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 Online
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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
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. . . 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
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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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Replying to @0xkbar
that weirdly is consumer driven it used to be extremely luxe because fares were subject to price controls and airlines had to compete on amenities now they can compete on price too and it turns out consumers care about that a lot
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thats not all of it, there is some sneaky contract theoretical consideration of making things slightly miserable to get some people to pay more for a better situation but i think its the bulk of it
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Replying to @eigenrobot
for airlines apparently one big thing is the rise of travel-search sites which typically order flights by increasing price so if you aren't in the five cheapest, many customers just won't ever see you (regardless of their actual price sensitivity)
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Replying to @ded_ruckus @eigenrobot
this being one reason why airlines started charging fees for first checked bag etc. -- they're moving costs from the headline number into other lines in the spreadsheet, so they can get the headline number down
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