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My dad could still be alive, but he's not

jenn.site

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Re: My dad could still be alive, but he's not

#211
post #96
post #28

There's another scenario where someone heads to the hospital and get stuck at a red light or behind and accident or you're speeding and kill someone. It's just hard to know sometimes which path to pick when you don't have a guaranteed outcome on either one. In any case, I'm sorry for your loss. My dad died too due to a heart attack, except he was alone.

This just doesn't seem like it takes probability into account. Getting someone to the hospital fast is almost always going to be better than waiting, and moving someone isn't usually inherently damaging if they don't have a spinal injury. In the context of a heart attack, it seems indisputable to me that it is better to drive if you have a safe and sober driver available.

It isn't all about getting somebody TO the hospital but getting them INTO the hospital/ED/ER. EMS in an ambulance who are alerting a hospital of an MI enroute will get their attention, a walk-in will have to wait unless there are obvious signs.

Calling 911 will normally get LEO on scene that know CPR and can do radio communications. A lot of dispatchers are EMDs (emergency medical dispatchers) that can start helping immediately. You may have off duty EMTs nearby that are scanning the radio. Finding a fixed target it much easier than finding a moving target (white car headed towards hospital), you are on your own if you get stuck in traffic. Statistically, 911/EMS is the best outcome. I agree with another commenter, exceptions do exist.

Re: My dad could still be alive, but he's not

#212
post #70

Earlier quoted context omitted.

Perhaps 2020 hindsight, even.

The 2020, in hindsight was largely correct. COVID was a highly infectious disease, it put a lot of people in the hospital, and a lot of people in the morgue. Social distancing and wearing masks slowed its spread, until an effective, safe vaccine was developed. Horse paste was not a cure for it, and after further investigation it turns out that it only had a positive effect on patients who, in addition to having COVID…

The SF Bay Area response was spot on ... in the beginning.

Then there were aspects that we had pretty quickly figured out made no sense (no hiking by yourself, no leaving to do solitary things). Worse, they were broadly ignored by most people-- I was worried I'd get busted in a parking lot with my telescope when I knew people who were having dinner parties.

Then the very strict orders continued well after the containment was ineffective and the rest of the country had, to some extent, eased up. A couple of weeks to flatten the curve became "wait until there's a vaccine" which is not what we'd all signed up for, and unnecessarily restrictive even for these purposes.

It would have been better to pick a "set point" for policy that could have been actually upheld, rather than setting a very strict policy that was often ignored and then enforced arbitrarily.

Re: My dad could still be alive, but he's not

#213
post #5

>my dad is dead, because his family members were too naive to know that the thing they were instructed to do by the state was a false thing. We're told a lot of things by "officials" not because it's correct, but because it holds the least legal liability for official parties involved, especially anything involving healthcare. These officials also sometimes include doctors, who work to protect themselves and the syst…

> We're told a lot of things by "officials" not because it's correct Often these rules are in place because they are statistically correct. What needs to be understood is that no rule can be so well written that there are no exceptions. Rules are guides. Understanding this we can understand why certain guidelines are created, because they are likely the right response 9/10 times. This is especially important when dea…

This was exactly what I was thinking (though less eruditely) when I was reading the blog post. In this particular case, waiting for the ambulance led to a worse outcome, but I would not be surprised that, statistically, a you're better off waiting for the ambulance than trying to get to the hospital via other means.

But unfortunately:

> if the operator had information about the ETA of the ambulance (we don't know this!) then the correct answer would have been to tell them to not wait. But if the operator had no information, then the correct decision is to say to wait.

I expect the operator just is not allowed to give advice like that, even if they did have information on ambulance ETA. There could be liability if someone is advised to drive to the hospital, and something bad happens. Even if that bad thing would have happened regardless. I think that's a bad reason to do the situation-dependent incorrect thing, but that's unfortunately how the world works sometimes.

Re: My dad could still be alive, but he's not

#214

Earlier quoted context omitted.

This is the laziest, most egregious "WeLl AkShUaLlY!!!" comment I've seen in a little while. Like, really embarrassing. > According to the regulator for Ontario doctors, Jamal initially tried to place all the blame on her innocent research associate, almost ruining her career. She then tried to discredit her colleagues, claiming they had ulterior motives for questioning her results. > When that didn’t work, they foun…

> This is the laziest, most egregious "WeLl AkShUaLlY!!!" comment I've seen in a little while. Like, really embarrassing. And yet I haven't heard how this affects this person's ability to be an endocrinologist. Most of any job is routine busywork—and if ethical purity is the requirement to hold a job that impacts the lives of the public, we may never have a politician (or hospital chief) for the rest of humanity. I a…

> and if ethical purity is the requirement to hold a job that impacts the lives of the public

Yes!

Re: My dad could still be alive, but he's not

#215
post #56

Earlier quoted context omitted.

> There's a need for an app to let patients track the ambulance I don't want to blame anyone, but I'm pretty sure that kind of visibility is not desired.

Not desired by whom? I think transparency is desired by citizens/customers. Do you think there are (good) reasons why obscurity is preferred?

This would be a great way for thieves to determine which house is likely to have just had everyone leave it in a hurry and not likely to return any time soon.

Re: My dad could still be alive, but he's not

#216
Absolute sympathy for the author.

My own story of heavy industrialized medical process goes the other way. My daughter could be dead, but she isn't. At birth, she presented with some abnormalities around her stomach. Not good. We lived in a somewhat remote location where the hospital's capacities were modest. Really not good.

Within 8 or 10 hours of birth, she and I were aboard the smallest plane I've ever been on, with a pilot, and neonatal specialist nurse and respiratory therapist (all had arrived on the plane). Daughter was in an incubator and I couldn't touch her.

Five or six hours later we were in one of the largest children's hospitals in Canada. Another hour or two and a probable diagnosis was sussed out, and a plan made for a surgical exploration / opportunistic fix.

I'm at an age where there are real professionals who register to me as children, and in the pre-op meeting, this is how the anesthesiologist struck me. He was even wearing a Star Wars t-shirt. I didn't mind either the age or the t-shirt, but it was jarring because it situated me somehow as a more responsible participant in the whole situation - a grown-up. Failing to tell him to use the force will proably be the esprit d'escalier that follows to my grave. (I mean, don't turn off the targeting computer, but use the force too.)

Anyway. Another six or seven hours - the worst of my life by far - and finally the good news emerges. Seven years ago now.

There were probably close to 100 people directly involved in providing care to her that day, and I couldn't imagine the number for indirect involvement.

To be honest, all of it was the first experience of gratitude in my life.

---

We are all burned daily by the rough edges of our approximating policies and norms - life's outrageous slings and arrows.

I'd spent a lifetime being too smart and too aloof to be impressed with anything. Suddenly the most important thing to have ever happened to me went sideways, and put me completely at the mercy of the great machine. It really came through for me. It's a good time to be alive.

---

aside: People will have lots of reasonable principled and pragmatic objections to $MEGACORP laundering image via $OUTREACH_EFFORT, but I'll also take the moment to say that Ronald McDonald House is the real deal. Lifesaver. Extraordinary reach to provide a sense of "new-normalcy"

utterly snide and unnecessary dig: The weakest meal (although not bad by any means) that I had at McDonald House came from Microsoft. Hard for a tech company to compete with groups named "3rd Street Grandma's Club" in terms of banger comfort food. Thanks for the pizza, MS.

Re: My dad could still be alive, but he's not

#217
I won't call clickbait on this as it is a personal site and the headline is accurate. I saw another article recently with the same issues.

He is dead from a heart attack. If dispatch, EMS, hospitals, etc. didn't exist doesn't mean he would be alive. They didn't kill him, they failed to save him.

The other article I saw was how the hospital "killed" a drowning victim. Water was never mentioned.

There are many failures in our systems. There will always be exceptions to rules. It is a heart-breaking story but at the same time it is impressive. Maybe the system failed on this call but the fact that their is a system with this many resources is amazing. Hit 3 digits on the phone and LEO, EMS, Fire are all alerted 24/7 us pretty impressive to me.

Re: My dad could still be alive, but he's not

#218

Earlier quoted context omitted.

Her behavior is completely psychopathic. It has to do with the integrity and willingness of someone to tell the truth; if she's willing to destroy evidence to avoid criticism, what other types of mistakes is she willing to cover up when dealing with a patient? This seems pretty obvious, how are you not understanding this? It isn't her effort to produce new knowledge, its her willingness to lie in the face of failure.…

> if she's willing to destroy evidence to avoid criticism, > ts her willingness to lie in the face of failure. This was not presented in the original post. My question was, why is alleged research misconduct a disqualification? Also a panel of this person's peers decided she merited reinstatement. > If a patient of hers dies or starts to decline, she could falsify cause. Not something that is happening in outpatient…

There's plenty of chances for misdiagnosis in outpatient endocrinology. If she misses or delays a thyroid cancer diagnosis, or doesn't follow up with a patient at risk, etc, and then lies to cover it up.

I answered your question clearly: research misconduct and her reasoning for it indicates a willingness to lie that should not be allowed in a high trust field such as medicine. She has been banned from receiving Canadian federal funding for life. Her medical license was reinstated but it was a split vote (3-2) and widely criticized, but she is banned from conducting research and has to be monitored by a therapist.

I get that you like to argue, but you should probably learn to admit when you're wrong.

Re: My dad could still be alive, but he's not

#219
post #44
post #5

>my dad is dead, because his family members were too naive to know that the thing they were instructed to do by the state was a false thing. We're told a lot of things by "officials" not because it's correct, but because it holds the least legal liability for official parties involved, especially anything involving healthcare. These officials also sometimes include doctors, who work to protect themselves and the syst…

Okay, but we're also specifically told to wait for ambulances because they can administer certain forms of care within the vehicle, right?

It kind of depends. EMTs are able to do some things, paramedics are able to do more things, and the hospital itself can do even more things.

I live about 6 minutes from the closest ER. If an ambulance can get to me in, say, 3 minutes, it's still not clear if it's better for me to get myself to the ER on my own. Maybe I get an ambulance with EMTs who aren't trained/authorized to do what needs to be done for me. Maybe I really need to be at the hospital within 8 minutes or I'm going to die, and waiting for an ambulance just isn't going to cut it.

But I think, statistically, people should usually prefer to wait for the ambulance. It's just that specific circumstances can make that the wrong move, but most people won't know when that's the case.

Re: My dad could still be alive, but he's not

#220

It's not moloch. It's all health systems, even ones that are religiously oriented. Triage and logistics and having enough trained people working all hours to handle all cases of life threatening situations... it's a bug in all systems. Nothing is scarier than the moment you realize you're in the hands of the medical establishment. Whatever that looks like, wherever you are. Ever tried to rush a mechanic to fix your c…

> It's not moloch. It's all health systems, even ones that are religiously oriented.

The moloch reference is a shibboleth for the rationalist community. It’s not an actual religious reference. There’s another reference to “updating” further down which is another rationalist term meaning “updating your priors”.

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