[HN Gopher] It's just a virus, the E.R. told him - days later, h...
___________________________________________________________________
It's just a virus, the E.R. told him - days later, he was dead
Author : wallflower
Score : 90 points
Date : 2025-10-06 03:57 UTC (19 hours ago)
(HTM) web link (www.nytimes.com)
(TXT) w3m dump (www.nytimes.com)
| timbritt wrote:
| https://archive.is/MgWJH
| gleenn wrote:
| FTA: "As hard as the job is, diagnostic accuracy in the E.R. is
| high overall. But a recent systematic review of published
| research estimated that 5.7 percent of E.R. patients will have at
| least one diagnostic error and 2 percent have a setback as a
| result."
|
| I feel like scrutinizing the industry for a 2-3% error on an
| obviously difficult problem is exactly why we pay so much in the
| United States for health care.
| adastra22 wrote:
| When the consequences are lethal for that 2-3%, that scrutiny
| is needed.
| jopsen wrote:
| A set back is not necessarily lethal.
|
| We expect so much from our health care providers, and we
| sometimes don't appreciate that they deal with a wide array
| of patients.
|
| Some will come in with a tiny brushing, asking if they are
| going to die. Others will walk around with a critical
| condition for days, saying maybe they were a little sore, but
| they didn't think it was too bad.
| actionfromafar wrote:
| Yes. Less scrutiny, more insurance middlemen please.
| AnthonyMouse wrote:
| It's not quite that one either. The _big_ problem is that
| most people get health insurance through their employer, and
| then it 's the employer choosing it rather than the insured.
| Otherwise people would choose different insurance and in
| particular insurance with lower premiums but higher
| deductibles, and then use the money they saved on premiums to
| pay out of pocket for things that cost less than the
| deductible. And then actually insist on getting a real quote
| and having the ability to compare prices for non-emergency
| medicine.
|
| So the main problem is _employer_ middlemen. Which happens in
| significant part because of tax incentives for employers to
| do that which _you_ can 't get if you do it yourself.
| potato3732842 wrote:
| >tax incentives for employers to do that which you can't
| get if you do it yourself.
|
| Is there any problem today that DOESN'T boil down to the
| government giving preferential treatment to some class or
| group?
| IAmBroom wrote:
| Yes, tons. You choose to focus on the government-aided
| ones.
| AnthonyMouse wrote:
| > I feel like scrutinizing the industry for a 2-3% error on an
| obviously difficult problem is exactly why we pay so much in
| the United States for health care.
|
| If only. Then the outcomes would be better.
|
| The real reason is that it's ostensibly supposed to be a market
| but the pricing for everything is completely opaque and
| shrouded in bureaucracy and corruption.
| sr-latch wrote:
| 2-3% error is too high, this is something we _should_ be
| scrutinizing, and healthcare _should_ be more expensive if the
| reason it's expensive is that we're pouring more resources into
| it to get diminishing returns on reducing mistakes.
|
| Costly healthcare due to scrutiny is not the problem with
| healthcare in the US. The problem is drug monopolies, medical
| (mal)practice without a license by insurance companies, and the
| lack of taxpayer funded healthcare-as-a-right.
|
| We need to create an environment where someone like Terblanche
| feels comfortable advocating for himself without feeling like
| he's being a burden on the ER, and physicians don't feel like
| they're wasting time by investigating seemingly trivial cases.
| Such a situation exists because we are not pouring enough money
| into healthcare in this country.
| hshdhdhehd wrote:
| It feels high to me because most ER cases should be obvious
| i.e. heart attacks, car accidents and strokes etc. So if say
| 10% of cases are non standard then 2% overall is 20% off
| that.
| harvey9 wrote:
| Not only is the case mix much broader than you imagine but
| even the three things you listed all have plenty of nuance
| at the individual case level.
| IAmBroom wrote:
| We don't have an anti-heart attack pill. Medicine hasn't
| developed the post-car-accident protocol. Strokes vary so
| much in type that they can go unrecognized by competent
| doctors for years.
| closewith wrote:
| > 2-3% error is too high, this is something we _should_ be
| scrutinizing, and healthcare _should_ be more expensive if
| the reason it's expensive is that we're pouring more
| resources into it to get diminishing returns on reducing
| mistakes
|
| There will be rapid diminishing returns. It may cost 5x to
| get to 1-2%. Maybe 10x.
| 0xDEAFBEAD wrote:
| An alternative way to throw money at the problem: Instead of
| trying to further improve accuracy, build out space for more ER
| beds, and implement continuous monitoring of marginal patients.
|
| Or, build devices to send home with patients which allow for
| cheap, continuous self-monitoring. That might be a legitimate
| application of AI actually, if you could use e.g. phone camera
| tricks to measure more health parameters. Even if imperfect, it
| could still pick up a few patients who should not have been
| sent home.
| CrossVR wrote:
| This is mentioned in the article, the fundamental problem is
| a capacity problem. If patients could be moved out of the ER
| department to hospital wards then there would be a greater
| ability for the ER department to monitor patients.
| nradov wrote:
| There is a (somewhat artificial) middle ground in US
| hospitals where patients can be admitted for observation
| but still be considered outpatient.
|
| https://doi.org/10.1001/amajethics.2023.901
| gowld wrote:
| This is because beds are artificially expensive because
| hospitals deploy maximum-feature bed equipment and
| services, to avoid malpractice claims, and to increase
| billing.
| ludicrousdispla wrote:
| We pay too much in the US because of the self-imposed medical
| labor shortage and that results in mistakes by over-worked
| staff.
| schnitzelstoat wrote:
| Yeah, it always seems crazy to me that in a country that is
| often so economically liberal and free market, medicine is
| still run like a medieval guild.
| aucisson_masque wrote:
| I thought so but reading the whole article, it seems like there
| has actually been mistakes. Several.
|
| Someone who goes to the hospital 3 times and still die because
| of an untreated disease is not just bad luck.
| throw-qqqqq wrote:
| > I feel like scrutinizing the industry for a 2-3% error on an
| obviously difficult problem is exactly why we pay so much in
| the United States for health care
|
| All research I've read on this topic finds that it is the US
| legal system that causes the crazy prices (incentivizing more
| testing to cover-your-ass and avoid liability etc.)
|
| Many comparative studies on health care cost and quality use
| the US military as a proxy, as it is free on the condition that
| you cannot litigate (very coarsely; it is more nuanced).
|
| The costs for treating US military personel is much closer to
| other countries (while treatment quality remains equal).
| neffy wrote:
| It's not just the legal system. A lot of US Doctors are
| typically paid on a piece rate basis, and the medical records
| systems are extremely fragmented, so there is an incentive to
| order repeat tests (as you get passed around from specialist
| to specialist), and no incentive to put the systems in to
| make that unnecessary.
| red-iron-pine wrote:
| I believe your points, but give me a source.
| nradov wrote:
| That is a factor but a relatively small one. Several US
| states have instituted limits on medical malpractice
| liability and that has had only a small impact on total
| healthcare system costs. It's often the patients themselves
| (or family members) who insist on trying every possible
| diagnostic test, and even with the growth of evidence-based
| medicine we still don't have clear clinical practice
| guidelines covering many of those situations.
| kakacik wrote:
| Part of the reason is - people are not machines, its extremely
| hard to diagnose quite a few situations since every body is a
| bit unique. Add tons of medications and issues every older
| person has, within their own unique bodies. Add symptoms like
| chest or abdominal or head pain which can mean hundreds of
| conditions, some benign some deadly. Add time pressure to
| diagnose quickly since that's how medical systems are set up.
| Wife is a doctor so I can see the perspective from the other
| side too.
|
| I've had a thrombosis formed in my calf after having a broken
| leg and using cast. I also caught covid during that time, and
| from what I've read now I believe it increases temporarily
| clotting of blood for certain people. When cast was removed,
| leg was still stiff as wooden plank and ankle didn't bend. I
| wasn't told to keep the leg higher so I didn't. Some weird mild
| pain started in the middle of the calf after few days, wife
| suggested it may be thrombosis rather than stiff muscles or
| tendons. Went to Switzerland's biggest hospital's ER, got blood
| tests, they were below limit for thrombosis, so I was just sent
| home.
|
| Pain didn't go away, luckily my wife considered it suspicious
| and asked another doctor who is an expert on this to recheck.
| Voila, thrombosis there.
|
| The cause of miss - ER doctors should have done more than just
| a blood test (even by their own ER protocols, checked that with
| wife and her colleagues), echography would have shown blood
| clot in the veins. If it got dislodged and ended up in lungs,
| that's a quick death within cca 20 mins, ambulance & CPR
| usually are not sufficient to keep person alive without major
| brain damage. Or blood clot goes into brain, cutting off some
| part of it with similar result. One peer from back home died
| exactly like that (lung variant, the most deadly one).
| red-iron-pine wrote:
| yeah this be part of it. each aircraft is designed to be
| effectively identical.
|
| yeah yeah there may be some gremlins or bugs in the airframe
| but in theory it should fly and handle just like each other
| aircraft.
|
| each human may be wildly different
| prerok wrote:
| I am happy you were able to solve it. One of my friends had
| exactly this problem, but he just died the next day :(
|
| Sorry to have the need to have shared this, but at least it's
| been on my mind every time I hear someone take their cast off
| and experience something similar.
| UI_at_80x24 wrote:
| That 5.7% number must be wrong. Ask anybody with a chronic
| medical condition.
|
| I've had uncountable number of doctor's visits including ER for
| 37 years before a proper diagnosis was made.
| mouse_ wrote:
| the problem is greed.
| IAmBroom wrote:
| So, your premise is that the US is unique in its lack of
| checklists in the ER?
| lhmiles wrote:
| Would have lived if he had a roommate. Do universities do single
| dorms now
| leptons wrote:
| Doubt it. A roommate has a life outside of that room, they
| aren't likely to be there, or know what to do. There's no
| certainty that a roommate would have been the factor that saved
| his life.
| bell-cot wrote:
| I'd characterize it as "another saving throw". The roommate
| might be absent, or preoccupied with his own life, or
| "staying away from the virus", or too self-doubting to do
| anything in time.
|
| Similar for Sam's girlfriend Kayla. If she'd been assertive
| and physically present, she might have saved his life.
|
| Similar any close friend of Sam's.
|
| Similar a bottom-tier resident staff member in Sam's dorm,
| worried about one of his residents and regularly checking.
|
| (Yes, the U's dorm system "could" officially try to keep an
| eye on sick residents. But with America's legal system, don't
| expect any sane university official to sign off on doing
| that.)
| Macha wrote:
| From the story it sounds like the parents were notified by
| the university one day after he'd last been in touch, so
| someone (be it a roommate or dorm staff) was checking in at
| least daily.
| mnw21cam wrote:
| If you visit the emergency department of a lot of British
| hospitals, there will be large posters reminding the doctors
| "Could it be sepsis?" because of similar instances that occurred
| over here.
| InfiniteLoup wrote:
| > there will be large posters reminding the doctors "Could it
| be sepsis?"
|
| I'm not sure how effective this is. Information presented this
| way quickly fades into background noise..
| gtr wrote:
| The patients can also see the posters, and it won't be
| background noise for them, so they can think of asking about
| it.
| f1shy wrote:
| Oh. There is nothing more contra productive than asking an
| experienced physician "could this not be X". They will
| typically go in "if you think google knows better, ask it
| and fuck off". Ask me how I know. I think that attitude
| even has a name (BTW, I'm guilty! If I say "there is a
| dangling pointer" and the guy starts with another theory, I
| will dismiss him quickly)
| IAmBroom wrote:
| My experience is completely the opposite. It often annoys
| them, but they are forced to address my question, and
| that's my goal.
| gowld wrote:
| Arguing with a doctor can lead to accusations of "drug-
| seeking behavior" (which can cause treatments to be
| refused, and there is some legal pressure behidn this) or
| "mental illness" (which can cause involuntary psychiatric
| hold, effectively kidnapping).
| thaumasiotes wrote:
| https://slatestarcodex.com/2019/09/16/against-against-
| pseudo...
|
| --- (long extract) ---
|
| This paper lists signs of drug-seeking behavior that
| doctors should watch out for, like:
|
| - Aggressively complaining about a need for a drug
|
| - Requesting to have the dose increased
|
| - Asking for specific drugs by name
|
| - Taking a few extra, unauthorised doses on occasion
|
| - Frequently calling the clinic
|
| - Unwilling to consider other drugs or non-drug
| treatments
|
| - Frequent unauthorised dose escalations after being told
| that it is inappropriate
|
| - Consistently disruptive behaviour when arriving at the
| clinic
|
| You might notice that all of these are things people
| might do _if they actually need the drug_. Consider this
| classic case study of pseudoaddiction from Weissman &
| Haddox, summarized by Greene & Chambers:
|
| > The 1989 introduction of pseudoaddiction happened in
| the form a single case report of a 17-year-old man with
| acute leukemia, who was hospitalized with pneumonia and
| chest wall pain. The patient was initially given 5 mg of
| intravenous morphine every 4 to 6 h on an as-needed
| dosing schedule but received additional doses and
| analgesics over time. After a few days, the patient
| started engaging in behaviors that are frequently
| associated with opioid addiction, such as requesting
| medication prior to scheduled dosing, requesting specific
| opioids, and engaging in pain behaviors (e.g., moaning,
| crying, grimacing, and complaining about various aches
| and pains) to elicit drug delivery. The authors argued
| that this was not idiopathic opioid addiction but
| pseudoaddiction, which resulted from medical under-
| treatment [...]
|
| Greene & Chambers present this as some kind of exotic
| novel hypothesis, but _think about this for a second like
| a normal human being_. You have a kid with a very painful
| form of cancer. His doctor guesses at what the right dose
| of painkillers should be. After getting this dose of
| painkillers, the kid continues to "engage in pain
| behaviors ie moaning, crying, grimacing, and complaining
| about various aches and pains", and begs for a higher
| dose of painkillers.
|
| I maintain that the normal human thought process is
| "Since this kid is screaming in pain, looks like I
| guessed wrong about the right amount of painkillers for
| him, I should give him more."
|
| The official medical-system approved thought process,
| which Greene & Chambers are defending in this paper, is
| "Since he is displaying signs of drug-seeking behavior,
| he must be an addict trying to con you into giving him
| his next fix."
|
| ------
| mindslight wrote:
| A good way to ward off the possibility of being accused
| of drug seeking behavior is to maintain your own stash of
| drugs. It always helps to have a good BATNA.
| eYrKEC2 wrote:
| I'm not a doctor, but I am an engineer --- so I am
| _SUPER_ used to being wrong -- my systems don't
| spontaneously heal themselves.
| WalterBright wrote:
| Dammit, Jim, I'm a bricklayer, not a doctor!
| WalterBright wrote:
| I usually preface such suggestions with "according to my
| google medical degree..." which seems to take the heat
| off.
| octo888 wrote:
| They especially love "According to ChatGPT..." these
| days. Make sure not to even make it a question
| octo888 wrote:
| If in the UK, you better have some tact, otherwise it'll go
| down like a lead balloon !
|
| Personally I'd make up a lie: "Oh! What a great idea those
| posters are...I lost my dear brother to sepsis...they told
| us it's so easy to miss..."
| dinobones wrote:
| My wife (then girlfriend) and I were at a concert. She went to
| the bathroom to pee. She came back crying.
|
| I told her she might have a UTI. It was not normal for it to hurt
| that badly to pee. She denied it. I bought her a UTI test, it
| came out positive. She was shaking. I told her we had to go to
| the hospital, she thought they were period cramps.
|
| I call a teledoc. They video chat. She explains the pain shes
| feeling in her lower back means it's likely a UTI, the infection
| has likely reached her kidneys, and we should go to the ER
| immediately.
|
| In the ER we think they're going to just give her some
| antibiotics and send her home. Nope. She throws up. Things go bad
| fast. Her heart rate is 160. She turns a color I've never seen a
| human before.
|
| The next 3 days were so incredibly hard. But I'm so thankful to
| all the medical workers that were attentive to us.
|
| Thankfully she makes a full recovery. For a week or so she was
| lethargic/tired but she's fully healthy now.
|
| A few months before I had read a story about a woman who's
| boyfriend had died from a UTI because they went to a gospital,
| gave him some antibiotics, and he ending up dying at home because
| the infection was already too progressed to fight off at home.
|
| Had the person who evaluated my girlfriend not evaluated
| seriously or just sent her off that could've been her. I'm so
| thankful they admitted her and took her care seriously.
|
| It's scary how quickly a UTI or some other benign infection can
| become sepsis. Take it seriously.
| Shank wrote:
| > Had the person who evaluated my girlfriend not evaluated
| seriously or just sent her off that could've been her. I'm so
| thankful they admitted her and took her care seriously.
|
| This might sound strange, but I think you deserve some credit
| for taking it seriously and being there. It's a documented
| issue that women's problems are frequently written off and
| downplayed as normal things like period pain.
|
| I'm really truly happy to hear that she made a full recovery as
| well. It is wonderful to hear that she is okay.
| InsideOutSanta wrote:
| _> Had the person who evaluated my girlfriend not evaluated
| seriously or just sent her off that could've been her_
|
| Everybody did well in that instance, including you. Many people
| won't advocate for themselves, so having someone around who
| will do it for them is incredibly important.
| arethuza wrote:
| Hamish MacInnes, the Scottish climber, was sectioned in a
| psychiatric hospital because of confusion and delirium caused
| by an undiagnosed UTI. It took 5 years for the infection to be
| diagnosed and treated.
|
| https://en.wikipedia.org/wiki/Hamish_MacInnes
| magicalhippo wrote:
| I recall with my grandmother it was almost 1:1. If she
| started sounding just slightly confused or slightly more
| forgetful than normal, my mom got her tested for UTI. And
| sure enough, in just about all the cases she had it.
|
| However the first time it did indeed take quite a while
| before they figured out she had a UTI, and it took a few
| times before we figured out the pattern.
| robflynn wrote:
| Yes, this is so scary! I know I'm just hopping in here with
| anecdotes but this happened to my friend's mother as well.
| She was seemingly getting dementia, her health got really
| bad, she was tired all the time, couldn't figure out what
| it was for a while. Eventually they figured out UTI,
| treated it, and all the mental stuff went away as well.
| _whiteCaps_ wrote:
| A common practice at my grandma's care home was if the
| women's personalities changed suddenly, get them on
| cranberry juice in case it was a UTI.
| toomuchtodo wrote:
| Well done advocating for her healthcare needs.
| 0xDEAFBEAD wrote:
| >In his effort to understand hospital safety and risk, he learned
| these oft-cited projections: more than 200,000 people will die
| each year from preventable medical errors. He was shocked.
| Conservatively, these estimates amount to at least one fatal
| Boeing 747 crash per week, Terblanche calculated.
|
| This reminds me of the book _The Checklist Manifesto_ by surgeon
| Atul Gawande. The book argues that aviation has achieved such a
| good safety record largely through the use of checklists, and
| Gawande describes his attempts to apply them to the field of
| medicine. Recommended. (Edit: I see that checklists are discussed
| later in the article; I would still recommend the book, as it has
| thoughts on how checklists can be applied more effectively.)
| f1shy wrote:
| Being a pilot I can attest how important checklists are, and I
| do advocate for using them in medicine (have practicing
| relatives, and I have them tired with that).
|
| But maybe you oversimplified the book? (Or the book
| oversimplified how safety was achieved?)
|
| There are some other 100s of reasons why aviation is safe.
| Heck, some of them could also be applied NOW: people must rest!
| I do NOT want to be treated by a doctor doing an idiotic 24hs
| shift, which is the norm in every country I know of...
|
| There is a whole list of things that can be transferred from
| aviation to medicine.
|
| Another point I know of is the "handover" of patients. Just as
| ATC hands over planes from one controller to another, some
| procedure should warrant the correct transfer of information
| between shifts. Oh boy I have hear some funny (and some bot at
| all funny) stories about it.
| rkomorn wrote:
| The long shifts are the most baffling thing to me. AFAIK
| they're also common in law enforcement.
|
| "Hey these people make life or death decisions. You know
| what's going to help? Fatigue."
|
| From the outside, it just seems insane.
| red-iron-pine wrote:
| how much more are you willing to pay? more law enforcement
| = more taxes
|
| more shifts for docs = more $$ paying for more medical
| staff.
|
| I can't speak to the police, but there have been a bunch of
| studies that showed that handoffs between shifts at
| hospitals is where things go bad. Someone doesn't document
| they gave an extra 2 cc of a drug to a patient, and next
| shift gives them more and causes issues, etc.
|
| Basically longer shifts = more fatigue, and the number of
| errors caused by fatigue were still lower than hand-off
| related errors.
| yjftsjthsd-h wrote:
| > more shifts for docs = more $$ paying for more medical
| staff.
|
| I don't follow. It can't be more expensive to pay 2
| doctors for 8 hour shifts than 1 doctor for 16 hours; if
| anything, I'd expect it to be cheaper (no overtime).
|
| > but there have been a bunch of studies that showed that
| handoffs between shifts at hospitals is where things go
| bad. Someone doesn't document they gave an extra 2 cc of
| a drug to a patient, and next shift gives them more and
| causes issues, etc.
|
| Hence pushing for checklists so that doesn't happen?
| bshep wrote:
| The docs dont get paid per hour, they are salaried, so 2
| docs is double the cost of 1 doc.
|
| This is why they are overworked, why pay 2 docs if 1 can
| do the work, the burnout of the doc is irrelevant as
| there are more docs to hire after they burn-out.
| tayo42 wrote:
| Do doctors do extra hours per week? I thought they work
| less days but do this crazy long shifts
| bshep wrote:
| sometimes, but extra hours dont get paid extra, so very
| little incentive to do so. there are many different
| models for compensation but you can think of it as a
| 'fixed salary with optional bonuses'.
|
| EDIT to add:
|
| Most places have a base + bonus structure. You get your
| base salary, and you see patients, for each patient seen
| you generate 'RVUs' which is how your group/practice
| generates income ( by billing insurance companies ). Once
| you generate enough RVUs to cover your base salary, you
| start accumulating 'bonus' and that gets paid out down
| the line using whatever formula your employer uses. There
| is some variation to this but for the most part groups
| follow a similar scheme.
|
| EDIT #2: This is US centric, i dont know how other
| countries do it.
| f1shy wrote:
| Yes I don't get the comments about salary vs hs. You need
| the same amount of people. The question is if you have 3
| people doing 24hs shifts or 3 people doing 3 8hs shift a
| day... has nothing to do with more people/salary/money is
| just organization of work.
| lostapathy wrote:
| Perhaps if we didn't expect superhuman schedules from
| doctors, doctors wouldn't command as much of a cost as
| they do now.
|
| From the doctors I know, it seems like most don't get
| into it for the money, but they put up with it long-term
| because of the money. If we treated them better and
| increased supply, they would almost certainly cost less.
| SoftTalker wrote:
| Doctors aren't paid by the hour.
|
| One doctor is one salary and one package of benefits. Two
| doctors is 2x that.
| waterhouse wrote:
| > Doctors aren't paid by the hour.
|
| Not explicitly, but do you think the salary wouldn't
| change in the medium to long term if the hours changed
| significantly? Of course, in the _short_ term you can
| burn out your doctors by making them work longer.
| dgs_sgd wrote:
| If the supply of doctors wasn't artificially suppressed
| as mentioned by comments above, it's likely that wages
| would go down. Whether that would make things overall
| more or less costly isn't easy to answer.
| jrockway wrote:
| Two people take twice the vacation of one person, have
| twice the healthcare costs, etc. It is almost always
| cheaper to have 1 person work 16 hours than it is to have
| 2 people work 8 hours.
| echelon wrote:
| Not if you count the cost of errors.
|
| Also, just bring in more affordable doctors from
| overseas. Have them take a test to qualify.
|
| US doctor comp is much higher than any of our peer states
| due to industry protectionism. Other industries don't put
| a cap on training and licensing and haven't been so
| distorted.
| lazide wrote:
| Personally, I haven't had a US born doctor in _ages_. In
| most areas it's typically Chinese, Indian, or Vietnamese.
| Nurses it's almost as common too.
| rkomorn wrote:
| I personally have no issues paying more taxes for better
| staffing.
| cogman10 wrote:
| > handoffs between shifts at hospitals is where things go
| bad.
|
| It'd cost more money, but the solution here is
| overlapping shifts.
|
| The reason shift handoffs go bad is it's usually a
| singular information dump right as the next round is
| getting into work mode.
|
| Overlap by an hour, long enough to pair on a round or
| two, and that information is much more likely to get
| remembered.
|
| I've been in hospitals a few times for shift changes and
| there have been a few times I've been the one to inform
| what the last shift was doing simply because it wasn't
| communicated.
|
| We do need more shifts and almost as important we need
| shift overlap.
| unnamed76ri wrote:
| Today's doctor shortage can be traced directly to
| government policy in the early 80s that lasted for 25
| years. They assumed we'd have too many doctors and
| pressured medical schools to reduce enrollment.
| EvanAnderson wrote:
| The lobbying by the AMA may go back to the 80s, but the
| 1997 "Balanced Budget Act" set the limit on residency
| slots.
|
| Nice background: https://www.washingtonexaminer.com/opini
| on/1692395/thanks-to...
| ikiris wrote:
| No, the "limit" is the expectation of free reimbusement
| by the hospitals. This is lobbying for them to get more
| socialized gov handouts.
| didntknowyou wrote:
| this is vastly complex than aviation. it is like 10 pilots
| and co-pilots trying to fly 100 planes and simultaneously
| switching between them. and with everyone overworked due to
| no mandated breaks.
|
| no amount of checklist would prevent mistakes. we need
| legislation to limit medical workload, which is unlikely due
| to the shortages.
| IAmBroom wrote:
| > no amount of checklist would prevent mistakes.
|
| So, don't even try?
|
| Why not both?
| charcircuit wrote:
| Autopilot makes such a scenario safe.
| 0xDEAFBEAD wrote:
| >But maybe you oversimplified the book? (Or the book
| oversimplified how safety was achieved?)
|
| Quite possibly!
|
| >There is a whole list of things that can be transferred from
| aviation to medicine.
|
| Please recommend more books!
| ACCount37 wrote:
| Unfortunately, healthcare is cursed.
|
| The demand is just short of infinite, it requires an
| extremely specialized and highly capable labor force, and it
| has piss poor labor productivity forever.
|
| Which is why the staff is stretched thin, as a rule and not
| as an exception.
|
| Not that there's a shortage of other issues that compound
| that. But even if those issues weren't a thing? The curse is
| far too strong.
| toast0 wrote:
| > The demand is just short of infinite, it requires an
| extremely specialized and highly capable labor force, and
| it has piss poor labor productivity forever.
|
| Just because demand (typically) outstrips supply doesn't
| mean demand is just short of infinite. It just means it's
| hard to measure the demand. This is just like highway
| traffic --- you can't know what the demand is when it's all
| full, you just know there's more demand than
| capacity/supply.
|
| If you built a crap ton more hospitals, and forced everyone
| into mandatory service in healthcare for 20 years, I'm sure
| you'd have more supply than demand. That's a terrible plan,
| but it would solve the supply problem. You could modulate
| the mandatory service period to adjust to the needs, and it
| would still be a terrible plan. :)
|
| Something better would be some steps to address the
| bottlenecks. How can we attract / train a larger labor
| force; how can we retain the labor force; how can we
| increase productivity; something about facilities. Who can
| make the changes and how can they be incentivized to do it.
|
| I'm outside of healthcare, but here are some armchair
| ideas. There's a lot of "administrative busy work" that
| makes everything harder to do; if you ever need to call
| around to multiple pharmacies to get your meds, there's two
| problems there: the first problem is that shouldn't need to
| happen, the second one is that it's amazingly difficult for
| pharmacies to communicate; it's not uncommon for a
| physician to order a test and the wrong test is performed,
| etc ... it's not easy to streamline communications, but it
| would improve productivity if done correctly. There's also
| a lot of things that reduce quality of life of healthcare
| professionals which reduces desire to go into the field and
| reduces time spent in the field. And of course, there's
| limitations on the number of residency spots.
| bshep wrote:
| The pharmacies issue is a constant problem: patient lives
| out of town so prescription is sent to his home pharmacy
| at his request, on the day of discharge he realized his
| pharmacy is closed and wants them sent to a local
| pharmacy, of course this always happens at 5pm when you
| are driving in traffic, the patient is angry because they
| want to leave but there is not much you can do. This
| happens very frequently, doesnt matter if you ask ahead
| of time for the patient to confirm the pharmacy,
| something inevitably happens.
|
| The other issue is peer to peers and prior
| authorizations, these take up a significant amount of
| time and are essentially ways the insurance companies put
| barriers to care and reduce their costs.
|
| I think some of your ideas could work but good luck
| getting anything past the politicians, some of these
| things would be expensive and others would be unpopular
| to those that donate to the politicians.
| in_cahoots wrote:
| For your first example, wouldn't the friction be reduced
| just by telling patients the business hours of the
| pharmacies nearby? I hate how this question is always
| posed, as if I'm supposed to come up with a name and
| address out of a hat. If it's the middle of the night or
| Christmas Eve and I'm trying to get medicine for the
| baby, the provider probably has a better intuition than
| myself as to which pharmacy will actually serve me. If I
| ask explicitly, the provider is usually happy to suggest
| some options. Even a simple web interface listing hours
| of operation would be better than the current method,
| where the patient is expected to pick a pharmacy from
| memory before they even know what medicine they need or
| how long it will be before they are discharged.
| kace91 wrote:
| This setup is crazy, as someone from another country.
|
| Why don't you have a unified system for the pharmacies
| and doctors to tap into?
|
| In my country, if I get a prescription it goes into my
| card. Then any pharmacy can read the card, see what
| prescriptions are yet not used, and provide the product
| (which marks the prescription as covered). Recurring
| products, like allergy medication or chronic illnesses,
| become automatically available again after a certain
| time, like a cooldown. You only need doctor intervention
| during the original diagnosis and prescription, or after
| rare issues (like needing an extra prescription because
| you lost the meds).
|
| I'd have thought this system or a very similar one is
| universal.
| marbro wrote:
| In the United States, the government deliberately creates a
| shortage of medical residencies through a longstanding cap
| on federal funding for graduate medical education,
| primarily administered via Medicare. Residencies represent
| the essential postgraduate training phase that new medical
| school graduates must complete to become licensed
| physicians, yet the vast majority of these positions are
| financed by Medicare payments to teaching hospitals. This
| funding mechanism traces back to the Balanced Budget Act of
| 1997, which Congress passed amid concerns over a perceived
| surplus of physicians at the time. The act froze the number
| of Medicare-supported residency slots at their 1996 levels,
| effectively limiting hospitals to reimbursements for a
| fixed quota of resident positions without adjustments for
| population growth or expanded medical school enrollment. As
| a result, while the number of U.S. medical school graduates
| has surged by over 30% since the late 1990s to meet rising
| healthcare demands, the pool of federally funded residency
| spots has remained largely stagnant, creating a persistent
| bottleneck that prevents thousands of qualified applicants
| from advancing into practice each year.
|
| This cap not only constrains overall physician supply but
| exacerbates shortages in critical areas like primary care
| and rural medicine, as hospitals hesitate to expand
| programs without guaranteed reimbursement. Recent
| legislative efforts, such as the bipartisan Resident
| Physician Shortage Reduction Act, seek to add thousands of
| new slots over several years, but until such reforms pass,
| the 1997 policy continues to throttle the pipeline of
| trained doctors, leaving patients with longer waits and
| uneven access to care.
| ikiris wrote:
| Nothing is stopping the market from paying for this
| themselves. They're just cheap.
| NetMageSCW wrote:
| The market has to get money to pay more. Health insurance
| is already expensive - raising it to ultimately hire more
| care givers doesn't work for most people - do you have
| the most expensive insurance option or the cheapest?
| ACCount37 wrote:
| I'm perfectly willing to believe that US has many, many
| issues that compound the curse - with some low hanging
| fruits among them.
|
| But there are numerous countries that aren't US, and
| don't share US laws.
|
| Do they have medical staff that's not overworked, or a
| healthcare system that doesn't suffer from a constant
| labor shortage, long wait times, poor treatment quality,
| or all of the above?
|
| The root of the issue is deeper than just "US is uniquely
| dumb".
| nradov wrote:
| There has been some improvement in terms of long hospital
| shifts, but there is value in maintaining continuity of care.
| Research has shown that preventable medical errors are
| correlated with the the frequency of handover. Proper
| documentation in the patient chart can help to an extent but
| there's tacit knowledge that comes from directly observing a
| live patient which can't be documented in any codified way.
| So a balance has to be struck in terms of errors due to
| fatigue versus errors due to care discontinuities.
| lostapathy wrote:
| I've been in the hospital more than once for a week at a
| time. At no point did I ever see the same doctor more than
| once in a 24 hour period - from that perspective, it seems
| irrelevant to continuity of care how long their shift was.
| NetMageSCW wrote:
| 14 handovers is a lot less than 21 when it comes to
| opportunity for error.
| CrossVR wrote:
| If you read the complete article it specifically mentions that
| Sam's condition did trigger some checklists, but those
| checklists were willfully ignored in favor of expediency.
|
| The problem isn't that there's not enough checklists, the
| problem is that there's one pilot and he's trying to fly 3
| Boeings at the same time from the air traffic control tower.
|
| > These unreliable warnings can lead to "alert fatigue" and,
| sometimes, a mental habit of discounting them.
|
| This is a problem the airline industry also struggles with and
| even more checklists is not the answer. A lower workload and
| better crew resource management is.
| quantumwoke wrote:
| I think it's more like Sam's condition did not clearly fit
| into a checklistable entity. Our heart rate and temperature
| go up when we have the flu, but we don't all go in to
| hospital for antibiotics or die at home. Probably they should
| have done more work-up the second time he came in but as the
| article points out that could also have been negative. He was
| probably just too young for checklists built for older people
| to pick up on his condition.
| stackskipton wrote:
| Also sounds like he was left alone which does not help
| either. I had similar to Sam, in early sepsis but none of
| markers were there until I went delirious. Wife picked up
| on it right away and that time, ER picked up on it.
| jll29 wrote:
| The Checklist Manifesto: How to Get Things Right by Atul
| Gawande https://www.amazon.com/-/en/Checklist-Manifesto-How-
| Things-R...
| draven wrote:
| > Sam's girlfriend, theorized that in the hospital Sam didn't
| want to be a bother and didn't advocate for himself
|
| I'm like that and it sucks, I now bring my wife to medical
| appointments so she can complain for me while I downplay
| everything.
| dsego wrote:
| If there is anything I've learned in my country (with national
| health care) where it's common for doctors to ignore you and
| say it's nothing, is to be overly pushy and even rude. It could
| be nothing, but a lot of time instincts are correct, and it's a
| mild embarrassment if you are making a fuss over nothing, but
| could be a life or death situation. And you could argue that
| everyone behaving like this is making it worse, and that might
| be right. But I remember multiple national headlines in recent
| years where little kids died of pneumonia after being sent home
| because they ruled out infection, sometimes even after parents
| already brought the kid back for the second or third time to
| the hospital after their condition wasn't improving. I know I'm
| not making chances even if it means getting a second opinion or
| driving to a different town to a different hospital, sometimes
| it's better to take things into your own hands than be
| complacent and rely solely on the medical system doing the
| right thing.
| potato3732842 wrote:
| The "there's someone here who'll still be alive to be deposed
| and/or testify if we fuck up" factor really gets them to be
| serious.
| blargthorwars wrote:
| Especially if the second person peppers their speech with
| correctly used medical terms.
| eYrKEC2 wrote:
| My son almost died in the first 24 hours of life. I said,
| "There's something wrong. There's something wrong." multiple
| times and the nurses finally told me, "YOU NEED TO CHILL OUT."
| I did chill out....
|
| Next morning the pediatrician did his rounds, checked on my
| son, and immediately started speaking Latin, to go over our
| heads while rushing around and getting equipment to clear his
| lungs of amniotic fluid.
|
| Reminds me of what my first engineering boss told me -- "When
| the people on the line say there is a problem. There is a
| problem."
| kameit00 wrote:
| Non paywalled version: https://archive.is/tJePt
| bell-cot wrote:
| Three major problems to note in the story:
|
| - Lack of any low-intensity monitored recovery option. If the kid
| could just have been sent home to a traditional worrying mother,
| who'd been told to watch for certain warning signs - then he very
| likely would have lived.
|
| - Critical shortages of front-line medical staff. (ER nurses
| especially noted here. But a dishonorable mention to the computer
| systems that the residents were fighting against.)
|
| - However short our medical system might be on front-line
| resources to treat patients needing care - once it's lawsuit
| time, resources seem plentiful.
| quantumwoke wrote:
| I don't quite understand your third problem. I also don't think
| the shortage of ER nurses necessarily contributed, as clearly
| the doctors and the friend thought he was well enough to go
| home. Definitely agree with the first problem though. We put
| our kids through a lot of risk by sending them to interstate
| college...
| quantumwoke wrote:
| Heartbreaking story. They talk a lot about the possibility of
| bacterial infection but it was not consistent with the blood
| tests. It seems he just got unlucky (although should have had a
| Chest X-Ray).
|
| Trying to reframe it in a coding analogy, there were a few
| abnormal logs maybe an exception or two but the coder was unable
| to figure it out and these exceptions happen all the time and so
| pushed to live anyway. Due to resource allocation issues they
| were pulled to a different job. Then the site crashed. Just
| awful.
| lotsofpulp wrote:
| This is 99.9% of "news".
| wewewedxfgdf wrote:
| Always get a second opinion from ChatGPT, a third from Claude and
| a fourth from Gemini.
|
| It is astounding how much more you can learn about your diagnosis
| from an LLM.
| ThePowerOfFuet wrote:
| What could possibly go wrong.
| rafaelero wrote:
| Things are already going severely wrong in 1% of the cases.
| At this point not getting a second opinion from an LLM is
| irresponsible, imo.
| blargthorwars wrote:
| This is precisely the thing that LLMs are great for: spicy
| auto-complete.
| CamperBob2 wrote:
| What do you think doctors do all day?
| OutOfHere wrote:
| I have found it very useful to discuss possible diagnoses and
| diagnostic steps with the LLM _before_ going to the ER. Once
| there, I told them what my expectations were along with the
| rationale for it. They agreed with 80% of it.
|
| Ultimately the ER was of no use in treatment, but the
| preparation did help rule out a serious diagnosis.
| adzm wrote:
| In my opinion, this is one of the more overlooked side effects of
| the covid pandemic: stretching resources in hospitals leads to
| lower quality care for everyone.
| codeulike wrote:
| Sepsis is hard to spot. Whats interesting about this article is
| that once you get into the details of whatt happened on the
| patients second visit, its largely about the hospital information
| systems and how they got in the way.
|
| An automated alert popped up warning that the doctors should
| consider Sepsis. That alert essentially then blocked progress,
| and the doctors ended up (essentially) ticking the 'not sepsis'
| box so that they could get on with their (reasonable) next step
| which was either ordering an x-ray or starting antibiotics. Then
| somehow after that, sepsis did not get re-considered.
|
| https://archive.is/tJePt#selection-1465.0-1491.52
|
| _It was Banerjee's task to document Sam's care, and as he began
| to do so, a pop-up appeared on his computer screen. Sam's fever
| and heart rate had triggered an automated warning for sepsis, a
| potentially life-threatening condition in which the immune system
| has a dangerous reaction to an infection. It requires speedy
| intervention. To help the hospital comply with state-mandated
| sepsis regulations, the pop-up provides a checklist of tests and
| orders used to identify and treat sepsis.
|
| Agyare had instructed Banerjee to hydrate Sam right away but to
| wait for the results of Sam's lab work before ordering a chest
| X-ray or the strong antibiotics used to treat sepsis.
|
| But Banerjee, a novice, got stuck. He couldn't figure out how to
| navigate the template to make some but not all of the auto-
| populated orders. "This was my first patient that triggered the
| sepsis pathway," he explained, in testimony. So he asked Connor
| Welsh, a third-year resident, for help.
|
| At 8:50 p.m., Welsh showed Banerjee how. From his own computer,
| he clicked into a field on Sam's chart to assert that sepsis was
| not likely: "Based on my evaluation," the automated note said,
| "this patient does not meet clinical criteria for bacterial
| sepsis." And then Welsh recorded what Banerjee said Agyare had
| said earlier: "Likely viral syndrome. Workup pending." Welsh's
| name appears on the note, but in his deposition he said he never
| interacted with Sam. Senior residents often help junior ones in
| this way, he said. "I signed this note based on the discussion
| with the provider, Dr. Banerjee, based on his evaluation and the
| medical management of Mr. Terblanche," he testified._
|
| ...
|
| _Sam's chart is 51 pages long, a catalog of billing codes and
| abbreviations, check-boxes and shorthand, updates and addenda.
| The record of the second visit contains numerous contradictions:
| Sam's heart rate was documented at 126, yet Banerjee clicked the
| box "normal." In one place it says Sam didn't have a cough, while
| in another it says he did. The signatures of doctors who
| testified they never saw Sam -- including one who was not in the
| hospital that night -- accompany notes. Vital signs were ordered
| and not taken, as was an EKG._
| didntknowyou wrote:
| medical opinion is that sepsis was not the cause of death
| despite the family's insistence.
|
| it is likely a rare condition that the doctors missed. this
| case is sad but being fixated on one diagnosis and building the
| case around that is just trying to pin blame.
| franktankbank wrote:
| Read all the issues with his diagnosis. One way or another
| the staff wasn't doing what the record says they did. How
| could you possibly get to the diagnosis if the tests your
| claim ordered was never done?
| didntknowyou wrote:
| did you read the article? i have a medical background and
| his hematology results does not support sepsis. the family
| pointing blame at the hospital for ignoring the sepsis
| automated warning is barking up the wrong tree and probably
| why the hospital ignored them.
|
| not saying the hospital is faultless because they clearly
| failed in this case but as in any courtroom if you charge a
| criminal with the wrong crime you are bound to lose.
| in_cahoots wrote:
| I think the real implications are much more chilling. As
| much as we like to believe otherwise, there is always a
| chance that a seemingly-healthy college kid will drop
| dead of something that even the best doctor wouldn't have
| anticipated.
|
| And as much as we would like to believe otherwise, the
| modern healthcare system is riddled with problems that no
| technology or checklists will fix. It doesn't take
| someone's death to verify this- just go read your own
| charts and discharge papers. Even for something
| relatively routine there are bound to be inaccuracies.
| Doctors know this, which is why they spend so much time
| doing handoffs and interviewing patients.
|
| We pretend that the medical 'record' is infallible,
| helping to reduce the mental load on doctors while
| protecting them from liability. But as this case shows,
| the 'record' is both inaccurate and not useful in showing
| fault. It's a paper tiger. I'm not saying we should scrap
| the whole system, but I do think it needs to be examined
| in a data-driven manner.
| fluoridation wrote:
| What do you mean? Isn't record-keeping a data-driven
| practice?
| in_cahoots wrote:
| No. I can transcribe every interaction with 100%
| accuracy, but if those notes aren't used in any way it's
| not data-driven. This article shows that the notes are
| inaccurate, suggestions using the notes are routinely
| ignored, and that doctors and legal review think this
| process is acceptable. There is no professional or legal
| liability if the records are wrong. And yet if you talk
| to a medical professional they'll explain that the
| records are to establish a legal paper trail if anything
| goes wrong.
|
| Some executive(s) have been told that detailed medical
| records are the solution to so many problems in modern
| medicine. But they lack either the guts or the expertise
| to make sure that these systems are actually
| accomplishing what they set out to do.
| naijaboiler wrote:
| As a surgeon, one truly humbling fact about humans is we
| are simultaneously incredibly fragile and impossibly
| resilient. You will be shocked at what people can survive
| and what flimsy things kill people
| Bucket0fFire wrote:
| I am an inpatient RN. This conversation is interesting for
| several reasons: laypeople, unless in hospital as a patient
| frequently, will have no idea how the "systems" in a
| hospital intertwine and work together - if we're lucky
| enough to have them do that. (I wish medical professionals
| had the energy to talk more about the minutiae of their
| work just so people better understood.) The "systems" I'm
| talking about are specialties and roles as well as computer
| this and technology that. Ethics taught to administrators
| as well as coders would change a LOT about what we are
| charting - fact is, hospitals are doing more today to cut
| costs and avoid liability than they are doing to put
| patients first. This is obvious just by the fact that they
| keep declaring they are putting patients first. Rule of
| thumb: the more the thing is advertised, the less likely it
| is true despite the understanding that THAT thing is
| extremely important to their target audience. (not to
| mention outcomes and statistics show who is getting good
| care and who is not -lots more to do with finances and
| financial resources than evidence-based practice, seems to
| me.) To the point of this article: While I'm charting, I
| get pop-ups CONSTANTLY. Most are from the software company
| wanting to give me a tour of the programs features while
| I'm literally just trying to find a note written by
| physical therapy, or chart vital signs - I would LOVE to
| have a proficient skill in navigating EPIC but no hospital
| where i've worked has given me training beyond the first
| week. No return to chart training after I've worked with
| their system for a while, later, when I would know what I'm
| looking to improve. Other pop-ups are for sepsis alerts as
| this discussion is about, or (for a RN) fall alerts or skin
| alerts... All the things that are part of my job and
| training to be regularly assessing. Here is my summary:
| What I have seen, for docs and especially for RNs is very
| obviously just micro-managing to insane degrees of
| interference, when what works to achieve the right process
| and best outcome is solid training, retraining,
| accountability by real people and with respect, and
| excellent leadership. I DID once work at a hospital where
| they had enough staff to follow up, answering questions
| staff had (nursing care or software hacks) and -most
| important- leadership that did not intimidate, and that
| could and would talk with the staff member not meeting
| standards, in real time, getting them past whatever hangup
| or misunderstanding gets in the way of excellent practice.
| Follow up and follow up again, with the attitude of
| teaching (versus punitive micro-management by those whose
| priority is the bottom line) and supporting the staff to do
| the right and best thing. Pop-ups and multiple clicks to
| say "ok" and "yes, I really do mean to do this thing" and
| "for real please confirm!" add too many wasted minutes,
| interrupting my thought processes every day day when
| seconds count for someone's life-saving treatment. I don't
| know if there is any other industry outside of medicine and
| nursing where the institution itself literally just adds
| one road block in front of another, keeping us from
| focusing and doing what our critical thinking and training
| have taught us to do. ...don't get me started on Moral
| Distress and Secondary Trauma because of ignorance around
| letting us care. . .
| codeulike wrote:
| OK fair enough, but the detail in the article about the
| hospital information system and 'Note bloat' are still very
| interesting to me. I've seen stories like this before - when
| everything triggers an alert, people start ignoring the
| alerts. (edit: it was this story:
| https://medium.com/backchannel/how-technology-led-a-
| hospital... )
| jll29 wrote:
| It may be that the ER's rapid throughput meant they adhere to
| the heuristic quoted in the article "When you
| hear hoofbeats, think of horses, not zebras." --
| Anon. (saying in medicine)
|
| whereas here, it was the (more rare) zebra, but nobody could
| take the time to do DD (differential diagnosis, i.e. to tease
| apart what can and cannot be the case).
| notmyjob wrote:
| It's usually something rare, almost by definition.
| ryandrake wrote:
| > An automated alert popped up warning that the doctors should
| consider Sepsis. That alert essentially then blocked progress,
| and the doctors ended up (essentially) ticking the 'not sepsis'
| box so that they could get on with their (reasonable) next step
| which was either ordering an x-ray or starting antibiotics.
|
| Man, I feel like I've been trying in vain to fight pop-ups for
| my whole software development career. Now we have an example
| where, at worst a pop-up got someone killed, and at best it was
| part of the chain of events that got someone killed. I don't
| know what it is that draws product designers to keep reaching
| for that horrible UX pattern, but it's got to be stopped.
| _Nobody reads these things_ so a popup is the worst place to
| put important information that the user needs to read!
|
| I think a lot of pop-up usage comes from company lawyers trying
| to cover butts: "Well, regulation says that users need to be
| informed of XYZ, so just stick a pop-up there. Then we can tell
| the regulator 'Hey at least we did our part to inform the
| user.'"
| bcrl wrote:
| This is why I think that we're getting to the point where
| software developers need to be trained in ethics and licensed
| in the same way as professional engineers are around the
| world. The people building the tools need to be held
| accountable when design choices kill people.
| WalterBright wrote:
| Doesn't the FDA already regulate medical software?
| nradov wrote:
| To an extent, but only if the software meets the criteria
| for being legally classified as a "medical device". And
| at the lower classification levels the regulations are
| very light. You don't necessarily have to prove any level
| of reliability or usability.
|
| https://www.fda.gov/medical-devices/classify-your-
| medical-de...
| Neywiny wrote:
| Ex employee of the division of imagine devices and
| software reliability here. I have nothing to add, and I'm
| not qualified to confirm or deny your comment. Just
| interesting to see a mention of my past life
| codeulike wrote:
| But thats part of the problem, as well as part of the
| solution. The FDA regulations say the software must do
| this and must do that, and you end up with thousands of
| pop up alerts. I think the regulations are well meaning
| but they way they translate into software is not
| realistic. In the article an FDA-regulated pop-up is part
| of the story.
| Zak wrote:
| Most software development is not much like engineering.
| That's probably the right choice for low-stakes consumer
| products, but wouldn't be accepted in avionics and
| shouldn't be accepted in medical software that impacts life
| safety.
| bcrl wrote:
| Ethics is applicable to many situations outside of life
| critical systems. Engineers take ethics very seriously
| because it is important, and I think it is important for
| software developers as well. The first time I worked
| closely with a Professional Engineer on a project, it was
| eye opening as to how the concern of doing things the
| ethical way shaped the interaction... Everything from
| identifying potential business conflicts to ensuring data
| collection for inputs to the design process was done
| correctly and traceable.
|
| Corporations already push enough random HR requirements
| on tech employees. I can't see how having a semester or 2
| of ethics courses is particularly onerous.
| Zak wrote:
| I think including ethics in the curriculum at both the
| high school and university level is a great idea. I do
| not like requiring software developers to be licensed is
| a good idea at all.
|
| Safety-critical software projects should have a licensed
| engineer in a supervisory role.
| GenerWork wrote:
| As a product designer, I can think of 2 reasons why the
| person that came up with this flow might've made it a popup:
|
| 1) That's the default design system pattern for alerts, so
| whoever was the designer just went with it.
|
| 2) There's other alert patterns (alert bar, toast, etc), but
| sepsis was deemed to be so dangerous to the patient that it
| deserved to have its own special friction inducing UI element
| to alert doctors to take action.
|
| >I don't know what it is that draws product designers to keep
| reaching for that horrible UX pattern
|
| There are legitimate cases for alert modals like this one,
| but this definitely is an example as to when it shouldn't be
| used.
| lazide wrote:
| Sepsis is indeed an immediate life threatening condition,
| and I bet the alert was added as some kind of legal/medical
| 'oh shit' type of condition - without thinking through the
| consequences from a UX perspective.
| pwg wrote:
| > that draws product designers to keep reaching for that
| horrible UX pattern
|
| Because in almost every GUI library, they are the default
| built-in "alert" setup that can be used. Almost any other
| alert system other than a "popup" has to be coded, and the
| designers and coders take the easy way out and just use the
| "built in popup widget" already in the library.
| cogman10 wrote:
| I've reached for a pop-up and stopped using them exactly
| because of the "nobody reads this" problem.
|
| What's the alternative when you have a potentially dangerous
| action that you need to give the user fair warning about?
| lazide wrote:
| <blink/> tag? (/s)
| cm2187 wrote:
| If you make the system idiot proof, they will just build better
| idiots...
| zbyforgotp wrote:
| Just to be precise. The sepsis alarm was not blocking x-ray or
| antibiotics but rather suggesting them.
|
| """ Agyare had instructed Banerjee to hydrate Sam right away
| but to wait for the results of Sam's lab work before ordering a
| chest X-ray or the strong antibiotics used to treat sepsis. """
| codeulike wrote:
| but then " _He couldn't figure out how to navigate the
| template to make some but not all of the auto-populated
| orders._ "
| NetMageSCW wrote:
| The question should be why was he trying to disregard the
| orders that were part of the standard protocol for a
| possible sepsis situation - just accept them all as
| intended.
| HelloMcFly wrote:
| > The signatures of doctors who testified they never saw Sam --
| including one who was not in the hospital that night --
| accompany notes.
|
| I'd bet 10 to 1 this is due to residents or fellows copy-
| pasting prior notes forward. An extremely common albeit rarely
| problematic practice that is nevertheless lazy and
| underpoliced.
| thelastgallon wrote:
| Everything is optimized for corporations to make more money, to
| avoid liability and maximize the billable dollars. Doctors want
| to move meat as quick as possible, most consultations are a
| couple of minutes! Every doctor has to be part of this rat race
| because of how the system is designed!
|
| "More than 200,000 people will die each year from preventable
| medical errors. He was shocked. Conservatively, these estimates
| amount to at least one fatal Boeing 747 crash per week."
|
| "Doctors talk about electronic medical records as an unpleasant
| and frustrating chore. They object to how the charts have evolved
| to prioritize billing and liability defense over clinical care.
| And they regard the symphony of well-meaning alerts and pop-ups
| as a distraction at best."
|
| "The check boxes and templates can aid efficiency, several
| doctors told me, but they also may distract physicians from the
| patients right in front of them."
| IAmBroom wrote:
| > Doctors want to move meat as quick as possible,
|
| I don't know a single doctor who wants this. Insurance
| companies want this. Don't blame healthcare workers for the
| hellish scenarios they are forced to work under.
| gowld wrote:
| A doctor (who is is a licensed professional, not unskilled
| labor) could accept lower pay for less work (fewer patients
| seen), instead high pay for less work (false-treating
| patients).
| roywiggins wrote:
| Doctors can't build bigger ERs or hospitals, you need
| physical infrastructure to give patients extra time.
| ikiris wrote:
| This is laughably out of touch with the actual limits of
| care. It's nursing staff and the shortage is a
| willingness to pay the costs of staffing.
| Eric_WVGG wrote:
| also see the private equity takeover of hospitals
| ModernMech wrote:
| It might be better put that doctors are incentivized to do
| this, and they are willingly doing things they're
| incentivized to do.
| VirusNewbie wrote:
| The hospitals in my area are non profit, my insurance company
| is non profit, I mean, where is the money hungry corporation in
| this story?
| thegrim33 wrote:
| Recently I got really, really sick. I was running a fever and
| bedridden for nearly a month straight. It got so bad one day that
| I ended up in two urgent cares and then they sent me onwards to
| the ER.
|
| They were constantly taking my blood, constantly running tests,
| and in the end they basically just shrugged and said it was
| seemingly some random virus they didn't have a test for, nothing
| they could do. I heard some doctors talking outside my room about
| how unusual it was for me to be sick for as long as I had been,
| and they just seemed to brush it off and one said something like
| "well he's still fairly young, he'll probably get through it
| eventually."
|
| They never figured out what it was, never were able to do
| anything to help me, just kind of shrugged, kept me overnight for
| more observation and then kicked me out the second the sun came
| out. My body and mind were absolutely shattered, especially after
| being woken up every 30min all night long for more blood draws,
| and I was told I could at least eat breakfast before I left, but
| they ended up reneging on this and kicking me out before
| breakfast time.
|
| This was at a major hospital, a well ranked one, in a major city.
| The experience really opened my eyes.
| dostick wrote:
| Did you ask ChatGPT or something? It usually knows more. And
| what they were taking tests for.
| yieldcrv wrote:
| although this is the new "WebMD" self diagnosis, and the AI
| will agree with you and make some things up in subtle ways,
| this is still a great way to steer licensed professionals and
| cut through their own double speak - since licensed
| professionals are also making things up in subtle ways, not
| give you enough information about their findings or
| medication, and overlook many things
| rediguanayum wrote:
| Not a doctor but I know some- Viruses are notoriously hard to
| diagnose because they don't culture. Some big academic
| hospitals do have a virus panel where they use brute force PCR
| assay akin to many Covid-19 tests targeting different virus but
| they are very expensive hence not broadly available. Community
| hospitals will have the same diagnostic experience you have. At
| most they might be able to test for Flu or Covid but that's
| about it. Another reason is that even if you test positive,
| there is very little the hospital can do. For the most part,
| just tell the patient to rest and take Tylenol/Ibuprofen. The
| anti-virals are just limited to Flu and Covid.
| nick__m wrote:
| The anti-virals are just limited to Flu and Covid.
|
| There are also antivirals for Herpes simplex and zoster, HIV,
| Hepatitis B and C and probably others that i don't know
| about. It's still a small arsenal but it not limited to Flu
| and Covid.
| shadowpho wrote:
| >They were constantly taking my blood, constantly running tests
|
| >My body and mind were absolutely shattered, especially after
| being woken up every 30min all night long for more blood draws,
|
| Would you rather they don't take your blood and run tests? How
| do you expect them to do any diagnosis?
|
| >They never figured out what it was, never were able to do
| anything to help me, just kind of shrugged
|
| What do you expect them to do?
| thephyber wrote:
| Consider their situation:
|
| Multiply the number of diseases/conditions by the average
| number of environmental factors multiplied by the number of
| genetic conditions which change how they present. The cross
| product is a MASSIVE search space and the ER doctors need to
| search it about 1-3 hours (on average).
|
| Sometimes patients lie or mischaracterize their symptoms,
| leading to uncertainty about the data they get.
|
| The emergency room is a triage center. For every bed that is
| full, there is back pressure into the lobby and out the door.
| Their job is to create a priority queue (or occasionally to
| turn into a triage center) based on patient volume keeping the
| highest average treatment quality possible, not to maximize
| treatment for any one patient.
|
| Symptoms alone aren't always determinative. Many flu-like
| viruses present with almost the exact symptoms, despite being
| different viruses and having different impact on the body. The
| ER may discharge you before the labs come back with a positive
| identification of the exact virus strain, meaning it may be way
| more dangerous than the seasonal flu, but they play the odds
| unless you have known comorbidities.
|
| Even if the doctors make a mistake in the ER and discharges
| you, there's a decent chance that will live. The body can fight
| off many diseases by itself (without doctor's intervention) and
| if not, there's a chance you can make it back to the ER for a
| second attempt. An ER's job is to keep you alive during your
| visit to the best of their knowledge, not to see you through
| the entire course of your disease. As discussed in the article,
| there are a shortage of hospital beds in other departments, so
| Ears end up being a poor stopgap for those.
|
| Chronic diseases became more common as doctors and medicine
| increased our lifetimes. ERs are not the right place to manage
| chronic diseases, but it's de facto where the indigent go for
| their only health care access and where acute issues related to
| chronic conditions are managed.
|
| People need massively more hospital care during their last year
| of life and boomers are going through that time of their life.
| Hospitals are businesses, so they are min-maxing their capital
| outlays (how many beds they can support) with equipment and
| staff. If they overspend, they have to charge more than the
| already outrageous prices they have. If they underspend, some
| people will get undertreated and hospital staff will get
| overworked, but that seems to be acceptable to American
| society, so that's what we get.
|
| Medical science isn't perfect. It doesn't have infinite
| resources to investigate every possible condition. You couldn't
| afford it if they decided to do every diagnostic test possible.
| at-fates-hands wrote:
| I started dating a woman once and she was a widow. I was kind
| of shocked a woman in her 20's was already a widow and she
| finally got around to telling me what happened. Very similar.
| Keep in mind this was some 15 years before COVID.
|
| Husband was pretty healthy. Nothing in his family history. Most
| of his family had died of natural causes. One day got really
| sick. Was bedridden for a few days. Fever, body aches,
| coughing. Third day they go into urgent care. Doctors think its
| just a bad case of the flu since it was late October. They give
| him some antiviral stuff and told him to take it easy and let
| it run its course.
|
| Two days later he got up and said he felt a little better.
| Spent 45 mins on the treadmill and afterwards said he was
| feeling great. The next day he got up and was pale AF, and she
| said when he was talking to her, she could smell the sepsis on
| his breathe. Called 911 and they took him to the ER. Took an
| xray and saw the sepsis had spread, and it was terminal. She
| spent the next 36 hours watching him slowly die.
|
| She said had they done a chest x-ray the first time he came in,
| they probably could've had a chance to save him. The way health
| care is now, doctors make you jump through all the hoops before
| they're willing to order more extensive tests and bloodwork.
|
| Just a sad story all the way around but I'm not surprised by
| your similar story either.
| mindslight wrote:
| I feel like the urge to fight, sue, and demand answers is the
| direct result of the constructive maliciousness of the medical
| environment, as orchestrated by the beancounters and
| provider/insurance bureaucracy. Let's say doctors had the
| bandwidth to not cut patient discussions short, not expect
| patients to need an adversarial "advocate", take the time to
| entertain unlikely hypotheses, monitor/admit for good faith
| investigative reasons rather than purely on liability rubric [0],
| etc. Then, when the doctors failed, you would feel that the
| failing was of a human group that earnestly did everything they
| could have. But the way the medical system has been whittled down
| into some bare bones bureaucratic assembly line, it makes it feel
| like every such failure is a willful and deliberate goal of the
| system. Why is the medical industry primarily focused on cost
| optimization through tightening the screws when they aren't even
| able to get the right answers?
|
| [0] Like seriously I wish I could have given this kid one of the
| many weeks of observation that hospitals have given my paid-by-
| Medicare family members. The beds are available, they're just
| full of elderly people who had some acute problem but the
| hospital won't readily discharge them due to chronic medical
| conditions (plus they're messed up after being starved for a day
| in the ER).
| TrackerFF wrote:
| From the info laid out in the article, it seems that
| unfortunately Sam was the Zebra, this time.
|
| The autopsy found pulmonary hemorrhage, enlarged heart, enlarged
| liver, damaged kidney.
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