so abysmal that I would consider not even seeking treatment for many serious conditions unless I knew the solution would be straightforward. Abysmal in terms of having good medical outcomes, and being treated respectfully by hospital staff (who tend to be extremely overworked). Plus, it's degrading to have no control over how much you wil…

I wonder how much stress over money affects the health of patients. It's just the last thing you want to worry about when your body is failing. I also think the system puts too much stress on relatives and the patient when it comes to choices and bureaucracy. Coming from Sweden, just having to choose between 7-8 different insurance plans is headache enough, but to have to choose your doctor, your hospital etc is just…

making choices all the time for everything is very taxing and energy consuming, and at some point I just want to be taken care of

That seems shockingly lazy to me, and possibly dangerous.

Re: How Doctors Die (2011)

#37

Post by philwelch »

goodcanadian wrote: post #28
philwelch wrote: post #21

Earlier quoted context omitted.

What happens in Sweden? Does the state assign a doctor to you? What happens if you don't like that doctor and want a different one? I wouldn't want to do away with the freedom of choice, convenient as it may be to have a default. Besides, once you've chosen all those things you can just stick with them for years on end.

I can't comment on Sweden, but in Canada, you essentially go to any doctor you want. It was in the US, where the insurance company more-or-less assigned a doctor, that I lacked freedom of choice.

That depends on your insurance company, too. In my city it's not a big problem.

Re: How Doctors Die (2011)

#38

Post by javert »

_delirium wrote: post #22
purplelobster wrote: post #15

Earlier quoted context omitted.

I wonder how much stress over money affects the health of patients. It's just the last thing you want to worry about when your body is failing. I also think the system puts too much stress on relatives and the patient when it comes to choices and bureaucracy. Coming from Sweden, just having to choose between 7-8 different insurance plans is headache enough, but to have to choose your doctor, your hospital etc is just…

I'm an American who typically values choice and being able to shop around, but I agree that it ends up creating this sort of unpleasant situation in healthcare. Lots of reasons, but two big ones are: 1) lots of buyers who cannot say no, e.g. someone in an ambulance on a way to a hospital is not in a strong negotiating position; and 2) the insurance model doesn't work that well, because incidents are strongly correlat…

Please realize that the current horrible insurance system is almost entirely a product of government regultory practice.

Re: How Doctors Die (2011)

#39

Post by _delirium »

javert wrote: post #38
_delirium wrote: post #22

Earlier quoted context omitted.

I'm an American who typically values choice and being able to shop around, but I agree that it ends up creating this sort of unpleasant situation in healthcare. Lots of reasons, but two big ones are: 1) lots of buyers who cannot say no, e.g. someone in an ambulance on a way to a hospital is not in a strong negotiating position; and 2) the insurance model doesn't work that well, because incidents are strongly correlat…

Please realize that the current horrible insurance system is almost entirely a product of government regultory practice.

I disagree; government regulatory practice is mainly taking some of the worse edges off the inherently broken model of "healthcare as insurance". I'm thinking particularly of major conditions. I think regular office visits could probably be paid for out of pocket, but the real money is going towards hospitals, and that's also where free-market solutions don't work at all.

In particular, I don't see how an unregulated system would solve the correlation-across-lifetime problems. A friend of mine was born with a congenital heart defect, a "preexisting condition" since birth. In a free market, it actuarially makes little sense to sell him insurance at any kind of affordable rate, because the uncertain event already happened (he lost a particular lottery at birth). And in a really free market, that would apply to many more people, because rational insurance companies would require genetic screening before allowing coverage (which they currently can't), allowing them to uncover all sorts of less obvious genetic lottery losers. Put differently, the random risk being insured is, in large part, entire lifetimes, which the insurance market cannot handle, particularly if you think individuals should have some kind of choice (vs. some kind of setup where parents have to buy their offspring's lifetime health insurance pre-conception).

Risk pooling across a large corporation's employees is sort of a hack to approximate the needed across-population risk pooling, in the absence of a true socialized risk pool. That hack has let he U.S. hobble through much of the post-WW2 era, since a large percentage of Americans had employment-for-life at large companies, but it's poorly suited to a world of freelancers and job-hopping.

Re: How Doctors Die (2011)

#40

Post by purplelobster »

javert wrote: post #36
purplelobster wrote: post #15

Earlier quoted context omitted.

I wonder how much stress over money affects the health of patients. It's just the last thing you want to worry about when your body is failing. I also think the system puts too much stress on relatives and the patient when it comes to choices and bureaucracy. Coming from Sweden, just having to choose between 7-8 different insurance plans is headache enough, but to have to choose your doctor, your hospital etc is just…

making choices all the time for everything is very taxing and energy consuming, and at some point I just want to be taken care of That seems shockingly lazy to me, and possibly dangerous.

Let me clarify that when I'm sick, I just want to be taken care of, I'm not saying that should apply to everything.

On to choices, having many choices do not make people happier, but rather the opposite, there is plenty of research backing this up. Obviously having no ability to choose makes people unhappy as well. I don't think it's laziness realizing and acting on what makes us happy and what doesn't.

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