3 ms·

Amazing. I agree that the ER was not necessary for your daughter, but am impressed you can extrapolate that one experience to the entire set of patients with he

Amazing. I agree that the ER was not necessary for your daughter, but am impressed you can extrapolate that one experience to the entire set of patients with heart failure, pneumonia, sepsis, pyelonephritis, appendicitis, intestinal obstruction, gastrointestinal bleeds, electrolyte disorders, fractures, NSTEMIs, and many others who are not wheeled in by police / paramedics but need urgent complex diagnostics and imaging. What deep understanding and wisdom you hold, and with such high confidence too.

arkitaip 5y ago
This is after all Hacker News where we provide simplistic and ultimately wrong solutions to problems we don't understand.
- jfengel 5y ago
  What do you mean? We're hackers. We're masters of the universe. We run the economy and solve problems. Of course something as trivial as health care can't be too hard. After all, they don't even Kaggle. </snark>
tantalor 5y ago
> ER was not necessary I don't know how you read that and came to this conclusion. Maybe you aren't a parent?
- padastra 5y ago
  He described that he was able to go to urgent care for his daughter for a quick fix and the ER was not necessary for them (and the urgent care doctor who saw them must have agreed or they would have been sent back to the ER). What conclusion should I have come to?
  - jcims 5y ago
    People go to the ER because they don't want to fuck around with situations that they know they are insufficiently trained to diagnose. When your child is bleeding out of their face why in the world would you roll the dice at the local strip mall urgent care when there is a giant children's hospital nearby? Why didn't the ER send a nurse out to triage this after 2 hours of waiting to say they could get sufficient help elsewhere? My experience with ERs over the past 20 years largely mirrors that of GPs. Then when we started going urgent care out of frustration we ultimately got inferior care for my wife that delayed a cancer diagnosis by 3-4 months.
    - padastra 5y ago
      A few hospitals now have urgent care and ERs right next to each other, with a triage nurse in front saying which area to go to. That seems like a good system. I obviously agree with you that people can’t be expected to perfectly discriminate which they should go to. The root of my comment was to defend the availability of ER services against someone who literally suggested that ERs were not needed for anyone who didn’t arrive by ambulance or by police, not to argue the specifics of his child’s case for which neither one of us have any real knowledge. I am sorry about your wife’s experience. It contributes to making healthcare discussions so challenging, because there are incredibly emotional, stressful, and unfair situations in each direction (people who got billed tens of thousands on one side; people who were not diagnosed on the other) — including in countries with socialized medicine. I would suggest that your wife would have been best served not by an ER doctor, but by a highly trained and thoughtful primary care physician who could have followed her and understood what she’s going through longitudinally. Sadly, we burden medical students with $200K in debt and then ask them to choose between a high-paying good-lifestyle specialty or a low-paying poor-lifestyle specialty. And then one layer down, the primary issue is it’s hard to pay PCPs more when 99.5% of their visits are for common colds, medication renewals, knee pain, etc. and 0.5% of their visits make huge impacts (e.g. diagnosis of cancer early). Just like trying to discriminate urgent care vs. ER, how does one know which patients to send to an NP who can take care of routine issues, and which to send to a PCP with a better understanding of complex issues including management of multiple specialists’ recommendations.
anu7df 5y ago
Amazing what people can read from a comment. Notice that I said ER has long ceased to be useful and not that ERs are useless. May be the subtlety in the difference is only in my state of mind as I wrote the comment. But, what I meant to say was that for a vast number of genuine ER cases that come in, even with triage prioritization, the care is delivered later than it should because of the number of non emergency cases clogging up the system. Most people I saw in the ER the other day had non acute symptoms, (while I cannot really say anything without knowing their medical history, the fact that most people were munching on takeouts or vending machine food and seemed to have been there for hours tells me the symptoms are probably not acute. Their circumstances may be such that ER is the only place they can go to, but that is a different problem.

arkitaip 5y ago

This is after all Hacker News where we provide simplistic and ultimately wrong solutions to problems we don't understand.

jfengel 5y ago
What do you mean? We're hackers. We're masters of the universe. We run the economy and solve problems. Of course something as trivial as health care can't be too hard. After all, they don't even Kaggle. </snark>

tantalor 5y ago

> ER was not necessary I don't know how you read that and came to this conclusion. Maybe you aren't a parent?

padastra 5y ago
He described that he was able to go to urgent care for his daughter for a quick fix and the ER was not necessary for them (and the urgent care doctor who saw them must have agreed or they would have been sent back to the ER). What conclusion should I have come to?
- jcims 5y ago
  People go to the ER because they don't want to fuck around with situations that they know they are insufficiently trained to diagnose. When your child is bleeding out of their face why in the world would you roll the dice at the local strip mall urgent care when there is a giant children's hospital nearby? Why didn't the ER send a nurse out to triage this after 2 hours of waiting to say they could get sufficient help elsewhere? My experience with ERs over the past 20 years largely mirrors that of GPs. Then when we started going urgent care out of frustration we ultimately got inferior care for my wife that delayed a cancer diagnosis by 3-4 months.
  - padastra 5y ago
    A few hospitals now have urgent care and ERs right next to each other, with a triage nurse in front saying which area to go to. That seems like a good system. I obviously agree with you that people can’t be expected to perfectly discriminate which they should go to. The root of my comment was to defend the availability of ER services against someone who literally suggested that ERs were not needed for anyone who didn’t arrive by ambulance or by police, not to argue the specifics of his child’s case for which neither one of us have any real knowledge. I am sorry about your wife’s experience. It contributes to making healthcare discussions so challenging, because there are incredibly emotional, stressful, and unfair situations in each direction (people who got billed tens of thousands on one side; people who were not diagnosed on the other) — including in countries with socialized medicine. I would suggest that your wife would have been best served not by an ER doctor, but by a highly trained and thoughtful primary care physician who could have followed her and understood what she’s going through longitudinally. Sadly, we burden medical students with $200K in debt and then ask them to choose between a high-paying good-lifestyle specialty or a low-paying poor-lifestyle specialty. And then one layer down, the primary issue is it’s hard to pay PCPs more when 99.5% of their visits are for common colds, medication renewals, knee pain, etc. and 0.5% of their visits make huge impacts (e.g. diagnosis of cancer early). Just like trying to discriminate urgent care vs. ER, how does one know which patients to send to an NP who can take care of routine issues, and which to send to a PCP with a better understanding of complex issues including management of multiple specialists’ recommendations.

anu7df 5y ago

Amazing what people can read from a comment. Notice that I said ER has long ceased to be useful and not that ERs are useless. May be the subtlety in the difference is only in my state of mind as I wrote the comment. But, what I meant to say was that for a vast number of genuine ER cases that come in, even with triage prioritization, the care is delivered later than it should because of the number of non emergency cases clogging up the system. Most people I saw in the ER the other day had non acute symptoms, (while I cannot really say anything without knowing their medical history, the fact that most people were munching on takeouts or vending machine food and seemed to have been there for hours tells me the symptoms are probably not acute. Their circumstances may be such that ER is the only place they can go to, but that is a different problem.