This should make your blood boil . . .

[MeaganS]

3 minutes ago, wathe said:

I have thoughts that I will post later.  But right now I'm off to go work in an over-crowded, overwhelmed, understaffed emergency department during a holiday week, in a pandemic, when many PCP's offices and other outpatient resources are closed.  I can guarantee that both I and many of my patients will leave the department frustrated at the end of the night.

Sorry! Dh has been having the same problems at his hospital. They have people in the hallways and their ER has turned into overflow ICU. He's been getting about 3 hours of sleep a night. It's frustrating for everyone right now. Good luck!

[wathe]

One more cranky post before I go - odds are that I will attempt to resuscitate someone tonight who wouldn't really have  wanted resuscitation if they'd known what it really meant.  But had never had the conversation with their PCP or family, and did not have a directive in place.  And family either won't be available in the moment that a decision is forced, or they will be overwhelmed and not able to make a decision.  So I will break ribs with chest compressions, and put a big tubes airways, and give  electric shocks, and then they will likely die anyway.  This happens all.the.time.  It's really hard on those who do the resuscitating TBH. 

[Moonhawk]

{{{ @wathe }}} You have all my love right now.

[Frances]

2 hours ago, gardenmom5 said:

It has it's own .problems- and it does get rationed too.  by age, by disability.  by "conditions".

I ended up on a UK health site doing research on TIAs . . .I was appalled at what I was reading.  you better believe the UK rations care.  It's naive to think they don't. TIAs are considered a risk factor for a full-blown stroke.  Even in the UK - those that have resources can (and do) get private health-care.  

 those deaths get listed as 'natural causes" - well, they're "natural causes" because the patient  has to wait so long to get care, they die.  In the US, drs wants them in the office within six weeks at the worst, and usually much, much, faster.  - this was from reading UK health sites, not someone's commentary.

I was also on their doing research on pregnancy in older moms . . . . I'm on a couple health groups (thyroid/ASD-PDA) that have very large draws from the UK.  (and all the complaints from UK residents who've tried to get healthcare through their system, and get put off and put off)  no thanks, I absolutely wouldn't want to be reliant on their system.

eta: if you want an example of how the US govt runs healthcare - check out the VA. . . . It's obscene.

I agree with you that every health system rations care, including the various universal health ones. Only very wealthy individuals will never experience healthcare rationing. But I also agree with the poster you were responding to that healthcare is a human right. Just because my husband and I are fortunate enough to both have jobs with great benefits, I don’t think that means that our family deserves better access to or better health care than anyone else in the US.

Yes, the UK system is underfunded right now, so it’s no surprise that people are complaining about some things. But at least if the citizens decided to fund it better, everyone benefits. I don’t think the vast majority of Canadians rate it as a point of pride for their country because it is so terrible. While in the US under the current system, we will always have the extremes of some receiving excellent almost unlimited care to those receiving almost nothing and everything in between. Plus, our system is amazingly inefficient. We spend more per capita on healthcare than all those developed nations with some sort of universal healthcare with generally overall worse health outcomes.

And while I don’t expect to ever see any form of universal healthcare in the US in my lifetime, just about the last type I can ever imagine happening here is a VA style system where all of the healthcare providers are employees of the federal government. So I don’t think how the VA is run is really any indicator of how universal healthcare could look here. Even Medicare is not a great example since it’s easy for some doctors to opt out of taking Medicare patients.

[katilac]

2 hours ago, MeaganS said:

I just wanted to say something regarding this point. That is actually the job of the ER. Their job isn't to diagnose you or make sure you have follow-up care. It is to see if you are sick enough to need to be hospitalized and give you whatever immediate care you require and if not determine if you are well enough to go home. Diagnostics is the job of a PCP and other specialists. I feel like a lot of people misunderstand this. ERs aren't designed to be a one-stop shop. It's in the name, "Emergency." This misunderstanding is one reason people are so frustrated with hospitals. They misunderstand the purpose of the care. DH comes across this a lot as a hospitalist. His job isn't to figure out and fix all the problems you have. His job is to get the problem that is made you be admitted in the first place in good enough shape for you to go home and work on it there. He's had patients in for head injuries who want him to investigate their diabetes or something. It's not why you are at the hospital.

That said, many people end up having to use them that way because they don't or can't get preliminary care, and that's a different issue. But it I just wanted to defend the ER, because it isn't their job to fix people's root issues or even diagnose them beyond anything emergent. 

Oh, I absolutely know that, and I didn't say anything negative about the ER. They are doing what they are supposed to do. I was just saying that the result of having the ER be the only place that can't turn you away is a lot of people not getting diagnoses or actual treatment; essential healthcare is rationed based on ability to pay. I 100% agree that it is not the job of the ER to fix root issues, and that is why they should not be the only option that can't turn you away. 

[brehon]

On 12/26/2020 at 8:22 PM, Mrs Tiggywinkle said:

I have seen many where only DNR is checked, and then I’ve seen some where it is clear that the doctor has not really sat and discussed things with the patient—for instance they want CPR but no intubation, which doesn’t make sense.  I’ve seen many where someone wants antibiotics and a feeding tube, or a noninvasive breathing machine like a bipap, but nothing else.  All of this is considered life sustaining treatment and that’s what the document covers.

God yes! I canNOT tell you how many codes I’ve run where the family requested medications only. It’s absolutely ludicrous! For those who don’t know—a chemical code {which really isn’t a medical thing} involves starting an IV/IO and only administering medications...

....which then sit in the vein/marrow and don’t circulate because there are no compressions. No compressions = no medicine circulating = no medicine (or anything else like oxygen) getting to the heart. It’s utterly useless.

(And, no, we don’t do this. We call the medical director and punt that football to him.)

 

[brehon]

5 hours ago, wathe said:

One more cranky post before I go - odds are that I will attempt to resuscitate someone tonight who wouldn't really have  wanted resuscitation if they'd known what it really meant.  But had never had the conversation with their PCP or family, and did not have a directive in place.  And family either won't be available in the moment that a decision is forced, or they will be overwhelmed and not able to make a decision.  So I will break ribs with chest compressions, and put a big tubes airways, and give  electric shocks, and then they will likely die anyway.  This happens all.the.time.  It's really hard on those who do the resuscitating TBH. 

Solidarity. This happens all the time in the EMS world, too. 

[Mrs Tiggywinkle]

5 hours ago, wathe said:

One more cranky post before I go - odds are that I will attempt to resuscitate someone tonight who wouldn't really have  wanted resuscitation if they'd known what it really meant.  But had never had the conversation with their PCP or family, and did not have a directive in place.  And family either won't be available in the moment that a decision is forced, or they will be overwhelmed and not able to make a decision.  So I will break ribs with chest compressions, and put a big tubes airways, and give  electric shocks, and then they will likely die anyway.  This happens all.the.time.  It's really hard on those who do the resuscitating TBH. 

I am convinced that almost no one would want resuscitation if they knew what it actually meant.  And the poor, poor outcomes. My old PCP told me once that she has never actually performed CPR; she did her medical student ED rotation but never had a code while there.  It happens.  So when she’s trying to discuss advance directives with her patients, she’s not coming from a place where even she knows what kind of horror it is.  And it’s not just once. You get a pulse back, maybe, and go to ICU where more than likely you’ll code again. And again. Until mercifully someone makes the decision to let go.

I am quite sure both Wathe and Brehon have the same stories I do of people who did not understand that’s it’s not like TV or who’s families were not made to understand the prognosis and reality.  Resuscitative care is neither kind nor(usually) life sustaining.  This is why it is so very important to have conversations ahead of time with your loved ones.  
 

On a personal level, I have vascular EDS and two known brain aneurysms that right now are not fixable.  My husband and my sister, both paramedics, are my proxies. I have actual legal paperwork that my mother, whom I love dearly, is not to be involved in any care decisions.  It is a very difficult thing to end life sustaining care, and I don’t think she could actually do it and would fight, maybe even a court battle, to keep me on life support.  These kind of situations happen much more frequently than you can imagine or ever make the news.  This is why it’s so very very important to be have your wishes written clearly and legally—and to truly understand the ramifications.

(End soapbox. And people with developmental disabilities is a totally different issue, but are as equally deserving of every form of life sustaining treatment they or their families desire)