7 ms·

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 i

by 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...”
- Kalium 7y ago
  I'm trying to suggest, as gently as possible, that a time when our medical system is verging on being flooded may not be the best of all possible moments imaginable to add a significant resource-consumer in the form of an experimental mass training program. I am attempting to encourage more systemic thinking and greater consideration of context. I understand that some may disagree with some or all of these arguments. Please accept my deepest apologies if I have in any way seemed to imply that the current reactive strategy is an ideal long-term solution. I do not in any way think this. Don't hesitate to ask if there's anything else I can clarify for you - I frequently fail to express myself as well as I'd like.
mistermann 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. Point of contention is what it seems like to me. There's certainly no shortage of people asserting that point, but what confuses me is, how does everyone know with such high certainty what is or is not possible, when it's never been tried before (afaik)? Has anything even remotely similar been tried before?
- omar_a1 7y ago
  Because it's common sense that an invasive medical procedure needs to be administered by someone with some semblance of competence in medicine, if you expect the patient to have a shot at not dying. An emergency doesn't change the hard technical requirement of administering ventilation. Or rather, this should be common sense, but the over-inflated egos on HN don't understand that it takes more than knowing which button does what to operate a ventilator. Being able to hold a paint brush is a very different skill level than painting a portrait.
  - jacquesm 7y ago
    > Being able to hold a paint brush is a very different skill level than painting a portrait. Painful given some past threads on this subject. Other than that: spot on.
    - mistermann 7y ago
      Do you believe that we can infer useful information about ventilators from this? I'm not seeing much relevance to this conversation.
      - jacquesm 7y ago
        I can infer some useful information about you from this thread. It is that you actually don't give a damn but you love arguing, the more the merrier and no matter whether or not you stray far off-topic, you'll be happy because that gives you yet another thing you can argue about. If there is relevance to this conversation in the 10,000 or so words that you have spent on this thread then I fail to see it, so I really don't know what this particular comment is trying to achieve other than that it has me considering whether I shouldn't just plain give up on HN. Don Hopkins has it right, sealioning is the perfect term to describe what you are doing and it is a destructive thing on something as fragile as this forum because it narrowly fits the guidelines and yet makes it impossible to have a normal conversation. It's the online version of passive aggressive belligerence with a veneer of sincerity on top.
barry-cotter 7y ago
> 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 will happen soon or not at all. The AMA and its equivalents worldwide have a very consistent attitude to anyone, anywhere being allowed to do anything a doctor can do. It should not be allowed. Psychologists should not be allowed prescribe; nurse practitioners should not be allowed practice independently under any circumstances, etc.
- cycrutchfield 7y ago
  Pretty reasonable if you ask me. History is littered with quacks and snake oil salesmen. There is a reason why becoming a physician is such an arduous and selective process.
  - barry-cotter 7y ago
    > History is littered with quacks and snake oil salesmen. Indeed, doctors did more harm than good until the early 1900s at the earliest, and we can only be sure that they were on net leading to lower rather than higher mortality with the introduction of antibiotics.

by Kalium 7y ago

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...”

Kalium 7y ago
I'm trying to suggest, as gently as possible, that a time when our medical system is verging on being flooded may not be the best of all possible moments imaginable to add a significant resource-consumer in the form of an experimental mass training program. I am attempting to encourage more systemic thinking and greater consideration of context. I understand that some may disagree with some or all of these arguments. Please accept my deepest apologies if I have in any way seemed to imply that the current reactive strategy is an ideal long-term solution. I do not in any way think this. Don't hesitate to ask if there's anything else I can clarify for you - I frequently fail to express myself as well as I'd like.

mistermann 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. Point of contention is what it seems like to me. There's certainly no shortage of people asserting that point, but what confuses me is, how does everyone know with such high certainty what is or is not possible, when it's never been tried before (afaik)? Has anything even remotely similar been tried before?

omar_a1 7y ago
Because it's common sense that an invasive medical procedure needs to be administered by someone with some semblance of competence in medicine, if you expect the patient to have a shot at not dying. An emergency doesn't change the hard technical requirement of administering ventilation. Or rather, this should be common sense, but the over-inflated egos on HN don't understand that it takes more than knowing which button does what to operate a ventilator. Being able to hold a paint brush is a very different skill level than painting a portrait.
- jacquesm 7y ago
  > Being able to hold a paint brush is a very different skill level than painting a portrait. Painful given some past threads on this subject. Other than that: spot on.
  - mistermann 7y ago
    Do you believe that we can infer useful information about ventilators from this? I'm not seeing much relevance to this conversation.
    - jacquesm 7y ago
      I can infer some useful information about you from this thread. It is that you actually don't give a damn but you love arguing, the more the merrier and no matter whether or not you stray far off-topic, you'll be happy because that gives you yet another thing you can argue about. If there is relevance to this conversation in the 10,000 or so words that you have spent on this thread then I fail to see it, so I really don't know what this particular comment is trying to achieve other than that it has me considering whether I shouldn't just plain give up on HN. Don Hopkins has it right, sealioning is the perfect term to describe what you are doing and it is a destructive thing on something as fragile as this forum because it narrowly fits the guidelines and yet makes it impossible to have a normal conversation. It's the online version of passive aggressive belligerence with a veneer of sincerity on top.

barry-cotter 7y ago

> 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 will happen soon or not at all. The AMA and its equivalents worldwide have a very consistent attitude to anyone, anywhere being allowed to do anything a doctor can do. It should not be allowed. Psychologists should not be allowed prescribe; nurse practitioners should not be allowed practice independently under any circumstances, etc.

cycrutchfield 7y ago
Pretty reasonable if you ask me. History is littered with quacks and snake oil salesmen. There is a reason why becoming a physician is such an arduous and selective process.
- barry-cotter 7y ago
  > History is littered with quacks and snake oil salesmen. Indeed, doctors did more harm than good until the early 1900s at the earliest, and we can only be sure that they were on net leading to lower rather than higher mortality with the introduction of antibiotics.