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> It’s much harder to ramp up production of medical professionals. I have a mixed opinion on this. In particular, I don't think we really need to create more s

> It’s much harder to ramp up production of medical professionals. I have a mixed opinion on this. In particular, I don't think we really need to create more skilled medical professionals, we just need to change the way they work. Most of doctors have exposure to the basics of intubating and ventilation through medical school. Those without direct critical care experience would likely be absolutely terrible at it. However, they all still have the baseline knowledge. They're able to assess patients, read charts, and report on vitals. I just asked my wife (a psychiatry resident) if she could intubate/ventilate a patient. Here response was, "If I were the last person alive, I could intubate. You wouldn't want me to do it, but I could do it. I don't know how to run a vent, but I'm sure I could figure it out if I consulted with a doctor/therapist that does". I think most non-critical care doctors would express the same opinion. What I'm getting at is we have a large amount of doctors that can act as multipliers for intensivists, hospitalist, ER docs, and pulmonologists. They are able to do much of the time consuming work while relying on specialists to guide overall care plan and intervene the on most challenging cases. ---- Given how medicine works, the chances of actually seeing this in action are low. But....it's an options.

saurik 7y ago
I now don't remember where I saw this, nor can I find it... but I swear I had seen something in the past week or two comparing how much retraining different medical professions needed to quickly get useful for staffing ventilator technology, and veterinarians came out on top; so like, people are (unless I dreamth this?!) looking into reusing people.
- SkyPuncher 7y ago
  Veterinarians make sense. The ones that do surgery already know how to run vents on animals. Humans are a form of animal, after all.
  - jacquesm 7y ago
    That's a better idea, also, veterinarians tend to be much more all-round.
- thu2111 7y ago
  You didn't dream it, it was in Forbes. The US did a disaster prep simulation for virulent flu, that involved a shortage of ventilator scenarios. They took people with something approximating medical backgrounds, including nurses, other kinds of docs and vetinarians, and gave them training in how to use a ventilator. After two days they were given a test and the vets had the best score.
joe_the_user 7y ago
The question in a lot of ways is how many exponential doublings do we have to have before this situation switches in peoples' minds from a peace-time inconvenience to essentially real war. Right now, the death rate still isn't higher than a flu epidemic but just the number of known infections promises a lot worse and the potential doublings after that are terrifying. It seems like there's an endless dialogue of: A: How would you accomplish X? B: I wouldn't, X is not what I do. But we need to give the final answer: A: I didn't ask whether you can do X. I'm telling you, "do X or many people die, you are all we have at this point. Think outside the box".
- Mediterraneo10 7y ago
  "The question in a lot of ways is how many exponential doublings do we have to have before this situation switches in peoples' minds from a peace-time inconvenience to essentially real war." The millions of people who would die in a worst-case scenario are mainly demographics that society is already used to neglecting: the elderly, the terminally ill, those with lifelong chronic illnesses where any infection could be a killer, etc. Therefore, I would expect this to continue to be considered more of a peacetime inconvenience than a real war. A frequent response to this is, "But they could overwhelm the healthcare system so you or me couldn't be treated for our needs!" Well, if the bulk of the population is left inconvenienced and unemployed for too long, I can imagine some ugly scenarios where the population demands, broadly speaking, that those demographics simply be triaged out of treatment so that they don't overwhelm the healthcare system for everyone else. This is said to be already happening in Italy to a degree.
  - empath75 7y ago
    That’s not true. Once you start getting into the tens of millions of deaths worldwide, that’s going to include a lot of young people and medical staff and people who will die of other treatable diseases or injuries because half of the doctors in the country are sick or otherwise occupied.
  - joe_the_user 7y ago
    Well, if the bulk of the population is left inconvenienced and unemployed for too long, I can imagine some ugly scenarios where the population demands, broadly speaking, that those demographics simply be triaged out of treatment so that they don't overwhelm the healthcare system for everyone else. People imagining such triaging seem to think that a willingness to be appalling brutal means such brutality could be achieved with limited costs. Italy's situation is far from the worst-case scenario. It's death rate is not that much higher than a seasonal flu, it's just the death-process that is far more messy. Which is to say, let the infection rate get high enough and you'll have hospitals crowded with the young and healthy even if carry the old directly to the morgue. Moreover, authorities shouting "all clear" in the midst of this dreck isn't going just summon a phalanx of consumers ready to go to restaurants, death chance or not. In short, just because you're evil doesn't mean you aren't stupid too.
No1 7y ago
> Given how medicine works, the chances of actually seeing this in action are low. This has already been happening in Lombardy according to an account I read about two weeks ago.
- SkyPuncher 7y ago
  Sorry, I should have been more specific. Given how American medicine works, I see challenges with this approach.
baybal2 7y ago
> I don't think we really need to create more skilled medical professionals, USA has 5 million medical professionals, almost as much medics per capita as Cuba.
- seppin 7y ago
  Because it is a very, very unhealthy country in normal times.
  - jjeaff 7y ago
    Nah, we don't have all those doctors for the sick. We have doctors for every type of plastic surgery you can imagine, doctors for aging, doctors for athletic training, doctors that specialize in hips, others in just ankles, also shoulders only, others that only do laser eye surgery, others that only do teeth, some just for gums, some only do tooth implants. And on and on. There is a shortage of doctors that actually treat sick people.
jacquesm 7y ago
You just asked a person qualified to give you their professional opinion and then you turned around and more or less completely undercut that professional opinion. You need the experience and you need the detailed instruction. That's why there are certification programs around the operating of complex healthcare machinery. Just like you don't want a front-ender doing back-end or systems work you don't want your psychiatry residents to operate an ICU.
- SkyPuncher 7y ago
  > Just like you don't want a front-ender doing back-end or systems This is not the argument I'm making though. That implies the front dev has no oversight. I'm making the argument that a frontend development can successfully complete features with the guidance/oversight of a backend dev. The results might not be ideal, but it can provide an acceptable outcome. ---- > You need the experience and you need the detailed instruction. That's why there are certification programs around the operating of complex healthcare machinery. These programs are focused on developing individuals who can robustly and independently manage this complex machinery. Should we also discredit airline pilots because laypeople have landed planes in emergencies? Or discredit sports professionals because many can kick a ball?
  - jacquesm 7y ago
    There are exactly 6 known instances of talk down landings that I'm aware of. All concerned general aviation and in one of them the person had prior flight experience. Several of those ended in a crash. A general aviation plane is in no way comparable to a large airliner, and no instance of such a landing has ever been recorded, nor has it been attempted. Life is not a movie, some stuff is just hard and requires a long time of training before we'll let you go 'solo'. One mistake and someone ends up dead, there are no do-overs, there is no undo button. The last thing ICU's need right now is on top of all the stress already going on there to be overrun by eager rookies that are trying to help. The best we can do - and this is happening in some places - is to move up the training schedule and to graduate ICU nurses early. This is need for several reasons: to man the extra ICU capacity that is coming online and to take the place of those who have died or can't take it anymore due to psychological stress.
cadlin 7y ago
Doctors that don't know how to properly operate a vent are currently a problem in the US. Not blaming them, as there doesn't seem to be any real alternative. Here's an /r/medicine discussion of it. https://www.reddit.com/r/medicine/comments/fr0x3m/how_do_you_deal_with_it_when_fellow_physicians/ https://www.reddit.com/r/medicine/comments/fr0x3m/how_do_you...
- SkyPuncher 7y ago
  I don't think you can pick a single /r/medicine thread as evidence of a widespread problem. My wife and every other doctor to ever practice medicine can give you anecdotal examples of other doctors mismanaging patients. Another thing to consider is this is a rapidly changing/progressing disease and there are no standards. The opinion of a recently graduated fellow has different biases than an experienced attending. They can both be correct while disagreeing on the specifics.
billfruit 7y ago
I think some European countries have tried to deploy Dermatoloists and Gynecologists, etc s into ER in the present scenario after a training course. Some medical students also could be utilised, if there is acute shortage, perhaps.
mistermann 7y ago
Do you have any idea how long it took your wife to learn to achieve the level of skill she is at? Let's say this was WW3, and we somehow lost 75% of these specialized personnel, what would be a ballpark estimate to get a reasonably intelligent person with no medical experience up to a "functional" level?
- SkyPuncher 7y ago
  There's a lot to this question. > what would be a ballpark estimate to get a reasonably intelligent person with no medical experience up to a "functional" level? It really depends and I'm speaking out of my comfort zone here. Becoming a doctor takes a really long time because it includes a LOT of background and general medicine knowledge. Doctors know a lot about medicine outside their speciality. Med school is 4 years (2 years of bookwork focus and 2 years of clinical focus) and builds on undergrad significantly. Residency is 3+ years. I'd say the majority of people with STEM backgrounds could have function acceptably as a general doctor with 2 to 5 years of postgrad training. Surgeons are built much more on experience so that's very hard to fast track. In my opinion, the real measure is the ability to handle edge cases/unusual cases. Specialized/limited scope workers, especially those with the direct support of an experienced individual, could pick up tasks much, much more easily as long as an expert is there to take over the challenging cases.
  - mistermann 7y ago
    Sorry, I probably should have been more clear, I was referring to teaching someone only the skills necessary to operate a ventilator, in a supporting role to a properly trained medical professional, who would handle the more complex situations. I'm willing to consider that it isn't possible, but if that is the case, I'd be keen to know the particulars of why. If there happened to be a documentary on respirators that covered some of the complexity involved, I would be on my couch watching it.
tcbawo 7y ago
There is an ophthalmologist/comedian on Twitter @dglaucomflecken with an entertaining, somewhat tongue in cheek feed with similar sentiments (https://twitter.com/DGlaucomflecken/status/1238954558140772354?s=19 https://twitter.com/DGlaucomflecken/status/12389545581407723...)
- jacquesm 7y ago
  Priceless, and just what the ICU backseat driver crowd needs to see.
- SkyPuncher 7y ago
  Thank you. That made my wife's morning.

saurik 7y ago

I now don't remember where I saw this, nor can I find it... but I swear I had seen something in the past week or two comparing how much retraining different medical professions needed to quickly get useful for staffing ventilator technology, and veterinarians came out on top; so like, people are (unless I dreamth this?!) looking into reusing people.

SkyPuncher 7y ago
Veterinarians make sense. The ones that do surgery already know how to run vents on animals. Humans are a form of animal, after all.
- jacquesm 7y ago
  That's a better idea, also, veterinarians tend to be much more all-round.
thu2111 7y ago
You didn't dream it, it was in Forbes. The US did a disaster prep simulation for virulent flu, that involved a shortage of ventilator scenarios. They took people with something approximating medical backgrounds, including nurses, other kinds of docs and vetinarians, and gave them training in how to use a ventilator. After two days they were given a test and the vets had the best score.

joe_the_user 7y ago

The question in a lot of ways is how many exponential doublings do we have to have before this situation switches in peoples' minds from a peace-time inconvenience to essentially real war. Right now, the death rate still isn't higher than a flu epidemic but just the number of known infections promises a lot worse and the potential doublings after that are terrifying. It seems like there's an endless dialogue of: A: How would you accomplish X? B: I wouldn't, X is not what I do. But we need to give the final answer: A: I didn't ask whether you can do X. I'm telling you, "do X or many people die, you are all we have at this point. Think outside the box".

Mediterraneo10 7y ago
"The question in a lot of ways is how many exponential doublings do we have to have before this situation switches in peoples' minds from a peace-time inconvenience to essentially real war." The millions of people who would die in a worst-case scenario are mainly demographics that society is already used to neglecting: the elderly, the terminally ill, those with lifelong chronic illnesses where any infection could be a killer, etc. Therefore, I would expect this to continue to be considered more of a peacetime inconvenience than a real war. A frequent response to this is, "But they could overwhelm the healthcare system so you or me couldn't be treated for our needs!" Well, if the bulk of the population is left inconvenienced and unemployed for too long, I can imagine some ugly scenarios where the population demands, broadly speaking, that those demographics simply be triaged out of treatment so that they don't overwhelm the healthcare system for everyone else. This is said to be already happening in Italy to a degree.
- empath75 7y ago
  That’s not true. Once you start getting into the tens of millions of deaths worldwide, that’s going to include a lot of young people and medical staff and people who will die of other treatable diseases or injuries because half of the doctors in the country are sick or otherwise occupied.
- joe_the_user 7y ago
  Well, if the bulk of the population is left inconvenienced and unemployed for too long, I can imagine some ugly scenarios where the population demands, broadly speaking, that those demographics simply be triaged out of treatment so that they don't overwhelm the healthcare system for everyone else. People imagining such triaging seem to think that a willingness to be appalling brutal means such brutality could be achieved with limited costs. Italy's situation is far from the worst-case scenario. It's death rate is not that much higher than a seasonal flu, it's just the death-process that is far more messy. Which is to say, let the infection rate get high enough and you'll have hospitals crowded with the young and healthy even if carry the old directly to the morgue. Moreover, authorities shouting "all clear" in the midst of this dreck isn't going just summon a phalanx of consumers ready to go to restaurants, death chance or not. In short, just because you're evil doesn't mean you aren't stupid too.

No1 7y ago

> Given how medicine works, the chances of actually seeing this in action are low. This has already been happening in Lombardy according to an account I read about two weeks ago.

SkyPuncher 7y ago
Sorry, I should have been more specific. Given how American medicine works, I see challenges with this approach.

baybal2 7y ago

> I don't think we really need to create more skilled medical professionals, USA has 5 million medical professionals, almost as much medics per capita as Cuba.

seppin 7y ago
Because it is a very, very unhealthy country in normal times.
- jjeaff 7y ago
  Nah, we don't have all those doctors for the sick. We have doctors for every type of plastic surgery you can imagine, doctors for aging, doctors for athletic training, doctors that specialize in hips, others in just ankles, also shoulders only, others that only do laser eye surgery, others that only do teeth, some just for gums, some only do tooth implants. And on and on. There is a shortage of doctors that actually treat sick people.

jacquesm 7y ago

You just asked a person qualified to give you their professional opinion and then you turned around and more or less completely undercut that professional opinion. You need the experience and you need the detailed instruction. That's why there are certification programs around the operating of complex healthcare machinery. Just like you don't want a front-ender doing back-end or systems work you don't want your psychiatry residents to operate an ICU.

SkyPuncher 7y ago
> Just like you don't want a front-ender doing back-end or systems This is not the argument I'm making though. That implies the front dev has no oversight. I'm making the argument that a frontend development can successfully complete features with the guidance/oversight of a backend dev. The results might not be ideal, but it can provide an acceptable outcome. ---- > You need the experience and you need the detailed instruction. That's why there are certification programs around the operating of complex healthcare machinery. These programs are focused on developing individuals who can robustly and independently manage this complex machinery. Should we also discredit airline pilots because laypeople have landed planes in emergencies? Or discredit sports professionals because many can kick a ball?
- jacquesm 7y ago
  There are exactly 6 known instances of talk down landings that I'm aware of. All concerned general aviation and in one of them the person had prior flight experience. Several of those ended in a crash. A general aviation plane is in no way comparable to a large airliner, and no instance of such a landing has ever been recorded, nor has it been attempted. Life is not a movie, some stuff is just hard and requires a long time of training before we'll let you go 'solo'. One mistake and someone ends up dead, there are no do-overs, there is no undo button. The last thing ICU's need right now is on top of all the stress already going on there to be overrun by eager rookies that are trying to help. The best we can do - and this is happening in some places - is to move up the training schedule and to graduate ICU nurses early. This is need for several reasons: to man the extra ICU capacity that is coming online and to take the place of those who have died or can't take it anymore due to psychological stress.

cadlin 7y ago

Doctors that don't know how to properly operate a vent are currently a problem in the US. Not blaming them, as there doesn't seem to be any real alternative. Here's an /r/medicine discussion of it. https://www.reddit.com/r/medicine/comments/fr0x3m/how_do_you_deal_with_it_when_fellow_physicians/ https://www.reddit.com/r/medicine/comments/fr0x3m/how_do_you...

SkyPuncher 7y ago
I don't think you can pick a single /r/medicine thread as evidence of a widespread problem. My wife and every other doctor to ever practice medicine can give you anecdotal examples of other doctors mismanaging patients. Another thing to consider is this is a rapidly changing/progressing disease and there are no standards. The opinion of a recently graduated fellow has different biases than an experienced attending. They can both be correct while disagreeing on the specifics.

billfruit 7y ago

I think some European countries have tried to deploy Dermatoloists and Gynecologists, etc s into ER in the present scenario after a training course. Some medical students also could be utilised, if there is acute shortage, perhaps.

mistermann 7y ago

Do you have any idea how long it took your wife to learn to achieve the level of skill she is at? Let's say this was WW3, and we somehow lost 75% of these specialized personnel, what would be a ballpark estimate to get a reasonably intelligent person with no medical experience up to a "functional" level?

SkyPuncher 7y ago
There's a lot to this question. > what would be a ballpark estimate to get a reasonably intelligent person with no medical experience up to a "functional" level? It really depends and I'm speaking out of my comfort zone here. Becoming a doctor takes a really long time because it includes a LOT of background and general medicine knowledge. Doctors know a lot about medicine outside their speciality. Med school is 4 years (2 years of bookwork focus and 2 years of clinical focus) and builds on undergrad significantly. Residency is 3+ years. I'd say the majority of people with STEM backgrounds could have function acceptably as a general doctor with 2 to 5 years of postgrad training. Surgeons are built much more on experience so that's very hard to fast track. In my opinion, the real measure is the ability to handle edge cases/unusual cases. Specialized/limited scope workers, especially those with the direct support of an experienced individual, could pick up tasks much, much more easily as long as an expert is there to take over the challenging cases.
- mistermann 7y ago
  Sorry, I probably should have been more clear, I was referring to teaching someone only the skills necessary to operate a ventilator, in a supporting role to a properly trained medical professional, who would handle the more complex situations. I'm willing to consider that it isn't possible, but if that is the case, I'd be keen to know the particulars of why. If there happened to be a documentary on respirators that covered some of the complexity involved, I would be on my couch watching it.

tcbawo 7y ago

There is an ophthalmologist/comedian on Twitter @dglaucomflecken with an entertaining, somewhat tongue in cheek feed with similar sentiments (https://twitter.com/DGlaucomflecken/status/1238954558140772354?s=19 https://twitter.com/DGlaucomflecken/status/12389545581407723...)

jacquesm 7y ago
Priceless, and just what the ICU backseat driver crowd needs to see.
SkyPuncher 7y ago
Thank you. That made my wife's morning.