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Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

choeger 7y ago
Look how radiologists work nowadays. They don't see their patients face to face. Everything except the decision making has been handed to someone else so they can be most efficient. That's the model a huge COVID19 ICU could work like.
- cycrutchfield 7y ago
  Still, it’s an ICU, not an outpatient clinic. I think you are a bit over-optimistic about just how much care can be delegated.
  - choeger 7y ago
    Forget about an ICU as we know it. Think about a field hospital near the beaches on D-Day.
ALittleLight 7y ago
I'm not saying "zero training". I'm suggesting the minimum training necessary to run a ventilator. That way doctors or nurses could simply hand off care to ventilator-operators who could contact the doctor or nurses if things got out of control. This wouldn't be as high quality care as people would usually get, but hopefully it would be better than nothing. Regarding whether doctors would want undertrained help - that's immaterial. If current healthcare workers have the capacity to handle the pending wave of sick people, then that's great and we shouldn't get in their way. If they have another, better solution, then let's do that. If the alternative to having minimally trained people operate ventilators is letting people die without any intervention - I'd want to see some explanation or evidence as to why letting people die is better.
- epmaybe 7y ago
  Respiratory therapists exist
- Kalium 7y ago
  I believe the point is that the minimum amount of training required to be of greater help than hindrance (i.e., net benefit) in an ICU and running ventilators is sufficiently high that it's not a small thing to spin up a cohort. To my exceptionally limited understanding - and I would love to be corrected if I'm wrong - operating a ventilator correctly is not a matter of standing in front of a machine and watching a few numbers for problematic readings. That can be done by machines and computers. What requires training is everything else around it, which requires an understanding of medical protocols, anatomy, the ability to respond usefully to emergencies without being in the way, and so on. Which is to say that this is not something that highly specialized and narrow technicians can be usefully trained for in a very short time at this particular moment. That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task.
  - marnett 7y ago
    > That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task. This thread isn’t about automating medical professionals responsibilities one task at a time, or attempting to step on their egos. I’m as proud of their title, their coat, and their debt as they are. If a pandemic respiratory virus is not the time to “consider exploring” this idea, when is? When people are left to die in their homes because the ambulances stop taking calls...? We are, of course, just shooting out ideas of grandeur. A reactive strategy will be maintained, people will die, and everyone will throw their hands up in the sky and say “nothing else could have been done. March simply was not the time to think about COVID-specific medical operation efficiencies. There will, however, be a time to explore...”
corebit 7y ago
This speaks volumes about the cronyist regulatory captured monopoly that the AMA has been able to install over the past hundred years.
- cycrutchfield 7y ago
  Ah yes, you surely know better than the trained professionals about how to best run an ICU. Just because you can call yourself a software engineer with little more than a high school diploma doesn’t mean that the same rules apply for doctors.
  - roenxi 7y ago
    Doctors and nurses probably aren't trained how to run an ICU, they spend more than a decade learning about human bodies and they only have so much time. If corebit happens to be an Operations Research specialist then it is reasonably likely that they would be better at running an ICU than a typical professional medical worker. Medicine has traditionally had a problem with a large number of very clever people who are sufficiently insulated from other communities that they are a bit behind the times. A good humourous example is the 1994 paper where a doctor will rediscover calculus.
    - cycrutchfield 7y ago
      > If corebit happens to be an Operations Research specialist then it is reasonably likely that they would be better at running an ICU than a typical professional medical worker. Why do people on HN consistently presume that they somehow know better than the experts? It’s distressing to me that anybody can say something like this with a straight face.
      - seppin 7y ago
        It's a computer engineer thing. They think because they are smart at coding they are smart everywhere else too. It gets worse when they get more money: https://twitter.com/elonmusk/status/1236029449042198528 https://twitter.com/elonmusk/status/1236029449042198528
bilbo0s 7y ago
Doctors don't want someone with zero training "helping". That's for sure. The original idea of 30 days training is an end of the world worst case scenario. No one wants that right now. And someone with 30 days training is more of a hinderance than a help. Press more techs, nurses and PAs into service first. But my SO runs, (COO), a system of hospitals. Including some teaching hospitals. And part of their plan definitely includes sequestering final year med students and all residents at their respective homes. Apparently the idea is that as hospital staff go down, this pool of residents and med students can be drawn on. I know she stays up nights worried sick that residents might go to a party, or invite their boyfriend over, or engage in some other risky behavior instead of stay home alone and safeguard their health. So I get the idea that they really don't have a backup to that plan. I suspect med students and residents are a pretty critical part of the plan for surge operations across the nation. Just pointing that out because I think hospital administrators and medical directors are starting to plan on doing things they wouldn't normally do. Like pressing 4th year med students into service, or taking 68 year old women off of ventilators if a 33 year old woman presents with a need for it. It's not so much a question of what doctors want to do, as it is a question of doing what has to be done to get through this with the maximum number of recoveries.
- zaroth 7y ago
  Curious what your SO thinks of this... If a health care worker has a positive test and no or mild symptoms, seems to me they could sleep alongside COVID patients and continue to treat just fine? Save a lot on PPE while you’re at it. A lot of workers would prefer that, rather then being quarantined at home where they will infect their families.
  - bilbo0s 7y ago
    There's talk along those lines. Not sure what they've settled on? Keep in mind, they don't really know how crowded these facilities are gonna get. Space may be at a premium. But yeah, at the same time going home is not always the best idea.
  - ThrowawayR2 7y ago
    Patients are continuing to emit more viruses as they breathe and cough. Put enough viral load into the health care worker and they'll be in just as bad shape as the patient regardless of how naturally resistant they are.
joe_the_user 7y ago
It seems like you've outlined a situation that could well be true. The US indeed has a training process that only generates useful competence with a full 8-12 year apprenticeship of hazing and theory. Of course, it flies in the face of a common sense view that someone careful, able to follow orders, just hold things or press button etc would provide some use in a world where the doctors are fundamentally limited. It seems like a world where the medical industry has piled goldstandard-or-nothing upon goldstandard-or-nothing approaches, to the point yeah, doctors really don't know how to produce useful people without those fricken' eight years or twelve years. Well friend, you should start thinking "outside the box" about how to make other people useful or many, many people will dies. FYI: The US produces field medic with 16 week training period after basic training. That might who you want attending to you but things are going to be resembling a war zone really soon.
- cycrutchfield 7y ago
  Imagine thinking that the role of a medical professional in the ICU is to just sit around and “press buttons”.
  - joe_the_user 7y ago
    In a huge medical emergency, when people essentially desperately pleading for a ramp-up of the effectiveness of medical personnel, it's kind of mind-boggling that the only answer you're giving is sneering at how little the layman knows (and yeah, that seems like a standard answer doctor in the US are going give). And, yeah, maybe I know little of what exactly ICU processes are but it seems indeed implausible that there are no intermediate levels of skills that are the slightest bit helpful, just about physical task can aided by a "third hand" etc.
    - deleted 7y ago
      [deleted]
  - mistermann 7y ago
    Imagine thinking that claim was actually contained within that comment.
anarazel 7y ago
Several schools, after requests, are graduating students early, precisely because of covid. And I don't think normal times and these are the same. Having younger, less likely to be infected staff is not nothing. And the variety of tasks is a lot lower right now, than during more typical times.
- cycrutchfield 7y ago
  I would be surprised if any of these students will be in the ICU. Most likely they will be assisting with more mild patients and freeing up experienced doctors to help with more severe patients.
empath75 7y ago
That will change when they have 20 times as many patients and the alternative is to let people die alone in the hallways with no help at all.
mistermann 7y ago
Has such a survey of doctors actually been performed, that also includes a range of scenarios under which the doctor might have to make such a decision?
- cycrutchfield 7y ago
  You should survey your aquatic friends, little sealion. Let’s reserve this forum for people having actual discussions.

choeger 7y ago

Look how radiologists work nowadays. They don't see their patients face to face. Everything except the decision making has been handed to someone else so they can be most efficient. That's the model a huge COVID19 ICU could work like.

cycrutchfield 7y ago
Still, it’s an ICU, not an outpatient clinic. I think you are a bit over-optimistic about just how much care can be delegated.
- choeger 7y ago
  Forget about an ICU as we know it. Think about a field hospital near the beaches on D-Day.

ALittleLight 7y ago

I'm not saying "zero training". I'm suggesting the minimum training necessary to run a ventilator. That way doctors or nurses could simply hand off care to ventilator-operators who could contact the doctor or nurses if things got out of control. This wouldn't be as high quality care as people would usually get, but hopefully it would be better than nothing. Regarding whether doctors would want undertrained help - that's immaterial. If current healthcare workers have the capacity to handle the pending wave of sick people, then that's great and we shouldn't get in their way. If they have another, better solution, then let's do that. If the alternative to having minimally trained people operate ventilators is letting people die without any intervention - I'd want to see some explanation or evidence as to why letting people die is better.

epmaybe 7y ago
Respiratory therapists exist
Kalium 7y ago
I believe the point is that the minimum amount of training required to be of greater help than hindrance (i.e., net benefit) in an ICU and running ventilators is sufficiently high that it's not a small thing to spin up a cohort. To my exceptionally limited understanding - and I would love to be corrected if I'm wrong - operating a ventilator correctly is not a matter of standing in front of a machine and watching a few numbers for problematic readings. That can be done by machines and computers. What requires training is everything else around it, which requires an understanding of medical protocols, anatomy, the ability to respond usefully to emergencies without being in the way, and so on. Which is to say that this is not something that highly specialized and narrow technicians can be usefully trained for in a very short time at this particular moment. That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task.
- marnett 7y ago
  > That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task. This thread isn’t about automating medical professionals responsibilities one task at a time, or attempting to step on their egos. I’m as proud of their title, their coat, and their debt as they are. If a pandemic respiratory virus is not the time to “consider exploring” this idea, when is? When people are left to die in their homes because the ambulances stop taking calls...? We are, of course, just shooting out ideas of grandeur. A reactive strategy will be maintained, people will die, and everyone will throw their hands up in the sky and say “nothing else could have been done. March simply was not the time to think about COVID-specific medical operation efficiencies. There will, however, be a time to explore...”

corebit 7y ago

This speaks volumes about the cronyist regulatory captured monopoly that the AMA has been able to install over the past hundred years.

cycrutchfield 7y ago
Ah yes, you surely know better than the trained professionals about how to best run an ICU. Just because you can call yourself a software engineer with little more than a high school diploma doesn’t mean that the same rules apply for doctors.
- roenxi 7y ago
  Doctors and nurses probably aren't trained how to run an ICU, they spend more than a decade learning about human bodies and they only have so much time. If corebit happens to be an Operations Research specialist then it is reasonably likely that they would be better at running an ICU than a typical professional medical worker. Medicine has traditionally had a problem with a large number of very clever people who are sufficiently insulated from other communities that they are a bit behind the times. A good humourous example is the 1994 paper where a doctor will rediscover calculus.
  - cycrutchfield 7y ago
    > If corebit happens to be an Operations Research specialist then it is reasonably likely that they would be better at running an ICU than a typical professional medical worker. Why do people on HN consistently presume that they somehow know better than the experts? It’s distressing to me that anybody can say something like this with a straight face.
    - seppin 7y ago
      It's a computer engineer thing. They think because they are smart at coding they are smart everywhere else too. It gets worse when they get more money: https://twitter.com/elonmusk/status/1236029449042198528 https://twitter.com/elonmusk/status/1236029449042198528

bilbo0s 7y ago

Doctors don't want someone with zero training "helping". That's for sure. The original idea of 30 days training is an end of the world worst case scenario. No one wants that right now. And someone with 30 days training is more of a hinderance than a help. Press more techs, nurses and PAs into service first. But my SO runs, (COO), a system of hospitals. Including some teaching hospitals. And part of their plan definitely includes sequestering final year med students and all residents at their respective homes. Apparently the idea is that as hospital staff go down, this pool of residents and med students can be drawn on. I know she stays up nights worried sick that residents might go to a party, or invite their boyfriend over, or engage in some other risky behavior instead of stay home alone and safeguard their health. So I get the idea that they really don't have a backup to that plan. I suspect med students and residents are a pretty critical part of the plan for surge operations across the nation. Just pointing that out because I think hospital administrators and medical directors are starting to plan on doing things they wouldn't normally do. Like pressing 4th year med students into service, or taking 68 year old women off of ventilators if a 33 year old woman presents with a need for it. It's not so much a question of what doctors want to do, as it is a question of doing what has to be done to get through this with the maximum number of recoveries.

zaroth 7y ago
Curious what your SO thinks of this... If a health care worker has a positive test and no or mild symptoms, seems to me they could sleep alongside COVID patients and continue to treat just fine? Save a lot on PPE while you’re at it. A lot of workers would prefer that, rather then being quarantined at home where they will infect their families.
- bilbo0s 7y ago
  There's talk along those lines. Not sure what they've settled on? Keep in mind, they don't really know how crowded these facilities are gonna get. Space may be at a premium. But yeah, at the same time going home is not always the best idea.
- ThrowawayR2 7y ago
  Patients are continuing to emit more viruses as they breathe and cough. Put enough viral load into the health care worker and they'll be in just as bad shape as the patient regardless of how naturally resistant they are.

joe_the_user 7y ago

It seems like you've outlined a situation that could well be true. The US indeed has a training process that only generates useful competence with a full 8-12 year apprenticeship of hazing and theory. Of course, it flies in the face of a common sense view that someone careful, able to follow orders, just hold things or press button etc would provide some use in a world where the doctors are fundamentally limited. It seems like a world where the medical industry has piled goldstandard-or-nothing upon goldstandard-or-nothing approaches, to the point yeah, doctors really don't know how to produce useful people without those fricken' eight years or twelve years. Well friend, you should start thinking "outside the box" about how to make other people useful or many, many people will dies. FYI: The US produces field medic with 16 week training period after basic training. That might who you want attending to you but things are going to be resembling a war zone really soon.

cycrutchfield 7y ago
Imagine thinking that the role of a medical professional in the ICU is to just sit around and “press buttons”.
- joe_the_user 7y ago
  In a huge medical emergency, when people essentially desperately pleading for a ramp-up of the effectiveness of medical personnel, it's kind of mind-boggling that the only answer you're giving is sneering at how little the layman knows (and yeah, that seems like a standard answer doctor in the US are going give). And, yeah, maybe I know little of what exactly ICU processes are but it seems indeed implausible that there are no intermediate levels of skills that are the slightest bit helpful, just about physical task can aided by a "third hand" etc.
  - deleted 7y ago
    [deleted]
- mistermann 7y ago
  Imagine thinking that claim was actually contained within that comment.

anarazel 7y ago

Several schools, after requests, are graduating students early, precisely because of covid. And I don't think normal times and these are the same. Having younger, less likely to be infected staff is not nothing. And the variety of tasks is a lot lower right now, than during more typical times.

cycrutchfield 7y ago
I would be surprised if any of these students will be in the ICU. Most likely they will be assisting with more mild patients and freeing up experienced doctors to help with more severe patients.

empath75 7y ago

That will change when they have 20 times as many patients and the alternative is to let people die alone in the hallways with no help at all.

mistermann 7y ago

Has such a survey of doctors actually been performed, that also includes a range of scenarios under which the doctor might have to make such a decision?

cycrutchfield 7y ago
You should survey your aquatic friends, little sealion. Let’s reserve this forum for people having actual discussions.