[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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