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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

#11

Post by wellareyousure »

questime wrote: post #5

It's politically toxic to discuss but a ton of money goes to keeping people not dead (not really alive either). You could give a lot more people medicare/medicaid if we let a 90 yr old with dementia/diatebetes/etc. pass with dignity.

Yes, certainly people in medicine are aware.

> we let a 90 yr old with dementia/diatebetes/etc. pass with dignity.

Often it's a 4 week old baby.

For every 1 sophisticated family member, there are 19 unsophisticated ones, who toss a weighted coin and, if it's heads, they decide they want their dying, non-responsive relative - possibly their baby, possibly their mom, etc. - to be kept alive at all costs. I don't know if this is politically toxic as much as it is cultural, and possibly globally cultural.

Re: Things I've noticed while visiting the ICU

#12

Post by bombcar »

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.

Re: Things I've noticed while visiting the ICU

#13

Post by maxerickson »

The solution to difficulty booking doctors isn't to pontificate on how to allocate their time, the solution to difficulty booking doctors is to make more doctors.

There's lots of levers that could be pulled in the US. Cut down on undergraduate requirements, incentivize large health systems to fund more training (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).

Medical care suffers under the bizarre idea that central planning and capacity management will control costs. Meanwhile, costs are spiraling up and up and up. Train more doctors and all the stupid games being played to optimize their utilization start to go away, because it is less worth it when demand is less than supply.

Re: Things I've noticed while visiting the ICU

#14

Post by MBCook »

voz_ wrote: post #8
questime wrote: post #5

It's politically toxic to discuss but a ton of money goes to keeping people not dead (not really alive either). You could give a lot more people medicare/medicaid if we let a 90 yr old with dementia/diatebetes/etc. pass with dignity.

I don't think its politically toxic, but rather, extremely humane that we care for our elderly. The real unfortunate part is that we, in the working class, have to make due with sharing slices of the pie so more money can go to our exploiters and owners - especially in the US, we are such a wealthy nation, and yet here we are bickering around who deserves care based on age. Sad.

> I don't think its politically toxic

Ever hear of the Obamacare death panels? The ones where doctors would decide if your loved one was too old and shouldn’t get treatment?

Yeah. That’s this.

What it really was that Medicare would pay for consultation with doctors (?) to discuss end of life care and setup living wills and DNRs and such if the person wanted.

That way if something happened and they were taken to the hospital they could be treated the way they wanted to be and not stuck in a coma on a vent for the rest of their life if that was against their wishes.

But the Republicans branded then “death panels” (which for political purposes was brilliant). So the choice of having help making those decisions was removed.

Re: Things I've noticed while visiting the ICU

#15

Post by Fatnino »

georgeg23 wrote: post #9

The hallucinations sound like a side effect from lorazepam (Ativan) -- something hospitals give almost everyone but is a hardcore drug. Consider asking nurses to stop administering it after you do your own research. https://www.webmd.com/drugs/2/drug-6685/ativan-oral/details#... ).

I went to the hospital for debilitating shoulder pain.

Came out 3 hours later with an xray that showed nothing wrong and a bottle of Ativan. Still no idea why they gave that to me. I didn't take any of the pills.

And the bill came out to over 7 thousand dollars.

Re: Things I've noticed while visiting the ICU

#16

Post by questime »

voz_ wrote: post #8
questime wrote: post #5

It's politically toxic to discuss but a ton of money goes to keeping people not dead (not really alive either). You could give a lot more people medicare/medicaid if we let a 90 yr old with dementia/diatebetes/etc. pass with dignity.

I don't think its politically toxic, but rather, extremely humane that we care for our elderly. The real unfortunate part is that we, in the working class, have to make due with sharing slices of the pie so more money can go to our exploiters and owners - especially in the US, we are such a wealthy nation, and yet here we are bickering around who deserves care based on age. Sad.

I disagree, spending on these things is growing at 2x GDP growth so yes more of the pie is going to this. What I'm suggesting is that at some point the pie isn't big enough for this. No matter what happens eventually standard of care will roll back/fewer people will be covered etc. Ideally we can innovate out of this situation but after spending 8 years working in healthcare I've gotten cynical about it.

Re: Things I've noticed while visiting the ICU

#17

Post by Mezzie »

anjc wrote: post #4

> the next time you have trouble booking a surgeon or even a gastroenterologist, you can remember that America’s supply of surgeons and gastroenterologists is being disproportionately used by the AARP crowd. What a horrible sentiment.

What's terrible about it?

I'm a younger (34) person with substantial healthcare needs (I have MS). Everything is always oriented towards the old, and I also pay taxes that are used to support them while getting nothing in return despite having similar needs.

Re: Things I've noticed while visiting the ICU

#18

Post by cliquecover »

anjc wrote: post #4

> the next time you have trouble booking a surgeon or even a gastroenterologist, you can remember that America’s supply of surgeons and gastroenterologists is being disproportionately used by the AARP crowd. What a horrible sentiment.

It's horrible but true. How do you budget for and prioritize access to scarce resources?

Re: Things I've noticed while visiting the ICU

#19

Post by virgildotcodes »

questime wrote: post #7
anjc wrote: post #4

> the next time you have trouble booking a surgeon or even a gastroenterologist, you can remember that America’s supply of surgeons and gastroenterologists is being disproportionately used by the AARP crowd. What a horrible sentiment.

Because of demographics this is a problem we will have to confront regardless - do you think medicare/medicaid spending will become 80% of government spending?

Maybe with higher taxes and a reallocation of defense spending we’d be able to sustain a more humane society for longer.

Is it indefinitely sustainable? Not sure. I don’t know if it’s as easy as just extrapolating from recent trends because there may be countless unknowns from biomedical advances to climate destabilized societies to being turned into biological batteries for our machine overlords in the next few centuries.

Re: Things I've noticed while visiting the ICU

#20

Post by z3rgl1ng »

questime wrote: post #5

It's politically toxic to discuss but a ton of money goes to keeping people not dead (not really alive either). You could give a lot more people medicare/medicaid if we let a 90 yr old with dementia/diatebetes/etc. pass with dignity.

This is an oft-repeated piece of received wisdom that is empirically untrue.

https://www.statnews.com/2018/06/28/end-of-life-health-spend...

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