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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
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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
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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)
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so, this margin for dialing back treatment intensity is pretty inflexible in practice, and not for crazy reasons
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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
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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
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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
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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
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I spoke to a healthcare economist who compared hospitals to the airline industry. There’s massive fixed costs and minimal variable costs for additional users. So your goal is to keep the flights/hospitals as full as possible al the time. If you’ve got an extra seat/bed, fill it!
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He also said that urban hospitals are nearly always full and therefore they are all about increasing throughput and reducing patient time in hospital. Conversely, rural hospitals are mostly empty and are always want expand capabilities to draw in more patients more nights bed.
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