Relying on emergency services only wastes soooooo much money. Waiting until problems are acute and they HAVE to be treated under EMTALA means doing way more expensive treatments and clogs up emergency services. Not to mention that not vaccinating or treating bacterial infections results in a bunch of cooties getting spread around the community. And when they’re getting those emergency services they can’t pay for them so the cost has to get absorbed into the bills of the patients who can pay either directly or through insurance.

“I don’t wanna pay for other people’s Healthcare!”

You already are, just in the least efficient and most expensive way possible.

I went into nursing instead of astrophysics. Decided I wanted a job that would outlast the apocalypse.

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…kinda. I suspect some of what they’re talking about is stuff like MEWS which is basically a calculation based on vital signs, labs, and assessment data that can make sure small changes in patient condition aren’t missed while they’re still small. I’ve actually had the EMR call the rapid response nurse for me based on the blood pressure reading that uploaded directly from the machine which meant I didn’t need to step away from the patient to start getting help in the room. It also factored in the level of consciousness (slightly loopy) that I charted earlier in the shift and immediately put them under suspicion for some kind of shock such as sepsis. There’s also a lot of things in modern EMRs that just remind us of things to make sure routine stuff isn’t missed like “hey this person had a positive MRSA test but there’s no infectious isolation precautions order?” or,“hey one of you did a suicide screening and the patient flagged but there’s no order for someone to be on suicide watch?”

But you also have times where those warnings lead to alarm fatigue which is where we get so sick of clicking through bullshit warnings that we start ignoring important ones. When I first started working it reminded me of modding morrowind as a kid, sometimes I’d get 20+ error messages about some mesh or other being missing and I’d be clicking through them so fast I’d miss a much more critical one and the whole thing would crash. Its actually a big part of how Radonda Vaught killed that lady at Vanderbilt a while back, the ICU nurses were dismissing that override warning as a part of their daily routine.

But now we’re getting into the next level of clinical alarm management where we’re starting to prune out the ones causing that fatigue. My last job used an EMR called epic, and epic actually has a little thumbs up / down icon in the top right corner of each warning. I actually wound up getting that suicide watch warning I mentioned before a lot because I worked on psychiatry and around half of my patients were suicidal at any one time. The thing about psychiatry though is that for that same suicide risk score on another unit we don’t need a person assigned to watch the patient usually. We mostly managed suicide risk by making sure that the patient doesn’t have access to the things that they would use to hurt themselves and reserved constant observation for patients that were willing and able to go to that extra mile to obtain or create the means to harm themselves with. I was getting that warning every time I opened the patients chart to put in routine 15min safety checks and it was infuriating and wasting time I didn’t have. So every time I got that warning, I would rate it with the thumbs down and take a second to explain in the little comment box what I just said. After the next time epic was updated, I didn’t see that warning again.

I guess the TLDR here is that ideally the computers are just augmenting our decision making in ways that make us faster and less prone to human error. In the end, though I think we’re going to find that there is a maximum information processing speed limit / cap for humans. I think a lot of companies are hoping that they can replace enough of human judgment with these systems such that they don’t have to pay for as many working hours when the real focus should be using these tools to make the people we have even better and just making sure those little life altering details don’t get missed. Same as how AI in art shouldn’t be being used to make whole pieces, it should be being used to help artists fill in grass or rock textures more quickly or upscale images. Ime it’s all about the usage and remembering that those tools should be used to help us, not replace us, if that makes sense.

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One of the things my parents did understand correctly as “new money” is that a significant portion of piddling etiquette rules about what color to wear at what times of the year and which fork goes on the left were largely ways for the bourgeoisie to attempt to maintain their advanced standing against the increases in (the potential for) equality that capitalism initially brought about. Unfortunately my parents are also a very “well we got ours so everyone else must be lazy” type of people who think that’s as good as equality can or should get.

Eeeeh. I kinda get why it fell out of favor. For context, the weird thing about the nursing perspective vs the MD perspective is that you don’t get as much of the benefit of large studies, but you also aren’t as sensitive to big pharma marketing studies either which… good AND bad. Like for school I had to take a class on evaluating the validity of drug trials and one of the studies mentioned was taking advantage of the fact that there’s basically no equivalent doses between different antipsychotics but you can also look at the doses from an experienced clinician perspective and be like huh they’re saying this drug has less side effects compared to 20mg of Haldol daily, but literally ANYTHING has less side effects than 20mg of Haldol daily; that dose is insane. The nursing perspective also tends to be more sensitive to variations in the needs of local populations, you’ve lived in an area and worked within that specific demographic and environmental setting for a few decades vs the doctors main body of knowledge often even includes studies from across the world. Just giving some background as to the upsides and downsides of my perspective.

So back to my point, I can tell you I associate lithium with being a last resort med for really sick patients who nothing else cuts it for. I associate it with horrible side effects including crazy weight gain and thyroid problems as well as fluid and electrolyte balances, and depakote and tegretol aren’t gonna cause that last one at all and also do have that advantage of blood level monitoring. I don’t see tegretol prescribed as much but depakote is probably what I see as the most prescribed med even before lamictal. Now lamictal I completely understand why I’m not seeing in the inpatient setting; you can’t rapidly titrate without risking the death rash (SJS/TENS), and the objective of inpatient care is always rapid stabilization with tweaking to occur in the community. And also maybe I’m associating lithium with all these horrible side effects because I’m seeing it used for patients suffering from both the direct effects of severe mania, especially those with the cumulative effect of multiple manic episodes over time, as well as all the other horrible things those episodes put them at risk of such as homelessness, substance abuse, and general increased risk of injury and illness due to decreased capacity for self care.

I guess the TLDR is, it wouldn’t shock me if the inability to patent salt was the reason lithium isn’t preferred, but I also associate it with being a pretty old-school heavy hitter like thorazine is for psychosis, and while my perspective has the advantage of being more experiential, that comes at the disadvantage of being less empirical (but its also often difficult to tell how empirical some studies are due to the influence of capitalism on the development of pharmaceuticals).

And CS Lewis made him useless Santa next to his lion Jesus allegory which you could have a lot of theological debates about but in the end is mostly just kinda funny also.

As a professional I’d basically be required to say the above, but I’m also watching from the inside as my country’s health system decays starting with populations that were underserved to begin with like the mentally ill. In other news I have a hospice interview tomorrow. If nothing else I’ll just get to focus on making people comfortable. That sounds so relaxing. I’m getting tired of having to tell people no all the time.

Well its mixed because he still wants to be able to force his mistresses to get them. He just wants the poor to keep reproducing at uncontrollable rates because the best way to have parents not care that you’re having sex with their children is to make sure they have too many to keep track of.

I am absolutely awestruck by the amount of bravery and critical thinking under stress that it must have taken to understand that you needed to sign a DNR for your 7 year old. Most parents in your situation would barely be able to add up 2+2, let alone comprehend enough of what the doctor was saying to make that kind of decision.

I’m also so happy for all of you that you wound up not needing that DNR. I hope she’s adapting well to her life with those limitations, but often children that age have enough neuroplasticity to work it out. She’s also certainly got parents who know how to put their own emotions aside and make sure she gets the care she needs, so under the circumstances she’s got a lot going for her. <3

The nurses and nursing assistants all have to wear trackers that track to see if they go near a hand sanitizer station or sink within 30 seconds after entering and 30 seconds before leaving a room. It’s to check for handwashing compliance but in addition to being a narrow and error-prone window it also doesn’t account for other common situations like poking your head into a room to check on someone while on the way to something else and not touching anything or anyone. It creates a situation where you’re better off just breezing through and ignoring a patient calling to you because if you go over there to acknowledge them but don’t have time to set down whatever you’re in the middle of, it’ll hurt your metrics. They might just need a cup of water you could grab and drop off on your way back in the other direction but fuck 'em, admin says you need to make a whole entry and exit ceremony of asking them what they need to keep your numbers up, so they’ll have to wait until you have time for that.

Yeah like tbh the original comment thread wasn’t worth banning them. Kinda silly but whatever. Literally everything after that was worth a ban though. They picked a molehill and just… fought to the last breath on it.

And if you’re really dedicated to being a person who saves lives and its a big part of your personal identity, you’d also be risking the lives of the future people you’d be able to help and your identity as a person who saves lives. You can’t help this one person in this specific life threatening situation but there’s other peripartum hemorrhages you could help and many more you could try to keep out of that condition to begin with. But to do that you have to let this one person die despite knowing how to help them too. Absolute shit sandwich.

I’m working on developing a better work life balance but for the longest time working as a nurse has been the thing I stuck around on ye olde mortal coil for. It’s what was worth sticking around to try and get through all that therapy for. I won’t try to say it’s healthy but if I lost my license I don’t really have a whole lot left to stick around for.

Bingo. This is my interpretation as well.

On a related note, I’ve been thinking lately about how many older men have gone absolutely batshit on me for suggesting that they may not be able to safely pee standing up anymore. Its so hardwired in some of them that sometimes even bilateral amputees with enough dementia will insist that they need to stand up to pee. I’ve literally pulled back the blankets to show them their missing legs and they look right back up at me and keep yelling at me to get out of the way.

It’s happened so much at this point that I’m very desensitized to it. They’ll be threatening to kill me and I’m just “ah yes the good ol’ standing piss argument.” It’s practically as developmentally normal as a toddler not being able to share toys or a teenager having an unstable personal identity. Not sure what the female equivalent is, most of the violence I receive from that population seems to relate to trauma / fear related to sexual assault; they have difficulty calmly accepting assistance toileting because they’re worried I’m going to hurt them vs it being less common to be a pride issue with women. Although I suppose the pride just boils down to a fear of being taken advantage of for being weak.

TLDR; loss of independence is rough and in addition to the driving thing there’s a few other interesting manifestations.

There’s also practical benefits. As someone without children I’d really like to see more funds and attention paid to education because I’m getting really fucking sick of interacting with stupid people.

I run into troubled young men a lot, unfortunately. I was raised female so I often lack the context to truly empathize with their life experiences, and I’m really hurting for coworkers to consult who can.