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I don't have much personal experience with hospitals, but there's a trend I've noticed across several articles now where the medical system is characterized by

I don't have much personal experience with hospitals, but there's a trend I've noticed across several articles now where the medical system is characterized by an unpredictable and frequent alternation between extreme competence and extreme incompetence. The author's dad was being seen by a variety of highly trained specialists all working to treat him, but "people need to sleep" seems to be a recent discovery in the ICU world, and if his family hadn't been there to help, every new nurse would have tried to give him the same medication that gave him a bad reaction, over and over, just because there wasn't an established place to write that (obviously important) information down. I've read that food with better nutrition than regular hospital food may reduce mortality rates by as much as half [0]. That's such a huge effect that it's shocking that hospital food is just expected to be bad. Everyone says nutrition is vital for health, but hospitals don't seem to care. I think the root problem is cost-cutting. Management cuts costs until the brink of disaster, and tries to hold it there for as long as possible. This is not a system that strives for the best outcome for patients within reasonable limits of the resources available; this is a system that attempts to extract as much value as possible from the patients, and patient death is only prevented as a means to that ends. [0] https://www.sciencedirect.com/science/article/pii/S0735109721009384 https://www.sciencedirect.com/science/article/pii/S073510972...

colechristensen 4y ago
>The author's dad was being seen by a variety of highly trained specialists all working to treat him The training doesn't really matter. Context is very important as is caring about doing a good job. You'll find a severe lack of both in hospitals. You eventually have to stand up and defend yourself against bad healthcare... or search endlessly for good healthcare which is terribly difficult to find.
cactus2093 4y ago
From reading the abstract you are completely mischaracterizing this study. For the average person healthy food usually means food with fewer calories and more micro-nutrients, like eating more broccoli and less white bread. This study is about malnourished patients who need more calories than they can even digest from an average meal so they need specialized high-calorie foods that are customized for their own metabolism. It's essentially exactly the opposite of what "healthy food" means in any other context. So it has nothing to do with any narrative about cost cutting and the quality of ingredients used in hospital cafeterias.
- cco 4y ago
  A closer reading of the intervention shows that it wasn't _just_ "more calories". But I think that is missing the forest for the trees, what this study showed is that when a patient is left on their own, they consume an inadequate diet that _puts their health at risk_ in a hospital. By a big margin! I would imagine, though the study didn't show this, that the primary factor in recovery here was having a human (dietician) actually paying attention to your recovery. On intake they put together a plan, and followed up routinely to ensure that the patient has consuming their diet. The GP's point is valid, hospitals are missing out on a 50% increase in health outcomes because they're letting patients fend for themselves with regard to nutrition. You're right that it isn't as easy as spending $6 per meal vs $3 to buy "better" food. But what it means is that hospitals are failing their patients because they aren't thinking and acting with a holistic eye towards patient outcomes.
tunap 4y ago
>"people need to sleep" Sleep is almost impossible with regular check-ups... 30 min or 60 min, don't remember. Excepting the comatose and most medicated(maybe not?), a person's sleep cycle is unable to reach REM when a stranger approaches and fiddles on regular intervals. I would think monitoring from afar(sensors, cameras) would be more beneficial, but I was informed the liability factors preclude such remote monitoring. edit: to add context, I slept in the room on separate occasions with 2 family members. While tests were not performed, the regular checks were mandated. I was exhausted after my shifts ended.
- QuercusMax 4y ago
  Last time I was in the hospital (in 2016 with a broken arm) it was very difficult to sleep because the bed had some device that pokes you every so often to make sure you don't develop bedsores from lying too still. This makes sense for someone who might be in there for weeks, but I was barely there overnight!
  - tomcam 4y ago
    Nightmarish yet darkly comical. Sort of torture adjacent…
- ThePadawan 4y ago
  More than 10 years ago now, I was in the ICU for myocarditis, leading to bradycardia, a very slow heart rate. During the night, it would drop to 40 (which is still fine), but sometimes below 30, at which point my heart monitor would blare an alarm, waking me up and scaring the absolute bejesus out of me, raising my heart rate immensely. A nurse would walk in, see that I was fine, and leave again. This occurred nightly for a few days.
  - throwaway2037 4y ago
    I don't understand this post. It reads like "have your cake and eat it too". The the heart monitor did not blare an alarm, maybe you died. Which one do you want?
Negitivefrags 4y ago
I don’t think the problem is cost cutting. I think the problem is just the same problem that every human enterprise has. Most people just don’t give a shit outside thier immediate responsibility. Looking at the global view and actually making changes that require persuading other people is a hard and often thankless task. Many people who do give a shit get this crushed out of them early in their career by the negativity you will face if you try. Much easier to just accept the status quo. Occasionally you get a group of people who really care and come together determined not to let things be crappy and they can form an organisation that is significantly more effective for a time. But once the rot of “We can’t fix things” sets in, it’s really really hard to turn things around.
- halpmeh 4y ago
  Everything you said is spot-on, but, brining things full circle, the lack of “shit giving” could be due to cost cutting. People don’t have an incentive to care. The end result, vis-a-vis their personal situation, is unchanged whether or not they go the extra mile. Part of this is because they exist in a rigid corporate structure hyper-focused on value extraction and not at all focused on the development of human capital.
- rscho 4y ago
  I work in a hospital, and occasionally in ICUs. You're wrong. Most workers are very much jaded, but they do care. Problem is, the system crushes you to death if you don't set pretty harsh limits to protect yourself. In a lot of cases, that means de-humanizing your work, put your feelings aside and work like a machine. Good little machines are just what management wants, right? Now higher management... wow, those people really don't give a hoot about anything that's not themselves! A second major contributor to inertia, is that the initiatives from lower echelons are usually set for failure by the intricacies of bureaucracy. And said bureaucrats are completely unimaginative about what they could do to fix things, because they never leave their office to see what's really happening in the trenches. So yes, in fine the problem is the extreme stupidity stemming from human collective behaviour. Complain, and suddenly _you_ are the problem!
  - 4y ago
lazyasciiart 4y ago
I don’t know why the haldol reaction didn’t go in his chart, but the whiteboard in the room (which is present in every high level hospital room I’ve been in) is exactly where the TV information and other patient preferences should be, and is the second best place after the chart to put a drug reaction. Cost cutting has nothing to do with “nobody wrote it on the place for writing it”.
blue039 4y ago

colechristensen 4y ago

>The author's dad was being seen by a variety of highly trained specialists all working to treat him The training doesn't really matter. Context is very important as is caring about doing a good job. You'll find a severe lack of both in hospitals. You eventually have to stand up and defend yourself against bad healthcare... or search endlessly for good healthcare which is terribly difficult to find.

cactus2093 4y ago

From reading the abstract you are completely mischaracterizing this study. For the average person healthy food usually means food with fewer calories and more micro-nutrients, like eating more broccoli and less white bread. This study is about malnourished patients who need more calories than they can even digest from an average meal so they need specialized high-calorie foods that are customized for their own metabolism. It's essentially exactly the opposite of what "healthy food" means in any other context. So it has nothing to do with any narrative about cost cutting and the quality of ingredients used in hospital cafeterias.

cco 4y ago
A closer reading of the intervention shows that it wasn't _just_ "more calories". But I think that is missing the forest for the trees, what this study showed is that when a patient is left on their own, they consume an inadequate diet that _puts their health at risk_ in a hospital. By a big margin! I would imagine, though the study didn't show this, that the primary factor in recovery here was having a human (dietician) actually paying attention to your recovery. On intake they put together a plan, and followed up routinely to ensure that the patient has consuming their diet. The GP's point is valid, hospitals are missing out on a 50% increase in health outcomes because they're letting patients fend for themselves with regard to nutrition. You're right that it isn't as easy as spending $6 per meal vs $3 to buy "better" food. But what it means is that hospitals are failing their patients because they aren't thinking and acting with a holistic eye towards patient outcomes.

tunap 4y ago

>"people need to sleep" Sleep is almost impossible with regular check-ups... 30 min or 60 min, don't remember. Excepting the comatose and most medicated(maybe not?), a person's sleep cycle is unable to reach REM when a stranger approaches and fiddles on regular intervals. I would think monitoring from afar(sensors, cameras) would be more beneficial, but I was informed the liability factors preclude such remote monitoring. edit: to add context, I slept in the room on separate occasions with 2 family members. While tests were not performed, the regular checks were mandated. I was exhausted after my shifts ended.

QuercusMax 4y ago
Last time I was in the hospital (in 2016 with a broken arm) it was very difficult to sleep because the bed had some device that pokes you every so often to make sure you don't develop bedsores from lying too still. This makes sense for someone who might be in there for weeks, but I was barely there overnight!
- tomcam 4y ago
  Nightmarish yet darkly comical. Sort of torture adjacent…
ThePadawan 4y ago
More than 10 years ago now, I was in the ICU for myocarditis, leading to bradycardia, a very slow heart rate. During the night, it would drop to 40 (which is still fine), but sometimes below 30, at which point my heart monitor would blare an alarm, waking me up and scaring the absolute bejesus out of me, raising my heart rate immensely. A nurse would walk in, see that I was fine, and leave again. This occurred nightly for a few days.
- throwaway2037 4y ago
  I don't understand this post. It reads like "have your cake and eat it too". The the heart monitor did not blare an alarm, maybe you died. Which one do you want?

Negitivefrags 4y ago

I don’t think the problem is cost cutting. I think the problem is just the same problem that every human enterprise has. Most people just don’t give a shit outside thier immediate responsibility. Looking at the global view and actually making changes that require persuading other people is a hard and often thankless task. Many people who do give a shit get this crushed out of them early in their career by the negativity you will face if you try. Much easier to just accept the status quo. Occasionally you get a group of people who really care and come together determined not to let things be crappy and they can form an organisation that is significantly more effective for a time. But once the rot of “We can’t fix things” sets in, it’s really really hard to turn things around.

halpmeh 4y ago
Everything you said is spot-on, but, brining things full circle, the lack of “shit giving” could be due to cost cutting. People don’t have an incentive to care. The end result, vis-a-vis their personal situation, is unchanged whether or not they go the extra mile. Part of this is because they exist in a rigid corporate structure hyper-focused on value extraction and not at all focused on the development of human capital.
rscho 4y ago
I work in a hospital, and occasionally in ICUs. You're wrong. Most workers are very much jaded, but they do care. Problem is, the system crushes you to death if you don't set pretty harsh limits to protect yourself. In a lot of cases, that means de-humanizing your work, put your feelings aside and work like a machine. Good little machines are just what management wants, right? Now higher management... wow, those people really don't give a hoot about anything that's not themselves! A second major contributor to inertia, is that the initiatives from lower echelons are usually set for failure by the intricacies of bureaucracy. And said bureaucrats are completely unimaginative about what they could do to fix things, because they never leave their office to see what's really happening in the trenches. So yes, in fine the problem is the extreme stupidity stemming from human collective behaviour. Complain, and suddenly _you_ are the problem!
- 4y ago

lazyasciiart 4y ago

I don’t know why the haldol reaction didn’t go in his chart, but the whiteboard in the room (which is present in every high level hospital room I’ve been in) is exactly where the TV information and other patient preferences should be, and is the second best place after the chart to put a drug reaction. Cost cutting has nothing to do with “nobody wrote it on the place for writing it”.

blue039 4y ago