4 ms·

This is stated as the likely result in the article, complete with the quote. The article notes that the ER, at that stage of the visit, is not tasked with a di

This is stated as the likely result in the article, complete with the quote. The article notes that the ER, at that stage of the visit, is not tasked with a diagnosis but deciding whether to admit to the hospital or discharge. The complaint is that, sepsis or not, horse or zebra, the symptoms presented were severe enough to warrant further tests (such as a chest x-ray, if for no reason other than to rule something out) as part of a hospital admission. Those tests might also have been inconclusive, and the patient might still have died, but it would have at least reflected the severity of what was presented. Instead, in a chaos of paperwork and a supervising physician who overruled every warning flag in favor of discharging the patient, the kid got sent back to die alone in his dorm room.

m_fayer 1y ago
This article brought up the sickening memory of taking my frail elderly mom to the er with similarly severe-but-general symptoms. The er was crowded and the hospital was crowded. The er clearly couldn’t treat her beyond basics, she needed to be admitted and monitored. But, as a sympathetic resident told me before mysteriously disappearing “there’s no space upstairs, I’ll try to get your mom in somehow”. I worked with EHRs at the time and knew how to advocate. They kept trying to discharge my deeply ill mom without explanation and bumping into my objections, I was talking to a different nurse or social worker or resident every 3 hours round the clock. I felt scared to leave even for a short time lest they expel her. In the end, I needed to go home to sleep and they discharged her at 6am, and when I arrived they had her bundled up and already waiting to be taken home, shivering and ashen. All they told me was that there’s no diagnosis, no reason to admit her and no beds anyway, she just needs to rest and have fluids, try urgent care if needed. Multiple social workers sympathetically assured me and my mom’s aide that we were good people for being up to taking care of my mom at home, so they could tick a discharge box. We emphatically were not. In the end, eventually, she was ok. The experience was harrowing. Many people talked to me but no one engaged with us, the interest was clearly in getting my mom out. It felt cruel and uncaring. I’m surprised the article doesn’t address the “refusal to admit” angle. It used to be that you could admit patients for care and monitoring without a diagnosis, but this simply isn’t a thing anymore. So, deeply ill people who for whatever reason don’t have access to adequate care and monitoring from a caretaker at home are simply surrendered to their fate.
- mindslight 1y ago
  Hospitals are fundamentally paper pushing bureaucracies that systematically don't give a fuck about patients, and the "case managers" and "social workers" are the worst of the lot. A hospital gave my dad covid in the middle of 2020, then insisted he be discharged still covid positive and unable to stand on his own (the PTs had just let him languish). That was some great public health policy right there. The only consolation was that it was summer so I could keep good airflow through the house. I avoided getting it, as far as I could tell. Found a freelance aide that didn't mind the rona, and we eventually got him back on his feet. And once you see how abjectly horrible this system is, you can't avoid noticing all of those terrible dynamics even in much lower-stakes interactions.
- jacquesm 1y ago
  They key element was the introduction of financial decisions into healthcare. This is all in the name of 'efficiency' and never mind the body count. The best thing that can happen to a health care worker is to be subjected to the system themselves.
  - franktankbank 1y ago
    The health care worker is not the one in charge of these decisions though. I don't consider an executive or administrator a "health care worker" so maybe that is who you mean?
    - m_fayer 1y ago
      IME, health care workers (doctors and nurses) often defend many of the habits and attitudes encouraged by the system and hated by patients, because the pressure on them has banded them into an "us vs them" or "soldier vs civilian" mentality. Also because the current situation has kicked off a cycle of antagonism between them and patients and especially the people advocating for said patients.
- rvba 1y ago
  In the 50s and 60s there would be those big hostpitals. But those were downsized in search of allmighty dollar. Also many families try to push elderly to hospital for few days.

m_fayer 1y ago

This article brought up the sickening memory of taking my frail elderly mom to the er with similarly severe-but-general symptoms. The er was crowded and the hospital was crowded. The er clearly couldn’t treat her beyond basics, she needed to be admitted and monitored. But, as a sympathetic resident told me before mysteriously disappearing “there’s no space upstairs, I’ll try to get your mom in somehow”. I worked with EHRs at the time and knew how to advocate. They kept trying to discharge my deeply ill mom without explanation and bumping into my objections, I was talking to a different nurse or social worker or resident every 3 hours round the clock. I felt scared to leave even for a short time lest they expel her. In the end, I needed to go home to sleep and they discharged her at 6am, and when I arrived they had her bundled up and already waiting to be taken home, shivering and ashen. All they told me was that there’s no diagnosis, no reason to admit her and no beds anyway, she just needs to rest and have fluids, try urgent care if needed. Multiple social workers sympathetically assured me and my mom’s aide that we were good people for being up to taking care of my mom at home, so they could tick a discharge box. We emphatically were not. In the end, eventually, she was ok. The experience was harrowing. Many people talked to me but no one engaged with us, the interest was clearly in getting my mom out. It felt cruel and uncaring. I’m surprised the article doesn’t address the “refusal to admit” angle. It used to be that you could admit patients for care and monitoring without a diagnosis, but this simply isn’t a thing anymore. So, deeply ill people who for whatever reason don’t have access to adequate care and monitoring from a caretaker at home are simply surrendered to their fate.

mindslight 1y ago
Hospitals are fundamentally paper pushing bureaucracies that systematically don't give a fuck about patients, and the "case managers" and "social workers" are the worst of the lot. A hospital gave my dad covid in the middle of 2020, then insisted he be discharged still covid positive and unable to stand on his own (the PTs had just let him languish). That was some great public health policy right there. The only consolation was that it was summer so I could keep good airflow through the house. I avoided getting it, as far as I could tell. Found a freelance aide that didn't mind the rona, and we eventually got him back on his feet. And once you see how abjectly horrible this system is, you can't avoid noticing all of those terrible dynamics even in much lower-stakes interactions.
jacquesm 1y ago
They key element was the introduction of financial decisions into healthcare. This is all in the name of 'efficiency' and never mind the body count. The best thing that can happen to a health care worker is to be subjected to the system themselves.
- franktankbank 1y ago
  The health care worker is not the one in charge of these decisions though. I don't consider an executive or administrator a "health care worker" so maybe that is who you mean?
  - m_fayer 1y ago
    IME, health care workers (doctors and nurses) often defend many of the habits and attitudes encouraged by the system and hated by patients, because the pressure on them has banded them into an "us vs them" or "soldier vs civilian" mentality. Also because the current situation has kicked off a cycle of antagonism between them and patients and especially the people advocating for said patients.
rvba 1y ago
In the 50s and 60s there would be those big hostpitals. But those were downsized in search of allmighty dollar. Also many families try to push elderly to hospital for few days.