-
-
on the other hand theres like semmelweis and thishttps://twitter.com/selentelechia/status/1392157498698715136?s=19 …
Show this thread -
ok a physician has just had a phone call with me laying out a bunch of helpful information i will append it in fifteen after eating a plate of tendies in the mean time my apologies to
@HMBrough_ and the other physicians of twitter for being Too Mad OnlineShow this thread -
ok. central claim: ICUs specifically tend to be awful places to be for a patient, and not only because of sleep deprivation. however, 1. ICUs tend to be places where patients stay for the minimal amount of time possible 2. this is partly because they are terrible to be in, but
Show this thread -
. . . partly because economics have led to a sort of Just In Time approach to ICU beds where they often operate close to capacity and so there's not much leeway to keep people in for longer than needed
Show this thread -
so, the extent to which patients are kept in the ICU is in a sense a min-maxing outcome, and there aren't a lot of dollar bills lying on the ground "we are making you psychotic" yes but imagine the counterfactual where you werent in an ICU which seems reasonable
Show this thread -
the margin on which things might be improved is on identifying specific treatments that require ICU-level badgering/monitoring and determining they don't actually help things eg maybe measuring blood pressure every 60s doesnt generally improve outcomes in some case
Show this thread -
the problem with this is that once a treatment is used in practice it becomes difficult to do research demonstrating that no actually its not helping even tho it seems like it should (IRBs dont like denying people what seems like an important treatment just to see what happens)
Show this thread -
so, this margin for dialing back treatment intensity is pretty inflexible in practice, and not for crazy reasons
Show this thread -
expanding on this general theme to the rest of the hospital, my friend observed that brute economics come into play here too hospitals apparently used to be very comfortable places. you could ask nurses to give you a massage. but economic pressures have degraded this
Show this thread -
insurance companies and government (medicare, VA, whatever) are paying specifically for treatments or perhaps outcomes that are easy to measure typically the consumer (patient) is not
Show this thread -
so you have a sort of multitask problem where "nice experience" is ruthlessly selected against because it is difficult to measure compared to (eg) patient survival, and so not a good goal metric for (eg) public health officials
Show this thread -
anyway much to think about, very interesting problem massive thanks to anonymous doctor who dropped all of this on me, you know who you are king
Show this thread
End of conversation
New conversation -
Loading seems to be taking a while.
Twitter may be over capacity or experiencing a momentary hiccup. Try again or visit Twitter Status for more information.