18 ms·

It's just a virus, the E.R. told him – days later, he was dead

247 points by wallflower 1y ago

timbritt 1y ago
https://archive.is/MgWJH https://archive.is/MgWJH
gleenn 1y ago
FTA: "As hard as the job is, diagnostic accuracy in the E.R. is high overall. But a recent systematic review of published research estimated that 5.7 percent of E.R. patients will have at least one diagnostic error and 2 percent have a setback as a result." I feel like scrutinizing the industry for a 2-3% error on an obviously difficult problem is exactly why we pay so much in the United States for health care.
- adastra22 1y ago
  When the consequences are lethal for that 2-3%, that scrutiny is needed.
  - ACCount37 1y ago
    [flagged]
    - hshdhdhehd 1y ago
      Ok Goodhart! We might need other measures. It might be damn complex. Ideally 100% would die from "malpractice" (or unknown able issues) because people are so healthy and society is so safe there is barely anyone in ER.
  - jopsen 1y ago
    A set back is not necessarily lethal. We expect so much from our health care providers, and we sometimes don't appreciate that they deal with a wide array of patients. Some will come in with a tiny brushing, asking if they are going to die. Others will walk around with a critical condition for days, saying maybe they were a little sore, but they didn't think it was too bad.
- actionfromafar 1y ago
  Yes. Less scrutiny, more insurance middlemen please.
  - AnthonyMouse 1y ago
    It's not quite that one either. The big problem is that most people get health insurance through their employer, and then it's the employer choosing it rather than the insured. Otherwise people would choose different insurance and in particular insurance with lower premiums but higher deductibles, and then use the money they saved on premiums to pay out of pocket for things that cost less than the deductible. And then actually insist on getting a real quote and having the ability to compare prices for non-emergency medicine. So the main problem is employer middlemen. Which happens in significant part because of tax incentives for employers to do that which you can't get if you do it yourself.
    - potato3732842 1y ago
      >tax incentives for employers to do that which you can't get if you do it yourself. Is there any problem today that DOESN'T boil down to the government giving preferential treatment to some class or group?
      - IAmBroom 1y ago
        Yes, tons. You choose to focus on the government-aided ones.
- Kenji 1y ago
  [dead]
- AnthonyMouse 1y ago
  > I feel like scrutinizing the industry for a 2-3% error on an obviously difficult problem is exactly why we pay so much in the United States for health care. If only. Then the outcomes would be better. The real reason is that it's ostensibly supposed to be a market but the pricing for everything is completely opaque and shrouded in bureaucracy and corruption.
- sr-latch 1y ago
  2-3% error is too high, this is something we _should_ be scrutinizing, and healthcare _should_ be more expensive if the reason it's expensive is that we're pouring more resources into it to get diminishing returns on reducing mistakes. Costly healthcare due to scrutiny is not the problem with healthcare in the US. The problem is drug monopolies, medical (mal)practice without a license by insurance companies, and the lack of taxpayer funded healthcare-as-a-right. We need to create an environment where someone like Terblanche feels comfortable advocating for himself without feeling like he's being a burden on the ER, and physicians don't feel like they're wasting time by investigating seemingly trivial cases. Such a situation exists because we are not pouring enough money into healthcare in this country.
  - hshdhdhehd 1y ago
    It feels high to me because most ER cases should be obvious i.e. heart attacks, car accidents and strokes etc. So if say 10% of cases are non standard then 2% overall is 20% off that.
    - harvey9 1y ago
      Not only is the case mix much broader than you imagine but even the three things you listed all have plenty of nuance at the individual case level.
    - IAmBroom 1y ago
      We don't have an anti-heart attack pill. Medicine hasn't developed the post-car-accident protocol. Strokes vary so much in type that they can go unrecognized by competent doctors for years.
    - sarchertech 1y ago
      The ER functions as primary care for a large percentage of the population. They see far far more than the kinds of thing a rational person with health insurance thinks of when they think about medical problems they’d go to the ER for.
  - closewith 1y ago
- deleted 1y ago
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- 0xDEAFBEAD 1y ago
  An alternative way to throw money at the problem: Instead of trying to further improve accuracy, build out space for more ER beds, and implement continuous monitoring of marginal patients. Or, build devices to send home with patients which allow for cheap, continuous self-monitoring. That might be a legitimate application of AI actually, if you could use e.g. phone camera tricks to measure more health parameters. Even if imperfect, it could still pick up a few patients who should not have been sent home.
  - CrossVR 1y ago
    This is mentioned in the article, the fundamental problem is a capacity problem. If patients could be moved out of the ER department to hospital wards then there would be a greater ability for the ER department to monitor patients.
    - nradov 1y ago
      There is a (somewhat artificial) middle ground in US hospitals where patients can be admitted for observation but still be considered outpatient. https://doi.org/10.1001/amajethics.2023.901 https://doi.org/10.1001/amajethics.2023.901
    - gowld 1y ago
      This is because beds are artificially expensive because hospitals deploy maximum-feature bed equipment and services, to avoid malpractice claims, and to increase billing.
- ludicrousdispla 1y ago
  We pay too much in the US because of the self-imposed medical labor shortage and that results in mistakes by over-worked staff.
  - schnitzelstoat 1y ago
    Yeah, it always seems crazy to me that in a country that is often so economically liberal and free market, medicine is still run like a medieval guild.
- aucisson_masque 1y ago
  I thought so but reading the whole article, it seems like there has actually been mistakes. Several. Someone who goes to the hospital 3 times and still die because of an untreated disease is not just bad luck.
- throw-qqqqq 1y ago
  > I feel like scrutinizing the industry for a 2-3% error on an obviously difficult problem is exactly why we pay so much in the United States for health care All research I’ve read on this topic finds that it is the US legal system that causes the crazy prices (incentivizing more testing to cover-your-ass and avoid liability etc.) Many comparative studies on health care cost and quality use the US military as a proxy, as it is free on the condition that you cannot litigate (very coarsely; it is more nuanced). The costs for treating US military personel is much closer to other countries (while treatment quality remains equal).
  - neffy 1y ago
    It´s not just the legal system. A lot of US Doctors are typically paid on a piece rate basis, and the medical records systems are extremely fragmented, so there is an incentive to order repeat tests (as you get passed around from specialist to specialist), and no incentive to put the systems in to make that unnecessary.
  - red-iron-pine 1y ago
    I believe your points, but give me a source.
  - nradov 1y ago
    That is a factor but a relatively small one. Several US states have instituted limits on medical malpractice liability and that has had only a small impact on total healthcare system costs. It's often the patients themselves (or family members) who insist on trying every possible diagnostic test, and even with the growth of evidence-based medicine we still don't have clear clinical practice guidelines covering many of those situations.
- kakacik 1y ago
  Part of the reason is - people are not machines, its extremely hard to diagnose quite a few situations since every body is a bit unique. Add tons of medications and issues every older person has, within their own unique bodies. Add symptoms like chest or abdominal or head pain which can mean hundreds of conditions, some benign some deadly. Add time pressure to diagnose quickly since that's how medical systems are set up. Wife is a doctor so I can see the perspective from the other side too. I've had a thrombosis formed in my calf after having a broken leg and using cast. I also caught covid during that time, and from what I've read now I believe it increases temporarily clotting of blood for certain people. When cast was removed, leg was still stiff as wooden plank and ankle didn't bend. I wasn't told to keep the leg higher so I didn't. Some weird mild pain started in the middle of the calf after few days, wife suggested it may be thrombosis rather than stiff muscles or tendons. Went to Switzerland's biggest hospital's ER, got blood tests, they were below limit for thrombosis, so I was just sent home. Pain didn't go away, luckily my wife considered it suspicious and asked another doctor who is an expert on this to recheck. Voila, thrombosis there. The cause of miss - ER doctors should have done more than just a blood test (even by their own ER protocols, checked that with wife and her colleagues), echography would have shown blood clot in the veins. If it got dislodged and ended up in lungs, that's a quick death within cca 20 mins, ambulance & CPR usually are not sufficient to keep person alive without major brain damage. Or blood clot goes into brain, cutting off some part of it with similar result. One peer from back home died exactly like that (lung variant, the most deadly one).
  - red-iron-pine 1y ago
    yeah this be part of it. each aircraft is designed to be effectively identical. yeah yeah there may be some gremlins or bugs in the airframe but in theory it should fly and handle just like each other aircraft. each human may be wildly different
  - prerok 1y ago
    I am happy you were able to solve it. One of my friends had exactly this problem, but he just died the next day :( Sorry to have the need to have shared this, but at least it's been on my mind every time I hear someone take their cast off and experience something similar.
- UI_at_80x24 1y ago
  That 5.7% number must be wrong. Ask anybody with a chronic medical condition. I've had uncountable number of doctor's visits including ER for 37 years before a proper diagnosis was made.
- mouse_ 1y ago
  the problem is greed.
- IAmBroom 1y ago
  So, your premise is that the US is unique in its lack of checklists in the ER?
lhmiles 1y ago
Would have lived if he had a roommate. Do universities do single dorms now
- leptons 1y ago
  Doubt it. A roommate has a life outside of that room, they aren't likely to be there, or know what to do. There's no certainty that a roommate would have been the factor that saved his life.
  - bell-cot 1y ago
    I'd characterize it as "another saving throw". The roommate might be absent, or preoccupied with his own life, or "staying away from the virus", or too self-doubting to do anything in time. Similar for Sam's girlfriend Kayla. If she'd been assertive and physically present, she might have saved his life. Similar any close friend of Sam's. Similar a bottom-tier resident staff member in Sam's dorm, worried about one of his residents and regularly checking. (Yes, the U's dorm system "could" officially try to keep an eye on sick residents. But with America's legal system, don't expect any sane university official to sign off on doing that.)
    - Macha 1y ago
      From the story it sounds like the parents were notified by the university one day after he'd last been in touch, so someone (be it a roommate or dorm staff) was checking in at least daily.
      - jacobgkau 1y ago
        The story specifically says Sam's friend Charlie contacted campus security after Sam stopped responding to Charlie and Kayla (Sam's girlfriend). Campus security wouldn't have known to check in within a day if Sam's friends weren't on top of keeping in touch with him. (Put another way, I certainly would've rotted longer than that if this had happened to me in college-- lucked into having my own dorm room & had acquaintances but not any friends who would've gone out of their way like that.)
mnw21cam 1y ago
If you visit the emergency department of a lot of British hospitals, there will be large posters reminding the doctors "Could it be sepsis?" because of similar instances that occurred over here.
- InfiniteLoup 1y ago
  > there will be large posters reminding the doctors "Could it be sepsis?" I'm not sure how effective this is. Information presented this way quickly fades into background noise..
  - gtr 1y ago
    The patients can also see the posters, and it won't be background noise for them, so they can think of asking about it.
    - f1shy 1y ago
      Oh. There is nothing more contra productive than asking an experienced physician “could this not be X”. They will typically go in “if you think google knows better, ask it and fuck off”. Ask me how I know. I think that attitude even has a name (BTW, I’m guilty! If I say “there is a dangling pointer” and the guy starts with another theory, I will dismiss him quickly)
      - IAmBroom 1y ago
        My experience is completely the opposite. It often annoys them, but they are forced to address my question, and that's my goal.
        gowld 1y ago
        Arguing with a doctor can lead to accusations of "drug-seeking behavior" (which can cause treatments to be refused, and there is some legal pressure behidn this) or "mental illness" (which can cause involuntary psychiatric hold, effectively kidnapping).
dinobones 1y ago
My wife (then girlfriend) and I were at a concert. She went to the bathroom to pee. She came back crying. I told her she might have a UTI. It was not normal for it to hurt that badly to pee. She denied it. I bought her a UTI test, it came out positive. She was shaking. I told her we had to go to the hospital, she thought they were period cramps. I call a teledoc. They video chat. She explains the pain shes feeling in her lower back means it’s likely a UTI, the infection has likely reached her kidneys, and we should go to the ER immediately. In the ER we think they’re going to just give her some antibiotics and send her home. Nope. She throws up. Things go bad fast. Her heart rate is 160. She turns a color I’ve never seen a human before. The next 3 days were so incredibly hard. But I’m so thankful to all the medical workers that were attentive to us. Thankfully she makes a full recovery. For a week or so she was lethargic/tired but she’s fully healthy now. A few months before I had read a story about a woman who’s boyfriend had died from a UTI because they went to a gospital, gave him some antibiotics, and he ending up dying at home because the infection was already too progressed to fight off at home. Had the person who evaluated my girlfriend not evaluated seriously or just sent her off that could’ve been her. I’m so thankful they admitted her and took her care seriously. It’s scary how quickly a UTI or some other benign infection can become sepsis. Take it seriously.
- Shank 1y ago
  > Had the person who evaluated my girlfriend not evaluated seriously or just sent her off that could’ve been her. I’m so thankful they admitted her and took her care seriously. This might sound strange, but I think you deserve some credit for taking it seriously and being there. It’s a documented issue that women’s problems are frequently written off and downplayed as normal things like period pain. I’m really truly happy to hear that she made a full recovery as well. It is wonderful to hear that she is okay.
  - bell-cot 1y ago
    [flagged]
- InsideOutSanta 1y ago
  > Had the person who evaluated my girlfriend not evaluated seriously or just sent her off that could’ve been her Everybody did well in that instance, including you. Many people won't advocate for themselves, so having someone around who will do it for them is incredibly important.
0xDEAFBEAD 1y ago
>In his effort to understand hospital safety and risk, he learned these oft-cited projections: more than 200,000 people will die each year from preventable medical errors. He was shocked. Conservatively, these estimates amount to at least one fatal Boeing 747 crash per week, Terblanche calculated. This reminds me of the book The Checklist Manifesto by surgeon Atul Gawande. The book argues that aviation has achieved such a good safety record largely through the use of checklists, and Gawande describes his attempts to apply them to the field of medicine. Recommended. (Edit: I see that checklists are discussed later in the article; I would still recommend the book, as it has thoughts on how checklists can be applied more effectively.)
- f1shy 1y ago
  Being a pilot I can attest how important checklists are, and I do advocate for using them in medicine (have practicing relatives, and I have them tired with that). But maybe you oversimplified the book? (Or the book oversimplified how safety was achieved?) There are some other 100s of reasons why aviation is safe. Heck, some of them could also be applied NOW: people must rest! I do NOT want to be treated by a doctor doing an idiotic 24hs shift, which is the norm in every country I know of… There is a whole list of things that can be transferred from aviation to medicine. Another point I know of is the “handover” of patients. Just as ATC hands over planes from one controller to another, some procedure should warrant the correct transfer of information between shifts. Oh boy I have hear some funny (and some bot at all funny) stories about it.
  - rkomorn 1y ago
    The long shifts are the most baffling thing to me. AFAIK they're also common in law enforcement. "Hey these people make life or death decisions. You know what's going to help? Fatigue." From the outside, it just seems insane.
    - red-iron-pine 1y ago
      how much more are you willing to pay? more law enforcement = more taxes more shifts for docs = more $$ paying for more medical staff. I can't speak to the police, but there have been a bunch of studies that showed that handoffs between shifts at hospitals is where things go bad. Someone doesn't document they gave an extra 2 cc of a drug to a patient, and next shift gives them more and causes issues, etc. Basically longer shifts = more fatigue, and the number of errors caused by fatigue were still lower than hand-off related errors.
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draven 1y ago
> Sam’s girlfriend, theorized that in the hospital Sam didn’t want to be a bother and didn’t advocate for himself I'm like that and it sucks, I now bring my wife to medical appointments so she can complain for me while I downplay everything.
- dsego 1y ago
  If there is anything I've learned in my country (with national health care) where it's common for doctors to ignore you and say it's nothing, is to be overly pushy and even rude. It could be nothing, but a lot of time instincts are correct, and it's a mild embarrassment if you are making a fuss over nothing, but could be a life or death situation. And you could argue that everyone behaving like this is making it worse, and that might be right. But I remember multiple national headlines in recent years where little kids died of pneumonia after being sent home because they ruled out infection, sometimes even after parents already brought the kid back for the second or third time to the hospital after their condition wasn't improving. I know I'm not making chances even if it means getting a second opinion or driving to a different town to a different hospital, sometimes it's better to take things into your own hands than be complacent and rely solely on the medical system doing the right thing.
  - potato3732842 1y ago
    The "there's someone here who'll still be alive to be deposed and/or testify if we fuck up" factor really gets them to be serious.
    - blargthorwars 1y ago
      Especially if the second person peppers their speech with correctly used medical terms.
- eYrKEC2 1y ago
  My son almost died in the first 24 hours of life. I said, "There's something wrong. There's something wrong." multiple times and the nurses finally told me, "YOU NEED TO CHILL OUT." I did chill out.... Next morning the pediatrician did his rounds, checked on my son, and immediately started speaking Latin, to go over our heads while rushing around and getting equipment to clear his lungs of amniotic fluid. Reminds me of what my first engineering boss told me -- "When the people on the line say there is a problem. There is a problem."
kameit00 1y ago
Non paywalled version: https://archive.is/tJePt https://archive.is/tJePt
bell-cot 1y ago
Three major problems to note in the story: - Lack of any low-intensity monitored recovery option. If the kid could just have been sent home to a traditional worrying mother, who'd been told to watch for certain warning signs - then he very likely would have lived. - Critical shortages of front-line medical staff. (ER nurses especially noted here. But a dishonorable mention to the computer systems that the residents were fighting against.) - However short our medical system might be on front-line resources to treat patients needing care - once it's lawsuit time, resources seem plentiful.
- quantumwoke 1y ago
  I don't quite understand your third problem. I also don't think the shortage of ER nurses necessarily contributed, as clearly the doctors and the friend thought he was well enough to go home. Definitely agree with the first problem though. We put our kids through a lot of risk by sending them to interstate college...
quantumwoke 1y ago
Heartbreaking story. They talk a lot about the possibility of bacterial infection but it was not consistent with the blood tests. It seems he just got unlucky (although should have had a Chest X-Ray). Trying to reframe it in a coding analogy, there were a few abnormal logs maybe an exception or two but the coder was unable to figure it out and these exceptions happen all the time and so pushed to live anyway. Due to resource allocation issues they were pulled to a different job. Then the site crashed. Just awful.
- lotsofpulp 1y ago
  This is 99.9% of “news”.
wewewedxfgdf 1y ago
Always get a second opinion from ChatGPT, a third from Claude and a fourth from Gemini. It is astounding how much more you can learn about your diagnosis from an LLM.
- ThePowerOfFuet 1y ago
  What could possibly go wrong.
  - rafaelero 1y ago
    Things are already going severely wrong in 1% of the cases. At this point not getting a second opinion from an LLM is irresponsible, imo.
- blargthorwars 1y ago
  This is precisely the thing that LLMs are great for: spicy auto-complete.
  - CamperBob2 1y ago
    What do you think doctors do all day?
- OutOfHere 1y ago
  I have found it very useful to discuss possible diagnoses and diagnostic steps with the LLM before going to the ER. Once there, I told them what my expectations were along with the rationale for it. They agreed with 80% of it. Ultimately the ER was of no use in treatment, but the preparation did help rule out a serious diagnosis.
adzm 1y ago
In my opinion, this is one of the more overlooked side effects of the covid pandemic: stretching resources in hospitals leads to lower quality care for everyone.
- triceratops 1y ago
  I don't think it was overlooked at all. This was the original justification for "flattening the curve".
codeulike 1y ago
Sepsis is hard to spot. Whats interesting about this article is that once you get into the details of whatt happened on the patients second visit, its largely about the hospital information systems and how they got in the way. An automated alert popped up warning that the doctors should consider Sepsis. That alert essentially then blocked progress, and the doctors ended up (essentially) ticking the 'not sepsis' box so that they could get on with their (reasonable) next step which was either ordering an x-ray or starting antibiotics. Then somehow after that, sepsis did not get re-considered. https://archive.is/tJePt#selection-1465.0-1491.52 https://archive.is/tJePt#selection-1465.0-1491.52 It was Banerjee’s task to document Sam’s care, and as he began to do so, a pop-up appeared on his computer screen. Sam’s fever and heart rate had triggered an automated warning for sepsis, a potentially life-threatening condition in which the immune system has a dangerous reaction to an infection. It requires speedy intervention. To help the hospital comply with state-mandated sepsis regulations, the pop-up provides a checklist of tests and orders used to identify and treat sepsis. Agyare had instructed Banerjee to hydrate Sam right away but to wait for the results of Sam’s lab work before ordering a chest X-ray or the strong antibiotics used to treat sepsis. But Banerjee, a novice, got stuck. He couldn’t figure out how to navigate the template to make some but not all of the auto-populated orders. “This was my first patient that triggered the sepsis pathway,” he explained, in testimony. So he asked Connor Welsh, a third-year resident, for help. At 8:50 p.m., Welsh showed Banerjee how. From his own computer, he clicked into a field on Sam’s chart to assert that sepsis was not likely: “Based on my evaluation,” the automated note said, “this patient does not meet clinical criteria for bacterial sepsis.” And then Welsh recorded what Banerjee said Agyare had said earlier: “Likely viral syndrome. Workup pending.” Welsh’s name appears on the note, but in his deposition he said he never interacted with Sam. Senior residents often help junior ones in this way, he said. “I signed this note based on the discussion with the provider, Dr. Banerjee, based on his evaluation and the medical management of Mr. Terblanche,” he testified. ... Sam’s chart is 51 pages long, a catalog of billing codes and abbreviations, check-boxes and shorthand, updates and addenda. The record of the second visit contains numerous contradictions: Sam’s heart rate was documented at 126, yet Banerjee clicked the box “normal.” In one place it says Sam didn’t have a cough, while in another it says he did. The signatures of doctors who testified they never saw Sam — including one who was not in the hospital that night — accompany notes. Vital signs were ordered and not taken, as was an EKG.
thelastgallon 1y ago
Everything is optimized for corporations to make more money, to avoid liability and maximize the billable dollars. Doctors want to move meat as quick as possible, most consultations are a couple of minutes! Every doctor has to be part of this rat race because of how the system is designed! "More than 200,000 people will die each year from preventable medical errors. He was shocked. Conservatively, these estimates amount to at least one fatal Boeing 747 crash per week." "Doctors talk about electronic medical records as an unpleasant and frustrating chore. They object to how the charts have evolved to prioritize billing and liability defense over clinical care. And they regard the symphony of well-meaning alerts and pop-ups as a distraction at best." "The check boxes and templates can aid efficiency, several doctors told me, but they also may distract physicians from the patients right in front of them."
- IAmBroom 1y ago
  > Doctors want to move meat as quick as possible, I don't know a single doctor who wants this. Insurance companies want this. Don't blame healthcare workers for the hellish scenarios they are forced to work under.
  - gowld 1y ago
    A doctor (who is is a licensed professional, not unskilled labor) could accept lower pay for less work (fewer patients seen), instead high pay for less work (false-treating patients).
    - roywiggins 1y ago
      Doctors can't build bigger ERs or hospitals, you need physical infrastructure to give patients extra time.
      - ikiris 1y ago
        This is laughably out of touch with the actual limits of care. It’s nursing staff and the shortage is a willingness to pay the costs of staffing.
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thegrim33 1y ago
Recently I got really, really sick. I was running a fever and bedridden for nearly a month straight. It got so bad one day that I ended up in two urgent cares and then they sent me onwards to the ER. They were constantly taking my blood, constantly running tests, and in the end they basically just shrugged and said it was seemingly some random virus they didn't have a test for, nothing they could do. I heard some doctors talking outside my room about how unusual it was for me to be sick for as long as I had been, and they just seemed to brush it off and one said something like "well he's still fairly young, he'll probably get through it eventually." They never figured out what it was, never were able to do anything to help me, just kind of shrugged, kept me overnight for more observation and then kicked me out the second the sun came out. My body and mind were absolutely shattered, especially after being woken up every 30min all night long for more blood draws, and I was told I could at least eat breakfast before I left, but they ended up reneging on this and kicking me out before breakfast time. This was at a major hospital, a well ranked one, in a major city. The experience really opened my eyes.
- dostick 1y ago
  Did you ask ChatGPT or something? It usually knows more. And what they were taking tests for.
  - yieldcrv 1y ago
    although this is the new "WebMD" self diagnosis, and the AI will agree with you and make some things up in subtle ways, this is still a great way to steer licensed professionals and cut through their own double speak - since licensed professionals are also making things up in subtle ways, not give you enough information about their findings or medication, and overlook many things
- rediguanayum 1y ago
  Not a doctor but I know some- Viruses are notoriously hard to diagnose because they don't culture. Some big academic hospitals do have a virus panel where they use brute force PCR assay akin to many Covid-19 tests targeting different virus but they are very expensive hence not broadly available. Community hospitals will have the same diagnostic experience you have. At most they might be able to test for Flu or Covid but that's about it. Another reason is that even if you test positive, there is very little the hospital can do. For the most part, just tell the patient to rest and take Tylenol/Ibuprofen. The anti-virals are just limited to Flu and Covid.
mindslight 1y ago
I feel like the urge to fight, sue, and demand answers is the direct result of the constructive maliciousness of the medical environment, as orchestrated by the beancounters and provider/insurance bureaucracy. Let's say doctors had the bandwidth to not cut patient discussions short, not expect patients to need an adversarial "advocate", take the time to entertain unlikely hypotheses, monitor/admit for good faith investigative reasons rather than purely on liability rubric [0], etc. Then, when the doctors failed, you would feel that the failing was of a human group that earnestly did everything they could have. But the way the medical system has been whittled down into some bare bones bureaucratic assembly line, it makes it feel like every such failure is a willful and deliberate goal of the system. Why is the medical industry primarily focused on cost optimization through tightening the screws when they aren't even able to get the right answers? [0] Like seriously I wish I could have given this kid one of the many weeks of observation that hospitals have given my paid-by-Medicare family members. The beds are available, they're just full of elderly people who had some acute problem but the hospital won't readily discharge them due to chronic medical conditions (plus they're messed up after being starved for a day in the ER).
TrackerFF 1y ago
From the info laid out in the article, it seems that unfortunately Sam was the Zebra, this time. The autopsy found pulmonary hemorrhage, enlarged heart, enlarged liver, damaged kidney.
kylehotchkiss 1y ago
We all want to uphold a system that limits medical school seats and won't create reliable immigration pathways for doctors to arrive here with just so doctors can maintain a specific salary. Then we'll go blame PE and consolidation and insurance or whatever. If doctors don't have enough time, then there aren't enough doctors. Our population is aging rapidly and the need is increasing despite population growth metrics. If there are more doctors, they will need to need to spread further into regions where they're in demand. This is a problem that we as voters should start to act upon.
- bckr 1y ago
  What do you think voters should do? How do we increase the number of doctors?
  - brandonmenc 1y ago
    Stop charging $300k for the medical degree.
  - wagwang 1y ago
    Our society will continue to feel the civilizational tax of not having enough kids unless AI doctor becomes a thing.
    - tastyfreeze 1y ago
      So, do your part. Make babies! It's fun and rewarding.
  - isubkhankulov 1y ago
    The current doctor workforce is limited by a congressional cap on Medicare-funded educational slots. Apparently it was established in 1997 to prevent a surplus. Of course, the opposite happened because of demographics and increased lifespans.
    - dpkirchner 1y ago
jacobgkau 1y ago
Beyond the case itself, I'd hazard a sad guess that the only reason this made news is because the victim's father was a lawyer who wasn't forced to simply take the hospital president's platitude at face value (and who had the time, money, and energy to put his normal career on pause and enroll in a master's program just to investigate the issue). If that were my family, it would be "that's terrible" but no actual action, because my parents wouldn't be able to do anything about it, nor would I if something like this ever happened to my own future kids.
- monero-xmr 1y ago
  There are legions of medical malpractice lawyers who would hear out your case. Personal injury attorneys advertise every place possible and they will gladly refer you to the correct place. You wouldn’t get a NYT writeup but a settlement? Litigation is as American as apple pie
  - jacobgkau 1y ago
    I was thinking similar-- a generic law firm could probably get a small payout, but wouldn't necessarily uncover as many details about the situation since they're not personally involved (and, as you said, would probably have less publicity as well).
    - monero-xmr 1y ago
      I think your worries are misplaced. This is bread and butter for lawyers. The problem with this case is it’s very fuzzy. We are seeing one side of the story as a lawsuit is certainly coming. Doctors are human and deal with high stress, life or death situations. They have medical malpractice insurance exactly for this. Even if you have a 99.9% perfect doctor, they will see many thousands of patients over their career, and that still means 1/1000 will die. People play the lottery on far worse odds. I found the article interesting less as a damning of the medical system and more of a spiritual situation. None of us know when a freak random event will end us. It is a sobering reality
esoleyman 1y ago
The ED is specifically attuned to these presentations but the sepsis alerts and algorithms in place are horrendous and will fire off even for this with viral illnesses and syndromes. Sepsis alerts are meant to find bacteremia in patients who present with a set of vital signs and laboratory findings indicative of it and even those definitions are not readily agreed upon. The ED is highly accurate with its diagnosis and treatments despite everything that has been said. Trying to find a zebra in the hoof beats of horses when the number of patients quickly outstrips your department’s capabilities is a fools errand because if the workup require will overwhelm throughout to the point that the delay in care will put other patients at risk. There is a fine line between doing enough and doing too much that will grind your department to a halt and then have your waiting room backing up. Unfortunately for this patient, his occult condition didn’t manifest itself within his two ED visits and we don’t have prognostic capabilities to tell who will and won’t decompensate. We all make value judgements and treat the patients in front of us
- gnfargbl 1y ago
  > Trying to find a zebra in the hoof beats of horses when the number of patients quickly outstrips your department’s capabilities is a fools errand because if the workup require will overwhelm throughout to the point that the delay in care will put other patients at risk. This is where that I hope (as a non-physician) that AI, used carefully, should actually be able to help. A well-designed ML system should have a decent chance at distinguishing a zebra from a horse because it has read absolutely everything, has perfect recall of that corpus, and has some ability to contextualize the knowledge it has to the situation at hand. I suspect that a good proportion of ER doctors already have those characteristics, but surely not all of them do, and surely not consistently. An AI-assisted system will still false-positive, because the computer is still just a tool, tools are never perfect and designers of safety systems tend to err on the side of false positives. However, a thoughtful pop-up that displays when the situation really may warrant it is surely more helpful to a physician that one that cries wolf to you constantly? My optimism assumes that there's fundamentally enough information available to make the diagnosis, however. If you're actually saying that finding the zebra would require gathering so much more information for each patient that it would lower overall outcomes for all patients, then I guess we're stuck.
mensetmanusman 1y ago
We need better tests for this. Globally one person dies every 3 seconds from sepsis.
- TrackerFF 1y ago
  From the article, the autopsy findings didn't support sepsis as cause of death.
- wayeq 1y ago
  that's rough, I'd hate to be that person
esoleyman 1y ago
There’s a thread about how emergency physicians are paid. It varies from group to group: Physicians can be salaried and receive benefits from their group or hospital Physicians can be 100% productivity based meaning that they will only get paid by the amount of patients they treat but they receive no other benefits from the group or hospital In between these two groups, there is a wide variety of compensation Packages that are complicated to discuss in this comment. Nonetheless, the overwriting factor for all emergency physicians is that we triage patients, not only after triage, but internally as well, including those patients at reside within the treatment rooms and those outside in the waiting room. The question is, can we see less patients and spend more time with them and the answer is yes but to the detriment of the entire department and possibly not seeing a patient who is sick and who hasn’t been seen yet. Do you have to be able to tell who you can spend five minutes with and who needs 30 minutes. Through put his king, but quality is queen, so there’s always a trade-off between seeing patients fast enough and to see enough patients through your shift, but to also how they were with all to determine which patients will require more time and more due diligence. Every shift is a pull and push between these two dichotomies and it’s never easy and there are multiple decisions that have to be made.
citizenpaul 1y ago
Its probably not PC but I think a huge part of this is the burnout associated with being forced to treat the same junkies day in and out. At some point you brain shuts off to possible alternatives and you just see everything as a "next, next,next" The answer is unfortunately you cannot treat everyone equal if they don't want to help themselves. I was at a ER for a bleeding puncture wound and was told to hold a bandage on it and wait while several 500lb people were seen because "they don't feel good". No $hit they weight 500lbs. Also kids apparently are always first, but I can see why that one is needed. They don't have automy like the other people there that are the source of their own problems.
- jimbob45 1y ago
  On the other hand, American health insurance is arguably the most aggressive in the world at punishing overweight individuals and smokers through penalty fees.
  - ineedaj0b 1y ago
    the fees are bought upon by the partakers of food and cigarettes. do they realize the strain excess weight carries for organs? would it be cheaper in china or Europe to be that size? No. Logistically, other countries would not have equipment readily available and having your poor lifestyle choices subsidized doesn’t mean the cost isn’t there
    - typpilol 1y ago
      My mom used to be an MRI nurse. Patients that were so large would have to be denied and referred to the local zoo. I wish I was kidding.
    - randycupertino 1y ago
      Obese individuals & smokers actually cost the system less money overall vs slim & healthy people because they die so much earlier - think of the 30+ years of savings! Dutch researchers compared three cohorts (healthy-living nonsmokers, smokers, and people with obesity) from age 20 to death. They found annual costs were higher for obesity through midlife, but lifetime spending was highest for healthy-living people, lowest for smokers, and intermediate for people with obesity, due to shorter life expectancy in the latter two groups. https://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.0050029 https://journals.plos.org/plosmedicine/article?id=10.1371%2F... Another study found total lifetime costs were ~14% lower for the obesity cohort and ~26% lower for smokers versus healthy living peers, again because longer life spans among the healthy group accrue more late life costs. https://www.researchgate.net/publication/5596865_Lifetime_Medical_Costs_of_Obesity_Prevention_No_Cure_for_Increasing_Health_Expenditure https://www.researchgate.net/publication/5596865_Lifetime_Me...
ChrisMarshallNY 1y ago
Similar thing happened to me, back in '96, but my wife saved my life, by forcing my primary care doctor to refer a neurologist. It was a brain tumor in the cerebellum. Bad place to have problems. The PC declared it a "virus," despite the fact that I could barely stand, and basically threw me out of his office. The neurologist took one look at me, from a dozen feet away, and said "Meet me at the emergency room." The next day, I was getting my noggin cracked open.
LeoPanthera 1y ago
I really hate that this style of clickbait headline is infecting HN. I know the rules say we can't change the headlines but I wish there was an exception for clickbait.
framerjohn 1y ago
We think that we live in a time of medical miracles, and we do, but people are also still dying very quickly from things like pneumonia, and getting strokes from viruses. Any of us could die or be disabled at any moment. Be thankful if you have your health. You can blame docs, and sure it can be that, but this is not like having a good computer technician- life is full of risks!
orthozato 1y ago
Ugh. This article hit me especially hard. I'm a medical student in my final year in a country where the last two years of our education consist of handling ER consultations for cases with a 'non-immediate risk of death'...
Mistletoe 1y ago
> But Banerjee, a novice, got stuck. He couldn’t figure out how to navigate the template to make some but not all of the auto-populated orders. “This was my first patient that triggered the sepsis pathway,” he explained, in testimony. So he asked Connor Welsh, a third-year resident, for help. This is the crux of the whole article. People who make software please take note the importance of what you do.
stuckindoors 1y ago
The problem isn’t adequate number of doctors….it too many trainees. Trainees training others is what happens at frequently at teaching hospitals. All these folks are too busy. Somethings the third year is inadequately trained to teach a first year - they teach them bad habits. And often academic facilities don’t value good patient care….they value national recognition and publications. It is the folks of the lecture course that get promotions. This I’m sure happens in all fields…in medicine it leads to deaths. There was a joke that you never want the visit an hospital in July, as that is when new residents were around. The fact is that there is an ounce of truth to that joke. It sure feels like mortality increases in July.
navs 1y ago
I lost my dad the same way in Fiji. At the time I chalked it up to it being Fiji, long considered a third world country. I guess it could have happened anywhere.
dcanelhas 1y ago
It's an interesting read. I guess the difference between this situation and the ideal case is that he would have been admitted for observation as a precaution in a world where there was plenty of room and staff to take care of even the less obvious emergency cases. Even in a very well functioning system similar cases might happen eventually, anyway (but at a much lower frequency). ROC plots come to mind. https://en.wikipedia.org/wiki/Receiver_operating_characteristic https://en.wikipedia.org/wiki/Receiver_operating_characteris...
michaelbrooks 1y ago
My brother was told his heart was healthy after having serious chest pains. The next day, he passed away from a heart attack due to heart disease. This was four years ago, when they were busy dealing with covid patients and in the UK.
toxicplanes1 1y ago
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aurizon 1y ago
Look at the USA age at death charts. The USA is around the same level as Cuba. Dissecting coverage/death, we find a huge bulge of high death rates in the poor which encompasses black/hispanic and others who have zero or minimal health care. To those in this group every interaction with health care costs $$, with cash copays needed. Pharmacare is the same, $$ plus copay. Thus they are driven towards zero/minimal health care = die young and unmedicated. Even an ambulance call can be well over $1000. To be sure, once you have medicaid/care after 65 or if you have a good health plan, your age at death is in the top 10 in the global tier. Once in the system there is a blizzard of administrative fees/codes - all of which require intense administrative time/costs to collect fees. This happens with all levels, doctors/pharmacists/drivers/nurses - all of which have their unions whose sole task is maximal revenue. I feel this is a broken system that protects itself to maximise revenue. At the bottom, generic worm medication that has a cost of well under $2 for a full course ends up at $1000+ for medication plus doctor's fees. Same with insulin, life needed medication and also generic. https://www.visualcapitalist.com/cost-of-insulin-by-country/ https://www.visualcapitalist.com/cost-of-insulin-by-country/ There is a corrupt political scheme operating in the USA 350 million people losing 6+ average years of life = that is the cost.
thenerdhead 1y ago
what we’re seeing now is that the immune system can go into overdrive, where certain immune cells trigger sepsis-like illness, sometimes in milder or chronic ways. long covid and related conditions seem like part of that same spectrum of immune dysfunction. there’s some great new research out of the university of virginia looking into this https://www.science.org/doi/10.1126/science.adq2509 https://www.science.org/doi/10.1126/science.adq2509 mis-c and the adult versions are rare but real, and there’s early promise with a treatment called larazotide https://www.science.org/doi/10.1126/scitranslmed.adu4284 https://www.science.org/doi/10.1126/scitranslmed.adu4284 the nih recover autopsy studies are also finding viral persistence in multiple organs, with more results coming soon https://recovercovid.org/pathobiology https://recovercovid.org/pathobiology i work on multiple NIH RECOVER efforts on this topic and post long covid research on x, and honestly the picture is both fascinating and pretty grim https://x.com/atranscendedman https://x.com/atranscendedman
renewiltord 1y ago
I usually override non-specialists with ChatGPT plus my access to physicians in other countries (Canada, UK, India). Even specialists I always double-check with other countries' specialists I know. There's a wide variation in doctor skill and they don't have interview systems like we do in tech. You need to be ready to override them. I always wondered why other people talk about "needing to advocate" and so on until I realized I'm just a really pushy patient. "would you mind prescribing this anyway?" And "Could you order an MRI just to confirm anyway?" They'll do it with some warning that insurance may not cover it and then you can choose to pay or not. And you have to push repeatedly (not forcefully, just repeatedly) to get your imaging and all that. Except for some paediatric infection for my daughter and the ob/gyn care for my wife, this is mostly for me: I've been in hospitals many time because of trauma (Motorcycle accident, stuff like that) and so long as I'm lucid I assume control. This is necessary in the US because there's no quarterback for your care here. There are people who do things but an overall CEO of Me does not exist. You have to play that role yourself or find an authority who can.
nikolay 1y ago
This is where AI could make a huge difference!
mannyv 1y ago
Viral infection + quick death = hantavirus. The article does't provide enough information about what he was doing before the game, unfortunately. But if he was cleaning out a shed or garage then Hanta is in play.
mariaerica 1y ago
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247 points by wallflower 1y ago

https://archive.is/MgWJH https://archive.is/MgWJH

FTA: "As hard as the job is, diagnostic accuracy in the E.R. is high overall. But a recent systematic review of published research estimated that 5.7 percent of E.R. patients will have at least one diagnostic error and 2 percent have a setback as a result." I feel like scrutinizing the industry for a 2-3% error on an obviously difficult problem is exactly why we pay so much in the United States for health care.

adastra22 1y ago
When the consequences are lethal for that 2-3%, that scrutiny is needed.
- ACCount37 1y ago
  [flagged]
  - hshdhdhehd 1y ago
    Ok Goodhart! We might need other measures. It might be damn complex. Ideally 100% would die from "malpractice" (or unknown able issues) because people are so healthy and society is so safe there is barely anyone in ER.
- jopsen 1y ago
  A set back is not necessarily lethal. We expect so much from our health care providers, and we sometimes don't appreciate that they deal with a wide array of patients. Some will come in with a tiny brushing, asking if they are going to die. Others will walk around with a critical condition for days, saying maybe they were a little sore, but they didn't think it was too bad.
actionfromafar 1y ago
Yes. Less scrutiny, more insurance middlemen please.
- AnthonyMouse 1y ago
  It's not quite that one either. The big problem is that most people get health insurance through their employer, and then it's the employer choosing it rather than the insured. Otherwise people would choose different insurance and in particular insurance with lower premiums but higher deductibles, and then use the money they saved on premiums to pay out of pocket for things that cost less than the deductible. And then actually insist on getting a real quote and having the ability to compare prices for non-emergency medicine. So the main problem is employer middlemen. Which happens in significant part because of tax incentives for employers to do that which you can't get if you do it yourself.
  - potato3732842 1y ago
    >tax incentives for employers to do that which you can't get if you do it yourself. Is there any problem today that DOESN'T boil down to the government giving preferential treatment to some class or group?
    - IAmBroom 1y ago
      Yes, tons. You choose to focus on the government-aided ones.
Kenji 1y ago
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AnthonyMouse 1y ago
> I feel like scrutinizing the industry for a 2-3% error on an obviously difficult problem is exactly why we pay so much in the United States for health care. If only. Then the outcomes would be better. The real reason is that it's ostensibly supposed to be a market but the pricing for everything is completely opaque and shrouded in bureaucracy and corruption.
sr-latch 1y ago
2-3% error is too high, this is something we _should_ be scrutinizing, and healthcare _should_ be more expensive if the reason it's expensive is that we're pouring more resources into it to get diminishing returns on reducing mistakes. Costly healthcare due to scrutiny is not the problem with healthcare in the US. The problem is drug monopolies, medical (mal)practice without a license by insurance companies, and the lack of taxpayer funded healthcare-as-a-right. We need to create an environment where someone like Terblanche feels comfortable advocating for himself without feeling like he's being a burden on the ER, and physicians don't feel like they're wasting time by investigating seemingly trivial cases. Such a situation exists because we are not pouring enough money into healthcare in this country.
- hshdhdhehd 1y ago
  It feels high to me because most ER cases should be obvious i.e. heart attacks, car accidents and strokes etc. So if say 10% of cases are non standard then 2% overall is 20% off that.
  - harvey9 1y ago
    Not only is the case mix much broader than you imagine but even the three things you listed all have plenty of nuance at the individual case level.
  - IAmBroom 1y ago
    We don't have an anti-heart attack pill. Medicine hasn't developed the post-car-accident protocol. Strokes vary so much in type that they can go unrecognized by competent doctors for years.
  - sarchertech 1y ago
    The ER functions as primary care for a large percentage of the population. They see far far more than the kinds of thing a rational person with health insurance thinks of when they think about medical problems they’d go to the ER for.
- closewith 1y ago
deleted 1y ago
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0xDEAFBEAD 1y ago
An alternative way to throw money at the problem: Instead of trying to further improve accuracy, build out space for more ER beds, and implement continuous monitoring of marginal patients. Or, build devices to send home with patients which allow for cheap, continuous self-monitoring. That might be a legitimate application of AI actually, if you could use e.g. phone camera tricks to measure more health parameters. Even if imperfect, it could still pick up a few patients who should not have been sent home.
- CrossVR 1y ago
  This is mentioned in the article, the fundamental problem is a capacity problem. If patients could be moved out of the ER department to hospital wards then there would be a greater ability for the ER department to monitor patients.
  - nradov 1y ago
    There is a (somewhat artificial) middle ground in US hospitals where patients can be admitted for observation but still be considered outpatient. https://doi.org/10.1001/amajethics.2023.901 https://doi.org/10.1001/amajethics.2023.901
  - gowld 1y ago
    This is because beds are artificially expensive because hospitals deploy maximum-feature bed equipment and services, to avoid malpractice claims, and to increase billing.
ludicrousdispla 1y ago
We pay too much in the US because of the self-imposed medical labor shortage and that results in mistakes by over-worked staff.
- schnitzelstoat 1y ago
  Yeah, it always seems crazy to me that in a country that is often so economically liberal and free market, medicine is still run like a medieval guild.
aucisson_masque 1y ago
I thought so but reading the whole article, it seems like there has actually been mistakes. Several. Someone who goes to the hospital 3 times and still die because of an untreated disease is not just bad luck.
throw-qqqqq 1y ago
> I feel like scrutinizing the industry for a 2-3% error on an obviously difficult problem is exactly why we pay so much in the United States for health care All research I’ve read on this topic finds that it is the US legal system that causes the crazy prices (incentivizing more testing to cover-your-ass and avoid liability etc.) Many comparative studies on health care cost and quality use the US military as a proxy, as it is free on the condition that you cannot litigate (very coarsely; it is more nuanced). The costs for treating US military personel is much closer to other countries (while treatment quality remains equal).
- neffy 1y ago
  It´s not just the legal system. A lot of US Doctors are typically paid on a piece rate basis, and the medical records systems are extremely fragmented, so there is an incentive to order repeat tests (as you get passed around from specialist to specialist), and no incentive to put the systems in to make that unnecessary.
- red-iron-pine 1y ago
  I believe your points, but give me a source.
- nradov 1y ago
  That is a factor but a relatively small one. Several US states have instituted limits on medical malpractice liability and that has had only a small impact on total healthcare system costs. It's often the patients themselves (or family members) who insist on trying every possible diagnostic test, and even with the growth of evidence-based medicine we still don't have clear clinical practice guidelines covering many of those situations.
kakacik 1y ago
Part of the reason is - people are not machines, its extremely hard to diagnose quite a few situations since every body is a bit unique. Add tons of medications and issues every older person has, within their own unique bodies. Add symptoms like chest or abdominal or head pain which can mean hundreds of conditions, some benign some deadly. Add time pressure to diagnose quickly since that's how medical systems are set up. Wife is a doctor so I can see the perspective from the other side too. I've had a thrombosis formed in my calf after having a broken leg and using cast. I also caught covid during that time, and from what I've read now I believe it increases temporarily clotting of blood for certain people. When cast was removed, leg was still stiff as wooden plank and ankle didn't bend. I wasn't told to keep the leg higher so I didn't. Some weird mild pain started in the middle of the calf after few days, wife suggested it may be thrombosis rather than stiff muscles or tendons. Went to Switzerland's biggest hospital's ER, got blood tests, they were below limit for thrombosis, so I was just sent home. Pain didn't go away, luckily my wife considered it suspicious and asked another doctor who is an expert on this to recheck. Voila, thrombosis there. The cause of miss - ER doctors should have done more than just a blood test (even by their own ER protocols, checked that with wife and her colleagues), echography would have shown blood clot in the veins. If it got dislodged and ended up in lungs, that's a quick death within cca 20 mins, ambulance & CPR usually are not sufficient to keep person alive without major brain damage. Or blood clot goes into brain, cutting off some part of it with similar result. One peer from back home died exactly like that (lung variant, the most deadly one).
- red-iron-pine 1y ago
  yeah this be part of it. each aircraft is designed to be effectively identical. yeah yeah there may be some gremlins or bugs in the airframe but in theory it should fly and handle just like each other aircraft. each human may be wildly different
- prerok 1y ago
  I am happy you were able to solve it. One of my friends had exactly this problem, but he just died the next day :( Sorry to have the need to have shared this, but at least it's been on my mind every time I hear someone take their cast off and experience something similar.
UI_at_80x24 1y ago
That 5.7% number must be wrong. Ask anybody with a chronic medical condition. I've had uncountable number of doctor's visits including ER for 37 years before a proper diagnosis was made.
mouse_ 1y ago
the problem is greed.
IAmBroom 1y ago
So, your premise is that the US is unique in its lack of checklists in the ER?

lhmiles 1y ago

Would have lived if he had a roommate. Do universities do single dorms now

leptons 1y ago
Doubt it. A roommate has a life outside of that room, they aren't likely to be there, or know what to do. There's no certainty that a roommate would have been the factor that saved his life.
- bell-cot 1y ago
  I'd characterize it as "another saving throw". The roommate might be absent, or preoccupied with his own life, or "staying away from the virus", or too self-doubting to do anything in time. Similar for Sam's girlfriend Kayla. If she'd been assertive and physically present, she might have saved his life. Similar any close friend of Sam's. Similar a bottom-tier resident staff member in Sam's dorm, worried about one of his residents and regularly checking. (Yes, the U's dorm system "could" officially try to keep an eye on sick residents. But with America's legal system, don't expect any sane university official to sign off on doing that.)
  - Macha 1y ago
    From the story it sounds like the parents were notified by the university one day after he'd last been in touch, so someone (be it a roommate or dorm staff) was checking in at least daily.
    - jacobgkau 1y ago
      The story specifically says Sam's friend Charlie contacted campus security after Sam stopped responding to Charlie and Kayla (Sam's girlfriend). Campus security wouldn't have known to check in within a day if Sam's friends weren't on top of keeping in touch with him. (Put another way, I certainly would've rotted longer than that if this had happened to me in college-- lucked into having my own dorm room & had acquaintances but not any friends who would've gone out of their way like that.)

mnw21cam 1y ago

If you visit the emergency department of a lot of British hospitals, there will be large posters reminding the doctors "Could it be sepsis?" because of similar instances that occurred over here.

InfiniteLoup 1y ago
> there will be large posters reminding the doctors "Could it be sepsis?" I'm not sure how effective this is. Information presented this way quickly fades into background noise..
- gtr 1y ago
  The patients can also see the posters, and it won't be background noise for them, so they can think of asking about it.
  - f1shy 1y ago
    Oh. There is nothing more contra productive than asking an experienced physician “could this not be X”. They will typically go in “if you think google knows better, ask it and fuck off”. Ask me how I know. I think that attitude even has a name (BTW, I’m guilty! If I say “there is a dangling pointer” and the guy starts with another theory, I will dismiss him quickly)
    - IAmBroom 1y ago
      My experience is completely the opposite. It often annoys them, but they are forced to address my question, and that's my goal.
      - gowld 1y ago
        Arguing with a doctor can lead to accusations of "drug-seeking behavior" (which can cause treatments to be refused, and there is some legal pressure behidn this) or "mental illness" (which can cause involuntary psychiatric hold, effectively kidnapping).

dinobones 1y ago

My wife (then girlfriend) and I were at a concert. She went to the bathroom to pee. She came back crying. I told her she might have a UTI. It was not normal for it to hurt that badly to pee. She denied it. I bought her a UTI test, it came out positive. She was shaking. I told her we had to go to the hospital, she thought they were period cramps. I call a teledoc. They video chat. She explains the pain shes feeling in her lower back means it’s likely a UTI, the infection has likely reached her kidneys, and we should go to the ER immediately. In the ER we think they’re going to just give her some antibiotics and send her home. Nope. She throws up. Things go bad fast. Her heart rate is 160. She turns a color I’ve never seen a human before. The next 3 days were so incredibly hard. But I’m so thankful to all the medical workers that were attentive to us. Thankfully she makes a full recovery. For a week or so she was lethargic/tired but she’s fully healthy now. A few months before I had read a story about a woman who’s boyfriend had died from a UTI because they went to a gospital, gave him some antibiotics, and he ending up dying at home because the infection was already too progressed to fight off at home. Had the person who evaluated my girlfriend not evaluated seriously or just sent her off that could’ve been her. I’m so thankful they admitted her and took her care seriously. It’s scary how quickly a UTI or some other benign infection can become sepsis. Take it seriously.

Shank 1y ago
> Had the person who evaluated my girlfriend not evaluated seriously or just sent her off that could’ve been her. I’m so thankful they admitted her and took her care seriously. This might sound strange, but I think you deserve some credit for taking it seriously and being there. It’s a documented issue that women’s problems are frequently written off and downplayed as normal things like period pain. I’m really truly happy to hear that she made a full recovery as well. It is wonderful to hear that she is okay.
- bell-cot 1y ago
  [flagged]
InsideOutSanta 1y ago
> Had the person who evaluated my girlfriend not evaluated seriously or just sent her off that could’ve been her Everybody did well in that instance, including you. Many people won't advocate for themselves, so having someone around who will do it for them is incredibly important.

0xDEAFBEAD 1y ago

>In his effort to understand hospital safety and risk, he learned these oft-cited projections: more than 200,000 people will die each year from preventable medical errors. He was shocked. Conservatively, these estimates amount to at least one fatal Boeing 747 crash per week, Terblanche calculated. This reminds me of the book The Checklist Manifesto by surgeon Atul Gawande. The book argues that aviation has achieved such a good safety record largely through the use of checklists, and Gawande describes his attempts to apply them to the field of medicine. Recommended. (Edit: I see that checklists are discussed later in the article; I would still recommend the book, as it has thoughts on how checklists can be applied more effectively.)

f1shy 1y ago
Being a pilot I can attest how important checklists are, and I do advocate for using them in medicine (have practicing relatives, and I have them tired with that). But maybe you oversimplified the book? (Or the book oversimplified how safety was achieved?) There are some other 100s of reasons why aviation is safe. Heck, some of them could also be applied NOW: people must rest! I do NOT want to be treated by a doctor doing an idiotic 24hs shift, which is the norm in every country I know of… There is a whole list of things that can be transferred from aviation to medicine. Another point I know of is the “handover” of patients. Just as ATC hands over planes from one controller to another, some procedure should warrant the correct transfer of information between shifts. Oh boy I have hear some funny (and some bot at all funny) stories about it.
- rkomorn 1y ago
  The long shifts are the most baffling thing to me. AFAIK they're also common in law enforcement. "Hey these people make life or death decisions. You know what's going to help? Fatigue." From the outside, it just seems insane.
  - red-iron-pine 1y ago
    how much more are you willing to pay? more law enforcement = more taxes more shifts for docs = more $$ paying for more medical staff. I can't speak to the police, but there have been a bunch of studies that showed that handoffs between shifts at hospitals is where things go bad. Someone doesn't document they gave an extra 2 cc of a drug to a patient, and next shift gives them more and causes issues, etc. Basically longer shifts = more fatigue, and the number of errors caused by fatigue were still lower than hand-off related errors.

deleted 1y ago

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draven 1y ago

> Sam’s girlfriend, theorized that in the hospital Sam didn’t want to be a bother and didn’t advocate for himself I'm like that and it sucks, I now bring my wife to medical appointments so she can complain for me while I downplay everything.

dsego 1y ago
If there is anything I've learned in my country (with national health care) where it's common for doctors to ignore you and say it's nothing, is to be overly pushy and even rude. It could be nothing, but a lot of time instincts are correct, and it's a mild embarrassment if you are making a fuss over nothing, but could be a life or death situation. And you could argue that everyone behaving like this is making it worse, and that might be right. But I remember multiple national headlines in recent years where little kids died of pneumonia after being sent home because they ruled out infection, sometimes even after parents already brought the kid back for the second or third time to the hospital after their condition wasn't improving. I know I'm not making chances even if it means getting a second opinion or driving to a different town to a different hospital, sometimes it's better to take things into your own hands than be complacent and rely solely on the medical system doing the right thing.
- potato3732842 1y ago
  The "there's someone here who'll still be alive to be deposed and/or testify if we fuck up" factor really gets them to be serious.
  - blargthorwars 1y ago
    Especially if the second person peppers their speech with correctly used medical terms.
eYrKEC2 1y ago
My son almost died in the first 24 hours of life. I said, "There's something wrong. There's something wrong." multiple times and the nurses finally told me, "YOU NEED TO CHILL OUT." I did chill out.... Next morning the pediatrician did his rounds, checked on my son, and immediately started speaking Latin, to go over our heads while rushing around and getting equipment to clear his lungs of amniotic fluid. Reminds me of what my first engineering boss told me -- "When the people on the line say there is a problem. There is a problem."

kameit00 1y ago

Non paywalled version: https://archive.is/tJePt https://archive.is/tJePt

bell-cot 1y ago

Three major problems to note in the story: - Lack of any low-intensity monitored recovery option. If the kid could just have been sent home to a traditional worrying mother, who'd been told to watch for certain warning signs - then he very likely would have lived. - Critical shortages of front-line medical staff. (ER nurses especially noted here. But a dishonorable mention to the computer systems that the residents were fighting against.) - However short our medical system might be on front-line resources to treat patients needing care - once it's lawsuit time, resources seem plentiful.

quantumwoke 1y ago
I don't quite understand your third problem. I also don't think the shortage of ER nurses necessarily contributed, as clearly the doctors and the friend thought he was well enough to go home. Definitely agree with the first problem though. We put our kids through a lot of risk by sending them to interstate college...

quantumwoke 1y ago

Heartbreaking story. They talk a lot about the possibility of bacterial infection but it was not consistent with the blood tests. It seems he just got unlucky (although should have had a Chest X-Ray). Trying to reframe it in a coding analogy, there were a few abnormal logs maybe an exception or two but the coder was unable to figure it out and these exceptions happen all the time and so pushed to live anyway. Due to resource allocation issues they were pulled to a different job. Then the site crashed. Just awful.

lotsofpulp 1y ago
This is 99.9% of “news”.

wewewedxfgdf 1y ago

Always get a second opinion from ChatGPT, a third from Claude and a fourth from Gemini. It is astounding how much more you can learn about your diagnosis from an LLM.

ThePowerOfFuet 1y ago
What could possibly go wrong.
- rafaelero 1y ago
  Things are already going severely wrong in 1% of the cases. At this point not getting a second opinion from an LLM is irresponsible, imo.
blargthorwars 1y ago
This is precisely the thing that LLMs are great for: spicy auto-complete.
- CamperBob2 1y ago
  What do you think doctors do all day?
OutOfHere 1y ago
I have found it very useful to discuss possible diagnoses and diagnostic steps with the LLM before going to the ER. Once there, I told them what my expectations were along with the rationale for it. They agreed with 80% of it. Ultimately the ER was of no use in treatment, but the preparation did help rule out a serious diagnosis.

adzm 1y ago

In my opinion, this is one of the more overlooked side effects of the covid pandemic: stretching resources in hospitals leads to lower quality care for everyone.

triceratops 1y ago
I don't think it was overlooked at all. This was the original justification for "flattening the curve".

codeulike 1y ago

Sepsis is hard to spot. Whats interesting about this article is that once you get into the details of whatt happened on the patients second visit, its largely about the hospital information systems and how they got in the way. An automated alert popped up warning that the doctors should consider Sepsis. That alert essentially then blocked progress, and the doctors ended up (essentially) ticking the 'not sepsis' box so that they could get on with their (reasonable) next step which was either ordering an x-ray or starting antibiotics. Then somehow after that, sepsis did not get re-considered. https://archive.is/tJePt#selection-1465.0-1491.52 https://archive.is/tJePt#selection-1465.0-1491.52 It was Banerjee’s task to document Sam’s care, and as he began to do so, a pop-up appeared on his computer screen. Sam’s fever and heart rate had triggered an automated warning for sepsis, a potentially life-threatening condition in which the immune system has a dangerous reaction to an infection. It requires speedy intervention. To help the hospital comply with state-mandated sepsis regulations, the pop-up provides a checklist of tests and orders used to identify and treat sepsis. Agyare had instructed Banerjee to hydrate Sam right away but to wait for the results of Sam’s lab work before ordering a chest X-ray or the strong antibiotics used to treat sepsis. But Banerjee, a novice, got stuck. He couldn’t figure out how to navigate the template to make some but not all of the auto-populated orders. “This was my first patient that triggered the sepsis pathway,” he explained, in testimony. So he asked Connor Welsh, a third-year resident, for help. At 8:50 p.m., Welsh showed Banerjee how. From his own computer, he clicked into a field on Sam’s chart to assert that sepsis was not likely: “Based on my evaluation,” the automated note said, “this patient does not meet clinical criteria for bacterial sepsis.” And then Welsh recorded what Banerjee said Agyare had said earlier: “Likely viral syndrome. Workup pending.” Welsh’s name appears on the note, but in his deposition he said he never interacted with Sam. Senior residents often help junior ones in this way, he said. “I signed this note based on the discussion with the provider, Dr. Banerjee, based on his evaluation and the medical management of Mr. Terblanche,” he testified. ... Sam’s chart is 51 pages long, a catalog of billing codes and abbreviations, check-boxes and shorthand, updates and addenda. The record of the second visit contains numerous contradictions: Sam’s heart rate was documented at 126, yet Banerjee clicked the box “normal.” In one place it says Sam didn’t have a cough, while in another it says he did. The signatures of doctors who testified they never saw Sam — including one who was not in the hospital that night — accompany notes. Vital signs were ordered and not taken, as was an EKG.

thelastgallon 1y ago

Everything is optimized for corporations to make more money, to avoid liability and maximize the billable dollars. Doctors want to move meat as quick as possible, most consultations are a couple of minutes! Every doctor has to be part of this rat race because of how the system is designed! "More than 200,000 people will die each year from preventable medical errors. He was shocked. Conservatively, these estimates amount to at least one fatal Boeing 747 crash per week." "Doctors talk about electronic medical records as an unpleasant and frustrating chore. They object to how the charts have evolved to prioritize billing and liability defense over clinical care. And they regard the symphony of well-meaning alerts and pop-ups as a distraction at best." "The check boxes and templates can aid efficiency, several doctors told me, but they also may distract physicians from the patients right in front of them."

IAmBroom 1y ago
> Doctors want to move meat as quick as possible, I don't know a single doctor who wants this. Insurance companies want this. Don't blame healthcare workers for the hellish scenarios they are forced to work under.
- gowld 1y ago
  A doctor (who is is a licensed professional, not unskilled labor) could accept lower pay for less work (fewer patients seen), instead high pay for less work (false-treating patients).
  - roywiggins 1y ago
    Doctors can't build bigger ERs or hospitals, you need physical infrastructure to give patients extra time.
    - ikiris 1y ago
      This is laughably out of touch with the actual limits of care. It’s nursing staff and the shortage is a willingness to pay the costs of staffing.

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thegrim33 1y ago

Recently I got really, really sick. I was running a fever and bedridden for nearly a month straight. It got so bad one day that I ended up in two urgent cares and then they sent me onwards to the ER. They were constantly taking my blood, constantly running tests, and in the end they basically just shrugged and said it was seemingly some random virus they didn't have a test for, nothing they could do. I heard some doctors talking outside my room about how unusual it was for me to be sick for as long as I had been, and they just seemed to brush it off and one said something like "well he's still fairly young, he'll probably get through it eventually." They never figured out what it was, never were able to do anything to help me, just kind of shrugged, kept me overnight for more observation and then kicked me out the second the sun came out. My body and mind were absolutely shattered, especially after being woken up every 30min all night long for more blood draws, and I was told I could at least eat breakfast before I left, but they ended up reneging on this and kicking me out before breakfast time. This was at a major hospital, a well ranked one, in a major city. The experience really opened my eyes.

dostick 1y ago
Did you ask ChatGPT or something? It usually knows more. And what they were taking tests for.
- yieldcrv 1y ago
  although this is the new "WebMD" self diagnosis, and the AI will agree with you and make some things up in subtle ways, this is still a great way to steer licensed professionals and cut through their own double speak - since licensed professionals are also making things up in subtle ways, not give you enough information about their findings or medication, and overlook many things
rediguanayum 1y ago
Not a doctor but I know some- Viruses are notoriously hard to diagnose because they don't culture. Some big academic hospitals do have a virus panel where they use brute force PCR assay akin to many Covid-19 tests targeting different virus but they are very expensive hence not broadly available. Community hospitals will have the same diagnostic experience you have. At most they might be able to test for Flu or Covid but that's about it. Another reason is that even if you test positive, there is very little the hospital can do. For the most part, just tell the patient to rest and take Tylenol/Ibuprofen. The anti-virals are just limited to Flu and Covid.

mindslight 1y ago

I feel like the urge to fight, sue, and demand answers is the direct result of the constructive maliciousness of the medical environment, as orchestrated by the beancounters and provider/insurance bureaucracy. Let's say doctors had the bandwidth to not cut patient discussions short, not expect patients to need an adversarial "advocate", take the time to entertain unlikely hypotheses, monitor/admit for good faith investigative reasons rather than purely on liability rubric [0], etc. Then, when the doctors failed, you would feel that the failing was of a human group that earnestly did everything they could have. But the way the medical system has been whittled down into some bare bones bureaucratic assembly line, it makes it feel like every such failure is a willful and deliberate goal of the system. Why is the medical industry primarily focused on cost optimization through tightening the screws when they aren't even able to get the right answers? [0] Like seriously I wish I could have given this kid one of the many weeks of observation that hospitals have given my paid-by-Medicare family members. The beds are available, they're just full of elderly people who had some acute problem but the hospital won't readily discharge them due to chronic medical conditions (plus they're messed up after being starved for a day in the ER).

TrackerFF 1y ago

From the info laid out in the article, it seems that unfortunately Sam was the Zebra, this time. The autopsy found pulmonary hemorrhage, enlarged heart, enlarged liver, damaged kidney.

kylehotchkiss 1y ago

We all want to uphold a system that limits medical school seats and won't create reliable immigration pathways for doctors to arrive here with just so doctors can maintain a specific salary. Then we'll go blame PE and consolidation and insurance or whatever. If doctors don't have enough time, then there aren't enough doctors. Our population is aging rapidly and the need is increasing despite population growth metrics. If there are more doctors, they will need to need to spread further into regions where they're in demand. This is a problem that we as voters should start to act upon.

bckr 1y ago
What do you think voters should do? How do we increase the number of doctors?
- brandonmenc 1y ago
  Stop charging $300k for the medical degree.
- wagwang 1y ago
  Our society will continue to feel the civilizational tax of not having enough kids unless AI doctor becomes a thing.
  - tastyfreeze 1y ago
    So, do your part. Make babies! It's fun and rewarding.
- isubkhankulov 1y ago
  The current doctor workforce is limited by a congressional cap on Medicare-funded educational slots. Apparently it was established in 1997 to prevent a surplus. Of course, the opposite happened because of demographics and increased lifespans.
  - dpkirchner 1y ago

jacobgkau 1y ago

Beyond the case itself, I'd hazard a sad guess that the only reason this made news is because the victim's father was a lawyer who wasn't forced to simply take the hospital president's platitude at face value (and who had the time, money, and energy to put his normal career on pause and enroll in a master's program just to investigate the issue). If that were my family, it would be "that's terrible" but no actual action, because my parents wouldn't be able to do anything about it, nor would I if something like this ever happened to my own future kids.

monero-xmr 1y ago
There are legions of medical malpractice lawyers who would hear out your case. Personal injury attorneys advertise every place possible and they will gladly refer you to the correct place. You wouldn’t get a NYT writeup but a settlement? Litigation is as American as apple pie
- jacobgkau 1y ago
  I was thinking similar-- a generic law firm could probably get a small payout, but wouldn't necessarily uncover as many details about the situation since they're not personally involved (and, as you said, would probably have less publicity as well).
  - monero-xmr 1y ago
    I think your worries are misplaced. This is bread and butter for lawyers. The problem with this case is it’s very fuzzy. We are seeing one side of the story as a lawsuit is certainly coming. Doctors are human and deal with high stress, life or death situations. They have medical malpractice insurance exactly for this. Even if you have a 99.9% perfect doctor, they will see many thousands of patients over their career, and that still means 1/1000 will die. People play the lottery on far worse odds. I found the article interesting less as a damning of the medical system and more of a spiritual situation. None of us know when a freak random event will end us. It is a sobering reality

esoleyman 1y ago

The ED is specifically attuned to these presentations but the sepsis alerts and algorithms in place are horrendous and will fire off even for this with viral illnesses and syndromes. Sepsis alerts are meant to find bacteremia in patients who present with a set of vital signs and laboratory findings indicative of it and even those definitions are not readily agreed upon. The ED is highly accurate with its diagnosis and treatments despite everything that has been said. Trying to find a zebra in the hoof beats of horses when the number of patients quickly outstrips your department’s capabilities is a fools errand because if the workup require will overwhelm throughout to the point that the delay in care will put other patients at risk. There is a fine line between doing enough and doing too much that will grind your department to a halt and then have your waiting room backing up. Unfortunately for this patient, his occult condition didn’t manifest itself within his two ED visits and we don’t have prognostic capabilities to tell who will and won’t decompensate. We all make value judgements and treat the patients in front of us

gnfargbl 1y ago
> Trying to find a zebra in the hoof beats of horses when the number of patients quickly outstrips your department’s capabilities is a fools errand because if the workup require will overwhelm throughout to the point that the delay in care will put other patients at risk. This is where that I hope (as a non-physician) that AI, used carefully, should actually be able to help. A well-designed ML system should have a decent chance at distinguishing a zebra from a horse because it has read absolutely everything, has perfect recall of that corpus, and has some ability to contextualize the knowledge it has to the situation at hand. I suspect that a good proportion of ER doctors already have those characteristics, but surely not all of them do, and surely not consistently. An AI-assisted system will still false-positive, because the computer is still just a tool, tools are never perfect and designers of safety systems tend to err on the side of false positives. However, a thoughtful pop-up that displays when the situation really may warrant it is surely more helpful to a physician that one that cries wolf to you constantly? My optimism assumes that there's fundamentally enough information available to make the diagnosis, however. If you're actually saying that finding the zebra would require gathering so much more information for each patient that it would lower overall outcomes for all patients, then I guess we're stuck.

mensetmanusman 1y ago

We need better tests for this. Globally one person dies every 3 seconds from sepsis.

TrackerFF 1y ago
From the article, the autopsy findings didn't support sepsis as cause of death.
wayeq 1y ago
that's rough, I'd hate to be that person

esoleyman 1y ago

There’s a thread about how emergency physicians are paid. It varies from group to group: Physicians can be salaried and receive benefits from their group or hospital Physicians can be 100% productivity based meaning that they will only get paid by the amount of patients they treat but they receive no other benefits from the group or hospital In between these two groups, there is a wide variety of compensation Packages that are complicated to discuss in this comment. Nonetheless, the overwriting factor for all emergency physicians is that we triage patients, not only after triage, but internally as well, including those patients at reside within the treatment rooms and those outside in the waiting room. The question is, can we see less patients and spend more time with them and the answer is yes but to the detriment of the entire department and possibly not seeing a patient who is sick and who hasn’t been seen yet. Do you have to be able to tell who you can spend five minutes with and who needs 30 minutes. Through put his king, but quality is queen, so there’s always a trade-off between seeing patients fast enough and to see enough patients through your shift, but to also how they were with all to determine which patients will require more time and more due diligence. Every shift is a pull and push between these two dichotomies and it’s never easy and there are multiple decisions that have to be made.

citizenpaul 1y ago

Its probably not PC but I think a huge part of this is the burnout associated with being forced to treat the same junkies day in and out. At some point you brain shuts off to possible alternatives and you just see everything as a "next, next,next" The answer is unfortunately you cannot treat everyone equal if they don't want to help themselves. I was at a ER for a bleeding puncture wound and was told to hold a bandage on it and wait while several 500lb people were seen because "they don't feel good". No $hit they weight 500lbs. Also kids apparently are always first, but I can see why that one is needed. They don't have automy like the other people there that are the source of their own problems.

jimbob45 1y ago
On the other hand, American health insurance is arguably the most aggressive in the world at punishing overweight individuals and smokers through penalty fees.
- ineedaj0b 1y ago
  the fees are bought upon by the partakers of food and cigarettes. do they realize the strain excess weight carries for organs? would it be cheaper in china or Europe to be that size? No. Logistically, other countries would not have equipment readily available and having your poor lifestyle choices subsidized doesn’t mean the cost isn’t there
  - typpilol 1y ago
    My mom used to be an MRI nurse. Patients that were so large would have to be denied and referred to the local zoo. I wish I was kidding.
  - randycupertino 1y ago
    Obese individuals & smokers actually cost the system less money overall vs slim & healthy people because they die so much earlier - think of the 30+ years of savings! Dutch researchers compared three cohorts (healthy-living nonsmokers, smokers, and people with obesity) from age 20 to death. They found annual costs were higher for obesity through midlife, but lifetime spending was highest for healthy-living people, lowest for smokers, and intermediate for people with obesity, due to shorter life expectancy in the latter two groups. https://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.0050029 https://journals.plos.org/plosmedicine/article?id=10.1371%2F... Another study found total lifetime costs were ~14% lower for the obesity cohort and ~26% lower for smokers versus healthy living peers, again because longer life spans among the healthy group accrue more late life costs. https://www.researchgate.net/publication/5596865_Lifetime_Medical_Costs_of_Obesity_Prevention_No_Cure_for_Increasing_Health_Expenditure https://www.researchgate.net/publication/5596865_Lifetime_Me...

ChrisMarshallNY 1y ago

Similar thing happened to me, back in '96, but my wife saved my life, by forcing my primary care doctor to refer a neurologist. It was a brain tumor in the cerebellum. Bad place to have problems. The PC declared it a "virus," despite the fact that I could barely stand, and basically threw me out of his office. The neurologist took one look at me, from a dozen feet away, and said "Meet me at the emergency room." The next day, I was getting my noggin cracked open.

LeoPanthera 1y ago

I really hate that this style of clickbait headline is infecting HN. I know the rules say we can't change the headlines but I wish there was an exception for clickbait.

framerjohn 1y ago

We think that we live in a time of medical miracles, and we do, but people are also still dying very quickly from things like pneumonia, and getting strokes from viruses. Any of us could die or be disabled at any moment. Be thankful if you have your health. You can blame docs, and sure it can be that, but this is not like having a good computer technician- life is full of risks!

orthozato 1y ago

Ugh. This article hit me especially hard. I'm a medical student in my final year in a country where the last two years of our education consist of handling ER consultations for cases with a 'non-immediate risk of death'...

Mistletoe 1y ago

> But Banerjee, a novice, got stuck. He couldn’t figure out how to navigate the template to make some but not all of the auto-populated orders. “This was my first patient that triggered the sepsis pathway,” he explained, in testimony. So he asked Connor Welsh, a third-year resident, for help. This is the crux of the whole article. People who make software please take note the importance of what you do.

stuckindoors 1y ago

The problem isn’t adequate number of doctors….it too many trainees. Trainees training others is what happens at frequently at teaching hospitals. All these folks are too busy. Somethings the third year is inadequately trained to teach a first year - they teach them bad habits. And often academic facilities don’t value good patient care….they value national recognition and publications. It is the folks of the lecture course that get promotions. This I’m sure happens in all fields…in medicine it leads to deaths. There was a joke that you never want the visit an hospital in July, as that is when new residents were around. The fact is that there is an ounce of truth to that joke. It sure feels like mortality increases in July.

navs 1y ago

I lost my dad the same way in Fiji. At the time I chalked it up to it being Fiji, long considered a third world country. I guess it could have happened anywhere.

dcanelhas 1y ago

It's an interesting read. I guess the difference between this situation and the ideal case is that he would have been admitted for observation as a precaution in a world where there was plenty of room and staff to take care of even the less obvious emergency cases. Even in a very well functioning system similar cases might happen eventually, anyway (but at a much lower frequency). ROC plots come to mind. https://en.wikipedia.org/wiki/Receiver_operating_characteristic https://en.wikipedia.org/wiki/Receiver_operating_characteris...

michaelbrooks 1y ago

My brother was told his heart was healthy after having serious chest pains. The next day, he passed away from a heart attack due to heart disease. This was four years ago, when they were busy dealing with covid patients and in the UK.

toxicplanes1 1y ago

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aurizon 1y ago

Look at the USA age at death charts. The USA is around the same level as Cuba. Dissecting coverage/death, we find a huge bulge of high death rates in the poor which encompasses black/hispanic and others who have zero or minimal health care. To those in this group every interaction with health care costs $$, with cash copays needed. Pharmacare is the same, $$ plus copay. Thus they are driven towards zero/minimal health care = die young and unmedicated. Even an ambulance call can be well over $1000. To be sure, once you have medicaid/care after 65 or if you have a good health plan, your age at death is in the top 10 in the global tier. Once in the system there is a blizzard of administrative fees/codes - all of which require intense administrative time/costs to collect fees. This happens with all levels, doctors/pharmacists/drivers/nurses - all of which have their unions whose sole task is maximal revenue. I feel this is a broken system that protects itself to maximise revenue. At the bottom, generic worm medication that has a cost of well under $2 for a full course ends up at $1000+ for medication plus doctor's fees. Same with insulin, life needed medication and also generic. https://www.visualcapitalist.com/cost-of-insulin-by-country/ https://www.visualcapitalist.com/cost-of-insulin-by-country/ There is a corrupt political scheme operating in the USA 350 million people losing 6+ average years of life = that is the cost.

thenerdhead 1y ago

what we’re seeing now is that the immune system can go into overdrive, where certain immune cells trigger sepsis-like illness, sometimes in milder or chronic ways. long covid and related conditions seem like part of that same spectrum of immune dysfunction. there’s some great new research out of the university of virginia looking into this https://www.science.org/doi/10.1126/science.adq2509 https://www.science.org/doi/10.1126/science.adq2509 mis-c and the adult versions are rare but real, and there’s early promise with a treatment called larazotide https://www.science.org/doi/10.1126/scitranslmed.adu4284 https://www.science.org/doi/10.1126/scitranslmed.adu4284 the nih recover autopsy studies are also finding viral persistence in multiple organs, with more results coming soon https://recovercovid.org/pathobiology https://recovercovid.org/pathobiology i work on multiple NIH RECOVER efforts on this topic and post long covid research on x, and honestly the picture is both fascinating and pretty grim https://x.com/atranscendedman https://x.com/atranscendedman

renewiltord 1y ago

I usually override non-specialists with ChatGPT plus my access to physicians in other countries (Canada, UK, India). Even specialists I always double-check with other countries' specialists I know. There's a wide variation in doctor skill and they don't have interview systems like we do in tech. You need to be ready to override them. I always wondered why other people talk about "needing to advocate" and so on until I realized I'm just a really pushy patient. "would you mind prescribing this anyway?" And "Could you order an MRI just to confirm anyway?" They'll do it with some warning that insurance may not cover it and then you can choose to pay or not. And you have to push repeatedly (not forcefully, just repeatedly) to get your imaging and all that. Except for some paediatric infection for my daughter and the ob/gyn care for my wife, this is mostly for me: I've been in hospitals many time because of trauma (Motorcycle accident, stuff like that) and so long as I'm lucid I assume control. This is necessary in the US because there's no quarterback for your care here. There are people who do things but an overall CEO of Me does not exist. You have to play that role yourself or find an authority who can.

nikolay 1y ago

This is where AI could make a huge difference!

mannyv 1y ago

Viral infection + quick death = hantavirus. The article does't provide enough information about what he was doing before the game, unfortunately. But if he was cleaning out a shed or garage then Hanta is in play.

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