4 ms·

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 tha

by 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 $$ paying for more medical staff. I can't speak to the police, but there have been a bunch of studies that showed that handoffs between shifts at hospitals is where things go bad. Someone doesn't document they gave an extra 2 cc of a drug to a patient, and next shift gives them more and causes issues, etc. Basically longer shifts = more fatigue, and the number of errors caused by fatigue were still lower than hand-off related errors.
  - yjftsjthsd-h 1y ago
    > more shifts for docs = more $$ paying for more medical staff. I don't follow. It can't be more expensive to pay 2 doctors for 8 hour shifts than 1 doctor for 16 hours; if anything, I'd expect it to be cheaper (no overtime). > 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. Hence pushing for checklists so that doesn't happen?
    - deleted 1y ago
      [deleted]
    - bshep 1y ago
      The docs dont get paid per hour, they are salaried, so 2 docs is double the cost of 1 doc. This is why they are overworked, why pay 2 docs if 1 can do the work, the burnout of the doc is irrelevant as there are more docs to hire after they burn-out.
      - tayo42 1y ago
        Do doctors do extra hours per week? I thought they work less days but do this crazy long shifts
        bshep 1y ago
        sometimes, but extra hours dont get paid extra, so very little incentive to do so. there are many different models for compensation but you can think of it as a 'fixed salary with optional bonuses'. EDIT to add: Most places have a base + bonus structure. You get your base salary, and you see patients, for each patient seen you generate 'RVUs' which is how your group/practice generates income ( by billing insurance companies ). Once you generate enough RVUs to cover your base salary, you start accumulating 'bonus' and that gets paid out down the line using whatever formula your employer uses. There is some variation to this but for the most part groups follow a similar scheme. EDIT #2: This is US centric, i dont know how other countries do it.
        f1shy 1y ago
        Yes I don’t get the comments about salary vs hs. You need the same amount of people. The question is if you have 3 people doing 24hs shifts or 3 people doing 3 8hs shift a day… has nothing to do with more people/salary/money is just organization of work.
      - lostapathy 1y ago
        Perhaps if we didn't expect superhuman schedules from doctors, doctors wouldn't command as much of a cost as they do now. From the doctors I know, it seems like most don't get into it for the money, but they put up with it long-term because of the money. If we treated them better and increased supply, they would almost certainly cost less.
  - rkomorn 1y ago
    I personally have no issues paying more taxes for better staffing.
  - cogman10 1y ago
    > handoffs between shifts at hospitals is where things go bad. It'd cost more money, but the solution here is overlapping shifts. The reason shift handoffs go bad is it's usually a singular information dump right as the next round is getting into work mode. Overlap by an hour, long enough to pair on a round or two, and that information is much more likely to get remembered. I've been in hospitals a few times for shift changes and there have been a few times I've been the one to inform what the last shift was doing simply because it wasn't communicated. We do need more shifts and almost as important we need shift overlap.
  - tdeck 1y ago
    The doctor is going to have to go home some time - some patients are going to have care needs that get handed off regardless. If they are going home after 8 hours instead of 24 hours, maybe they'll be better at remembering to hand off everything properly to the next person.
- unnamed76ri 1y ago
  Today’s doctor shortage can be traced directly to government policy in the early 80s that lasted for 25 years. They assumed we’d have too many doctors and pressured medical schools to reduce enrollment.
  - EvanAnderson 1y ago
    The lobbying by the AMA may go back to the 80s, but the 1997 "Balanced Budget Act" set the limit on residency slots. Nice background: https://www.washingtonexaminer.com/opinion/1692395/thanks-to-doctors-there-arent-enough-doctors/ https://www.washingtonexaminer.com/opinion/1692395/thanks-to...
  - ikiris 1y ago
    No, the “limit” is the expectation of free reimbusement by the hospitals. This is lobbying for them to get more socialized gov handouts.
deleted 1y ago
[deleted]
didntknowyou 1y ago
this is vastly complex than aviation. it is like 10 pilots and co-pilots trying to fly 100 planes and simultaneously switching between them. and with everyone overworked due to no mandated breaks. no amount of checklist would prevent mistakes. we need legislation to limit medical workload, which is unlikely due to the shortages.
- IAmBroom 1y ago
  > no amount of checklist would prevent mistakes. So, don't even try? Why not both?
- charcircuit 1y ago
  Autopilot makes such a scenario safe.
0xDEAFBEAD 1y ago
>But maybe you oversimplified the book? (Or the book oversimplified how safety was achieved?) Quite possibly! >There is a whole list of things that can be transferred from aviation to medicine. Please recommend more books!
ACCount37 1y ago
Unfortunately, healthcare is cursed. The demand is just short of infinite, it requires an extremely specialized and highly capable labor force, and it has piss poor labor productivity forever. Which is why the staff is stretched thin, as a rule and not as an exception. Not that there's a shortage of other issues that compound that. But even if those issues weren't a thing? The curse is far too strong.
- toast0 1y ago
  > The demand is just short of infinite, it requires an extremely specialized and highly capable labor force, and it has piss poor labor productivity forever. Just because demand (typically) outstrips supply doesn't mean demand is just short of infinite. It just means it's hard to measure the demand. This is just like highway traffic --- you can't know what the demand is when it's all full, you just know there's more demand than capacity/supply. If you built a crap ton more hospitals, and forced everyone into mandatory service in healthcare for 20 years, I'm sure you'd have more supply than demand. That's a terrible plan, but it would solve the supply problem. You could modulate the mandatory service period to adjust to the needs, and it would still be a terrible plan. :) Something better would be some steps to address the bottlenecks. How can we attract / train a larger labor force; how can we retain the labor force; how can we increase productivity; something about facilities. Who can make the changes and how can they be incentivized to do it. I'm outside of healthcare, but here are some armchair ideas. There's a lot of "administrative busy work" that makes everything harder to do; if you ever need to call around to multiple pharmacies to get your meds, there's two problems there: the first problem is that shouldn't need to happen, the second one is that it's amazingly difficult for pharmacies to communicate; it's not uncommon for a physician to order a test and the wrong test is performed, etc ... it's not easy to streamline communications, but it would improve productivity if done correctly. There's also a lot of things that reduce quality of life of healthcare professionals which reduces desire to go into the field and reduces time spent in the field. And of course, there's limitations on the number of residency spots.
  - bshep 1y ago
    The pharmacies issue is a constant problem: patient lives out of town so prescription is sent to his home pharmacy at his request, on the day of discharge he realized his pharmacy is closed and wants them sent to a local pharmacy, of course this always happens at 5pm when you are driving in traffic, the patient is angry because they want to leave but there is not much you can do. This happens very frequently, doesnt matter if you ask ahead of time for the patient to confirm the pharmacy, something inevitably happens. The other issue is peer to peers and prior authorizations, these take up a significant amount of time and are essentially ways the insurance companies put barriers to care and reduce their costs. I think some of your ideas could work but good luck getting anything past the politicians, some of these things would be expensive and others would be unpopular to those that donate to the politicians.
nradov 1y ago
There has been some improvement in terms of long hospital shifts, but there is value in maintaining continuity of care. Research has shown that preventable medical errors are correlated with the the frequency of handover. Proper documentation in the patient chart can help to an extent but there's tacit knowledge that comes from directly observing a live patient which can't be documented in any codified way. So a balance has to be struck in terms of errors due to fatigue versus errors due to care discontinuities.
- lostapathy 1y ago
  I've been in the hospital more than once for a week at a time. At no point did I ever see the same doctor more than once in a 24 hour period - from that perspective, it seems irrelevant to continuity of care how long their shift was.
  - NetMageSCW 1y ago
    14 handovers is a lot less than 21 when it comes to opportunity for error.

by f1shy 1y ago

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 $$ paying for more medical staff. I can't speak to the police, but there have been a bunch of studies that showed that handoffs between shifts at hospitals is where things go bad. Someone doesn't document they gave an extra 2 cc of a drug to a patient, and next shift gives them more and causes issues, etc. Basically longer shifts = more fatigue, and the number of errors caused by fatigue were still lower than hand-off related errors.
- yjftsjthsd-h 1y ago
  > more shifts for docs = more $$ paying for more medical staff. I don't follow. It can't be more expensive to pay 2 doctors for 8 hour shifts than 1 doctor for 16 hours; if anything, I'd expect it to be cheaper (no overtime). > 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. Hence pushing for checklists so that doesn't happen?
  - deleted 1y ago
    [deleted]
  - bshep 1y ago
    The docs dont get paid per hour, they are salaried, so 2 docs is double the cost of 1 doc. This is why they are overworked, why pay 2 docs if 1 can do the work, the burnout of the doc is irrelevant as there are more docs to hire after they burn-out.
    - tayo42 1y ago
      Do doctors do extra hours per week? I thought they work less days but do this crazy long shifts
      - bshep 1y ago
        sometimes, but extra hours dont get paid extra, so very little incentive to do so. there are many different models for compensation but you can think of it as a 'fixed salary with optional bonuses'. EDIT to add: Most places have a base + bonus structure. You get your base salary, and you see patients, for each patient seen you generate 'RVUs' which is how your group/practice generates income ( by billing insurance companies ). Once you generate enough RVUs to cover your base salary, you start accumulating 'bonus' and that gets paid out down the line using whatever formula your employer uses. There is some variation to this but for the most part groups follow a similar scheme. EDIT #2: This is US centric, i dont know how other countries do it.
      - f1shy 1y ago
        Yes I don’t get the comments about salary vs hs. You need the same amount of people. The question is if you have 3 people doing 24hs shifts or 3 people doing 3 8hs shift a day… has nothing to do with more people/salary/money is just organization of work.
    - lostapathy 1y ago
      Perhaps if we didn't expect superhuman schedules from doctors, doctors wouldn't command as much of a cost as they do now. From the doctors I know, it seems like most don't get into it for the money, but they put up with it long-term because of the money. If we treated them better and increased supply, they would almost certainly cost less.
- rkomorn 1y ago
  I personally have no issues paying more taxes for better staffing.
- cogman10 1y ago
  > handoffs between shifts at hospitals is where things go bad. It'd cost more money, but the solution here is overlapping shifts. The reason shift handoffs go bad is it's usually a singular information dump right as the next round is getting into work mode. Overlap by an hour, long enough to pair on a round or two, and that information is much more likely to get remembered. I've been in hospitals a few times for shift changes and there have been a few times I've been the one to inform what the last shift was doing simply because it wasn't communicated. We do need more shifts and almost as important we need shift overlap.
- tdeck 1y ago
  The doctor is going to have to go home some time - some patients are going to have care needs that get handed off regardless. If they are going home after 8 hours instead of 24 hours, maybe they'll be better at remembering to hand off everything properly to the next person.
unnamed76ri 1y ago
Today’s doctor shortage can be traced directly to government policy in the early 80s that lasted for 25 years. They assumed we’d have too many doctors and pressured medical schools to reduce enrollment.
- EvanAnderson 1y ago
  The lobbying by the AMA may go back to the 80s, but the 1997 "Balanced Budget Act" set the limit on residency slots. Nice background: https://www.washingtonexaminer.com/opinion/1692395/thanks-to-doctors-there-arent-enough-doctors/ https://www.washingtonexaminer.com/opinion/1692395/thanks-to...
- ikiris 1y ago
  No, the “limit” is the expectation of free reimbusement by the hospitals. This is lobbying for them to get more socialized gov handouts.

deleted 1y ago

[deleted]

didntknowyou 1y ago

this is vastly complex than aviation. it is like 10 pilots and co-pilots trying to fly 100 planes and simultaneously switching between them. and with everyone overworked due to no mandated breaks. no amount of checklist would prevent mistakes. we need legislation to limit medical workload, which is unlikely due to the shortages.

IAmBroom 1y ago
> no amount of checklist would prevent mistakes. So, don't even try? Why not both?
charcircuit 1y ago
Autopilot makes such a scenario safe.

0xDEAFBEAD 1y ago

>But maybe you oversimplified the book? (Or the book oversimplified how safety was achieved?) Quite possibly! >There is a whole list of things that can be transferred from aviation to medicine. Please recommend more books!

ACCount37 1y ago

Unfortunately, healthcare is cursed. The demand is just short of infinite, it requires an extremely specialized and highly capable labor force, and it has piss poor labor productivity forever. Which is why the staff is stretched thin, as a rule and not as an exception. Not that there's a shortage of other issues that compound that. But even if those issues weren't a thing? The curse is far too strong.

toast0 1y ago
> The demand is just short of infinite, it requires an extremely specialized and highly capable labor force, and it has piss poor labor productivity forever. Just because demand (typically) outstrips supply doesn't mean demand is just short of infinite. It just means it's hard to measure the demand. This is just like highway traffic --- you can't know what the demand is when it's all full, you just know there's more demand than capacity/supply. If you built a crap ton more hospitals, and forced everyone into mandatory service in healthcare for 20 years, I'm sure you'd have more supply than demand. That's a terrible plan, but it would solve the supply problem. You could modulate the mandatory service period to adjust to the needs, and it would still be a terrible plan. :) Something better would be some steps to address the bottlenecks. How can we attract / train a larger labor force; how can we retain the labor force; how can we increase productivity; something about facilities. Who can make the changes and how can they be incentivized to do it. I'm outside of healthcare, but here are some armchair ideas. There's a lot of "administrative busy work" that makes everything harder to do; if you ever need to call around to multiple pharmacies to get your meds, there's two problems there: the first problem is that shouldn't need to happen, the second one is that it's amazingly difficult for pharmacies to communicate; it's not uncommon for a physician to order a test and the wrong test is performed, etc ... it's not easy to streamline communications, but it would improve productivity if done correctly. There's also a lot of things that reduce quality of life of healthcare professionals which reduces desire to go into the field and reduces time spent in the field. And of course, there's limitations on the number of residency spots.
- bshep 1y ago
  The pharmacies issue is a constant problem: patient lives out of town so prescription is sent to his home pharmacy at his request, on the day of discharge he realized his pharmacy is closed and wants them sent to a local pharmacy, of course this always happens at 5pm when you are driving in traffic, the patient is angry because they want to leave but there is not much you can do. This happens very frequently, doesnt matter if you ask ahead of time for the patient to confirm the pharmacy, something inevitably happens. The other issue is peer to peers and prior authorizations, these take up a significant amount of time and are essentially ways the insurance companies put barriers to care and reduce their costs. I think some of your ideas could work but good luck getting anything past the politicians, some of these things would be expensive and others would be unpopular to those that donate to the politicians.

nradov 1y ago

There has been some improvement in terms of long hospital shifts, but there is value in maintaining continuity of care. Research has shown that preventable medical errors are correlated with the the frequency of handover. Proper documentation in the patient chart can help to an extent but there's tacit knowledge that comes from directly observing a live patient which can't be documented in any codified way. So a balance has to be struck in terms of errors due to fatigue versus errors due to care discontinuities.

lostapathy 1y ago
I've been in the hospital more than once for a week at a time. At no point did I ever see the same doctor more than once in a 24 hour period - from that perspective, it seems irrelevant to continuity of care how long their shift was.
- NetMageSCW 1y ago
  14 handovers is a lot less than 21 when it comes to opportunity for error.