Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Things I've noticed while visiting the ICU

trevorklee.substack.com

Post reply on HN
Print view View original

281–290 of 387 posts

Re: Things I've noticed while visiting the ICU

#281

Post by Gatsky »

rscho wrote: post #260
Gatsky wrote: post #245

Earlier quoted context omitted.

Curiosity is essential. Eg guy with chest pain and trop rise gets sold by ED as a NSTEMI. But why is the pulse pressure so high? Hang on what is that scar on his back? Oh he had an aortic root repair 20 years ago after a car accident... Ok I’m calling in the radiologist at 2am to do a CT angiogram. Sure enough, his aortic root repair is failing, and he has new onset AR. Curiosity saved that guy’s ass, following the p…

So curiosity as a remedy for systemic failure to perform a full exam and actually do the job correctly in the first place? Not a very convincing argument.

Not really, the clinical signs were subtle, I couldn’t hear the AR. If you had a ‘protocol’ to pick up these edge cases, you would be doing a CT and echo on every chest pain that walks in the door. The workup was perfectly evidenced based and standardised.

I don’t think it is ideal to operate this way though, to be clear. Obviously this could have easily been missed by me or anyone else. But you aren’t arguing that point. You are approaching it from the perspective of minimising the variance in clinical quality. I don’t agree with you that this requires standardising how clinicians are, not just what they do.

Re: Things I've noticed while visiting the ICU

#282

Post by dtgriscom »

hef19898 wrote: post #265

Wow, that first paragraph is as cynical as it gets: " The ICU is filled with old people." It ends with people now knowing why it tales so long to get doctors appointments, and saying the author is not sure whether ir nit this is a good thing, that we (the articlee is about the US but is pretty much the same everywhere) spend so much of our health care resources on the old. While his dad, also not in his twenties, was…

What's cynical about stating the truth? Are you disagreeing with his observations, or just hoping he'd have the good taste to keep them to himself?

Re: Things I've noticed while visiting the ICU

#283

Post by Aeolun »

civilized wrote: post #221
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 wonder if part of the issue is having to remember a bunch of random things about a bunch of different people so that you can apply the information at the relevant time. E.g. the left arm is easier to find a vein, but this information is only useful for 30 seconds a day during a blood draw, so it's hard for people to remember or even retrieve (how much notes do you have to read through to find this info?) If the inf…

Like, google glasses but for ICU workers?

Re: Things I've noticed while visiting the ICU

#284

Post by hef19898 »

dtgriscom wrote: post #282
hef19898 wrote: post #265

Wow, that first paragraph is as cynical as it gets: " The ICU is filled with old people." It ends with people now knowing why it tales so long to get doctors appointments, and saying the author is not sure whether ir nit this is a good thing, that we (the articlee is about the US but is pretty much the same everywhere) spend so much of our health care resources on the old. While his dad, also not in his twenties, was…

What's cynical about stating the truth? Are you disagreeing with his observations, or just hoping he'd have the good taste to keep them to himself?

Saying ICU are overproportionally occupied by the lederly, abd very young also if this a different ICU, is a fact. Continuing to say that is reason "you" have to wait for getting a slot and asking whether or not the observed sotuation is actually hood is cynical.

Re: Things I've noticed while visiting the ICU

#285

Post by Aeolun »

jillesvangurp wrote: post #240
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 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.

Re: Things I've noticed while visiting the ICU

#286

Post by chrismorgan »

rscho wrote: post #278
joenot443 wrote: post #264

Earlier quoted context omitted.

I don’t either but fully agree GP’s assessment, you chose a strange character to use there.

It's the default on my keyboard, and the commonly accepted symbol in my language. Next time, I'll choose something else.

I was not familiar with keyboard layouts including DEGREE SIGN handily, so I though there was at least a decent chance you had deliberately gone fancy. (I double-checked that it was ° and not º U+00BA MASCULINE ORDINAL INDICATOR, which I would expect to see on some keyboards, and “Nº” is incidentally distinctly better than “N°”, since it’s the shape of an o rather than a circle.)

To the best of my knowledge, I have never come across “n°” before. “№” plenty, “#” plenty, “No. ” plenty, “no. ” a few times, but not “n°” with a lowercase n.

Looking through https://en.wikipedia.org/wiki/Numero_sign#Usages>… hmm, French AZERTY? I see now that it does have ° readily accessible.

I think another aspect that made it harder for me to recognise immediately was the lack of a full stop; I’d probably have recognised “n° 1” a bit faster. (I’d write “№ 1” rather than “№1”, though personally I’d go fancy with NARROW NO-BREAK SPACE, but that’s ’cos I enjoy doing crazy things like that.)

P.S. I live in Australia. Similar Anglocentrism to the USA in language, though less pronounced in matters of culture.

Re: Things I've noticed while visiting the ICU

#287

Post by Aeolun »

coding123 wrote: post #74
jmhmd wrote: post #52

Earlier quoted context omitted.

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.

Jeez, no kidding. I imagine if they made a realistic doctor show they'd be constantly showing the doctor at the bar (on days off) trying to make money on side gigs like health startups. Stumbling in a hangover to appointments on "work days" and giving everyone the same diagnosis as the last (and likely whatever sickness they themselves had recently). Also giving everyone fluids and an ativan so the patient says - "i…

I’m half convinced the ER diagnoses everyone with no apparent issues with dehydration so they don’t feel stupid about coming in for no reason.

Re: Things I've noticed while visiting the ICU

#288

Post by Aeolun »

incone123 wrote: post #266
opportune wrote: post #218

Earlier quoted context omitted.

Completely agree. Any educated layperson can figure out and follow a clinical decision tree. I mean it can work in your favor if you know you need something and know how to get the decision tree to give you what you want, but otherwise clinicians should definitely be actual experts and not just meat following something a computer could do

You still have the problem of writing a sufficiently detailed tree. I had a blood test last year and when I discussed the result with the doc, he asked me the clinic location where the blood was taken, because then he could estimate time between blood draw and lab test and interpret the result accordingly.

It’s your blood usually tested immediately? At least my hospital gives me results right away (well, say within 30 minutes).

Re: Things I've noticed while visiting the ICU

#289

Post by Aeolun »

jrgoff wrote: post #238
dimal wrote: post #214

Earlier quoted context omitted.

Maybe you don’t want creativity in the ICU, but as a patient with chronic health issues, I do want creative clinicians. Over and over my entire life, I’ve gone to doctors with health issuesand watched as they mentally plug my symptoms into a flowchart that they learned in medical school, then they find that the symptoms don’t match anything that a standard protocol can treat, then they shrug their shoulders and say t…

Yes, it's so tiresome and frustrating. I once had a period of a few months where my sleep was down to around 5 hours/night (normally I would get 8-9), I was exhausted and my body just wouldn't sleep more than that. Went to a doctor who offered a couple of thoughts "some people only need that much sleep" and "there's only one thing it could be, but that's not what it is". He wasn't even going to test the "one thing" u…

The fact that they’re more open to believing that anything might work cuts both ways :)

Re: Things I've noticed while visiting the ICU

#290

Post by Aeolun »

Gatsky wrote: post #245
rscho wrote: post #88

Earlier quoted context omitted.

I'm sorry but curiosity and creativity are certainly the n°1 enemy of the patient, especially in ICU settings. Curiosity and creativity are grandpa's medicine, and a total antithesis to evidence-based modern medicine, that attempts (and largely fails) to be an application of science instead of the whims of the decision-makers. What you should want is curious and creative _researchers_, but precise and totally unimagi…

Curiosity is essential. Eg guy with chest pain and trop rise gets sold by ED as a NSTEMI. But why is the pulse pressure so high? Hang on what is that scar on his back? Oh he had an aortic root repair 20 years ago after a car accident... Ok I’m calling in the radiologist at 2am to do a CT angiogram. Sure enough, his aortic root repair is failing, and he has new onset AR. Curiosity saved that guy’s ass, following the p…

I guess this is why the hospital asks me to list historical surgeries.
Post reply on HN