I’m an internal medicine resident who has worked in the ICU for several months so I can offer the other side of the story. The author strikes me as naive but well-intentioned and I don’t think...
Exemplary
I’m an internal medicine resident who has worked in the ICU for several months so I can offer the other side of the story. The author strikes me as naive but well-intentioned and I don’t think doubt his intelligence like some of the other comments. I won’t address everything he discussed unless there’s more interest from you all but here are some key points I’d like to bring up.
Improving mortality (preventing death) is the end-all goal of critical care medicine and the vast majority of studies that guide the field. Thus everything we do has some component of will this help or hurt patient chances of survival? Their comfort is also a priority but it takes a back seat to saving lives obviously. Now, being hyper-focused on the mortality aspect sometimes leads to more attention being given to sicker patients as well and there is only so much manpower and mind power in these units. The goal is to ultimately downgrade patients from the ICU however and the majority of patients are out within a week or so when their mortality risk is improved and the focus can shift to comfort and eventual discharge.
Delirium/hallucinating in the ICU is common (ICU delirium is a term we use) due to the nature of the body and thus mind being very sick and not having a normal routine. There are precautions to take including not letting patients nap during the day and making sure they are aware what time it is, where they are, what year it is, etc. It is difficult to manage agitation and delirium without medication, although it is generally preferred, due to staffing issues. Ideally every patient would have somebody constantly available at bedside to remind them what is going on and to help them stay anchored in reality, which is why family spending time at bedside is so helpful for us.
The author also discusses frustrations at how lab results are a snapshot of a single moment in time and that is a good point that we definitely take into consideration when managing patients. Unfortunately it is a limitation of medicine as a whole. Most tests that we do require a blood draw and each blood draw has associated risks and is actively making the patient anemic slowly over time.
In an ideal world, much of the authors complaints would be able to be addressed but in the real one with limited resources, manpower, and testing capability we are where we are for a reason. That’s not to say that improvements could not be made, however.
I’m not sure what the point of this point is? ’Good/bad things’ kind of imply some sort of meaningful choice. I’m not sure people dying once they’ve lived long enough is a ‘good thing’ either but...
Or, to put it in even starker terms, the next time you have trouble booking a surgeon or even a gastroenterologist, you can remember that America’s supply of surgeons and gastroenterologists is being disproportionately used by the AARP crowd. I’m not sure if this is a good thing, but I don’t think anyone has a better solution.
I’m not sure what the point of this point is? ’Good/bad things’ kind of imply some sort of meaningful choice. I’m not sure people dying once they’ve lived long enough is a ‘good thing’ either but it appears to be the reality for many.
I found this incredibly frustrating to read. I can only assume that this guy is a foreigner who is new to the medical system, someone who has been extremely blessed and has never even had family...
I found this incredibly frustrating to read. I can only assume that this guy is a foreigner who is new to the medical system, someone who has been extremely blessed and has never even had family who needed to go to the hospital for serious issues before, or is simply an idiot. He makes a lot of criticisms that he is really unqualified to make considering how little he understands about the ICU.
Right off the bat he complains about how many old people are in the ICU and it just stinks of ageism. He complains about these people being in the last 5-10 years of their life as if they are just going to uncontrollably die at any minute. That entire projection is also incredibly biased; yes, the average lifespan is about 76-77 years, but that’s accounting for all forms of death, including everyone who is dying young.
I’m not going to pretend that all of his criticisms were without merit, and there are some that I did agree with, but overall most of them seem to completely miss the point that the ICU is not intended to be a place where one stays for long periods of time. It is designed around getting patients stable and then getting them out. The author talks about hallucinations and delusions and doesn’t stop to wonder why they are so prevalent. They criticize them for not being able to give better long term mental care without understanding why an ICU is not a good place to diagnose such problems.
I mean... clicking his profile, you get to this about him: Which has been around at least since 2021, during which time he posted this description on HN: So, neither a foreigner, nor new to the...
I can only assume that this guy is a foreigner who is new to the medical system
I mean... clicking his profile, you get to this about him:
Writer of long, niche blog posts, mostly about biology. President of Highway Pharmaceuticals, a drug repurposing effort.
Which has been around at least since 2021, during which time he posted this description on HN:
Highway Pharmaceuticals is developing drugs for autoimmune conditions that aren't treated well by biologics. We currently have a lead compound and an indication and are headed towards an IND.
So, neither a foreigner, nor new to the medical system, nor an idiot; and likely a lot more familiar with it than you and me combined.
And where are you seeing that he is complaining about "old people" in the ICU? He even says his own relative is 70 years old.
This is such a bad faith reading, IDK what to tell you even.
There is a vast difference between working in a hospital and working in a drug company. And who are you to accuse me of bad faith here? Do you honestly expect me to get up in the morning looking...
There is a vast difference between working in a hospital and working in a drug company.
And who are you to accuse me of bad faith here? Do you honestly expect me to get up in the morning looking to things to complain about? I’m speaking from my own experience.
You said the guy is either a foreigner, new to the medical system (not "hospitals"), or an idiot. He is none of the three. A "drug company" is part of the medical system, and being a founder at a...
You said the guy is either a foreigner, new to the medical system (not "hospitals"), or an idiot. He is none of the three. A "drug company" is part of the medical system, and being a founder at a drug/healthcare company necessarily means you're at least more familiar with the system than the average person. If you keep digging into his profile, it's pretty clear he is.
Like, I don't know the guy. I don't care if you hate him, if you think he's an idiot anyway, if you think he's too white/not white enough to have an opinion about something... but the most charitable view I can give your comment is that you only read the paragraph titles and immediately responded to them while making up the contents of the paragraphs themselves.
You say he complained about the ICU being filled with old people. It wasn't a complaint.
You say he "talks about hallucinations and delusions and doesn’t stop to wonder why they are so prevalent.", when he spends eight paragraphs doing exactly that.
I'm no stranger to skimming. I do it plenty. But responding to the blanks you're filling yourself, when you're filling them the least charitable way possible, is plain toxic imo.
I’ll have you know that I not only read through the entire thing, I had read it twice and did some googling about lifespan statistics just to make sure I knew what I was talking about. You are the...
I’ll have you know that I not only read through the entire thing, I had read it twice and did some googling about lifespan statistics just to make sure I knew what I was talking about.
You are the one who is making uncharitable assumptions about me. I will admit that calling the author an idiot is harsh but he is making statements about things that it appears clear he doesn’t entirely understand.
I would have loved to discuss my thoughts with you but I would rather not talk to people who accuse me of things.
I think you’re expecting too much from an article titled “things I noticed.” Writing from the viewpoint of an uninformed outside visitor is a common form of journalism. Part of the point is to...
I think you’re expecting too much from an article titled “things I noticed.” Writing from the viewpoint of an uninformed outside visitor is a common form of journalism. Part of the point is to notice obvious things that people who work there might not even think to mention.
Saying there are a lot of old people in the ICU is that sort of observation. It’s well-known and still might be surprising to someone new.
It might have been nice if they then did more research to put their observations into more perspective, but someone else could add perspective, too.
Maybe I am expecting too much, but yes, I was expecting someone who cares enough to write and post this kind of thing would have been motivated to research and better understand why things were...
Maybe I am expecting too much, but yes, I was expecting someone who cares enough to write and post this kind of thing would have been motivated to research and better understand why things were run the way they were.
I’m not a medical expert. I’ve just been around long enough to have to spend time in the ICU, both as patient and visitor. That is why I find it so frustrating that they don’t seem to understand why things are run the way they are; I imagine they must have been living an extremely fortunate life to not have spent time there before.
I’m an internal medicine resident who has worked in the ICU for several months so I can offer the other side of the story. The author strikes me as naive but well-intentioned and I don’t think doubt his intelligence like some of the other comments. I won’t address everything he discussed unless there’s more interest from you all but here are some key points I’d like to bring up.
Improving mortality (preventing death) is the end-all goal of critical care medicine and the vast majority of studies that guide the field. Thus everything we do has some component of will this help or hurt patient chances of survival? Their comfort is also a priority but it takes a back seat to saving lives obviously. Now, being hyper-focused on the mortality aspect sometimes leads to more attention being given to sicker patients as well and there is only so much manpower and mind power in these units. The goal is to ultimately downgrade patients from the ICU however and the majority of patients are out within a week or so when their mortality risk is improved and the focus can shift to comfort and eventual discharge.
Delirium/hallucinating in the ICU is common (ICU delirium is a term we use) due to the nature of the body and thus mind being very sick and not having a normal routine. There are precautions to take including not letting patients nap during the day and making sure they are aware what time it is, where they are, what year it is, etc. It is difficult to manage agitation and delirium without medication, although it is generally preferred, due to staffing issues. Ideally every patient would have somebody constantly available at bedside to remind them what is going on and to help them stay anchored in reality, which is why family spending time at bedside is so helpful for us.
The author also discusses frustrations at how lab results are a snapshot of a single moment in time and that is a good point that we definitely take into consideration when managing patients. Unfortunately it is a limitation of medicine as a whole. Most tests that we do require a blood draw and each blood draw has associated risks and is actively making the patient anemic slowly over time.
In an ideal world, much of the authors complaints would be able to be addressed but in the real one with limited resources, manpower, and testing capability we are where we are for a reason. That’s not to say that improvements could not be made, however.
I’m not sure what the point of this point is? ’Good/bad things’ kind of imply some sort of meaningful choice. I’m not sure people dying once they’ve lived long enough is a ‘good thing’ either but it appears to be the reality for many.
Yes, this is broadly consistent with what I've seen.
I found this incredibly frustrating to read. I can only assume that this guy is a foreigner who is new to the medical system, someone who has been extremely blessed and has never even had family who needed to go to the hospital for serious issues before, or is simply an idiot. He makes a lot of criticisms that he is really unqualified to make considering how little he understands about the ICU.
Right off the bat he complains about how many old people are in the ICU and it just stinks of ageism. He complains about these people being in the last 5-10 years of their life as if they are just going to uncontrollably die at any minute. That entire projection is also incredibly biased; yes, the average lifespan is about 76-77 years, but that’s accounting for all forms of death, including everyone who is dying young.
I’m not going to pretend that all of his criticisms were without merit, and there are some that I did agree with, but overall most of them seem to completely miss the point that the ICU is not intended to be a place where one stays for long periods of time. It is designed around getting patients stable and then getting them out. The author talks about hallucinations and delusions and doesn’t stop to wonder why they are so prevalent. They criticize them for not being able to give better long term mental care without understanding why an ICU is not a good place to diagnose such problems.
I mean... clicking his profile, you get to this about him:
Which has been around at least since 2021, during which time he posted this description on HN:
So, neither a foreigner, nor new to the medical system, nor an idiot; and likely a lot more familiar with it than you and me combined.
And where are you seeing that he is complaining about "old people" in the ICU? He even says his own relative is 70 years old.
This is such a bad faith reading, IDK what to tell you even.
There is a vast difference between working in a hospital and working in a drug company.
And who are you to accuse me of bad faith here? Do you honestly expect me to get up in the morning looking to things to complain about? I’m speaking from my own experience.
You said the guy is either a foreigner, new to the medical system (not "hospitals"), or an idiot. He is none of the three. A "drug company" is part of the medical system, and being a founder at a drug/healthcare company necessarily means you're at least more familiar with the system than the average person. If you keep digging into his profile, it's pretty clear he is.
Like, I don't know the guy. I don't care if you hate him, if you think he's an idiot anyway, if you think he's too white/not white enough to have an opinion about something... but the most charitable view I can give your comment is that you only read the paragraph titles and immediately responded to them while making up the contents of the paragraphs themselves.
I'm no stranger to skimming. I do it plenty. But responding to the blanks you're filling yourself, when you're filling them the least charitable way possible, is plain toxic imo.
I’ll have you know that I not only read through the entire thing, I had read it twice and did some googling about lifespan statistics just to make sure I knew what I was talking about.
You are the one who is making uncharitable assumptions about me. I will admit that calling the author an idiot is harsh but he is making statements about things that it appears clear he doesn’t entirely understand.
I would have loved to discuss my thoughts with you but I would rather not talk to people who accuse me of things.
I think you’re expecting too much from an article titled “things I noticed.” Writing from the viewpoint of an uninformed outside visitor is a common form of journalism. Part of the point is to notice obvious things that people who work there might not even think to mention.
Saying there are a lot of old people in the ICU is that sort of observation. It’s well-known and still might be surprising to someone new.
It might have been nice if they then did more research to put their observations into more perspective, but someone else could add perspective, too.
Maybe I am expecting too much, but yes, I was expecting someone who cares enough to write and post this kind of thing would have been motivated to research and better understand why things were run the way they were.
I’m not a medical expert. I’ve just been around long enough to have to spend time in the ICU, both as patient and visitor. That is why I find it so frustrating that they don’t seem to understand why things are run the way they are; I imagine they must have been living an extremely fortunate life to not have spent time there before.
HN discussion (374 comments): https://news.ycombinator.com/item?id=33661482