US Politics: Getting Rid of the Senate

[MerenthaClone]

Ooh! One of my favorite rant topics. Here's one reason patient satisfaction scores should be heartily ignored, but I've got more!. So, we're having a busy, busy day in my ICU. Our doctors and charge nurses keep being pulled off the unit because the rapid response teams are needed basically everywhere in the hospital, our patient acuity is skyrocketing and we're having to make 1:1 assignments for a high portion of my unit. So, I'm basically running around helping my other nurses because we're struggling with two near-constant almost-arrests in my section alone, and that's when I'm not being pulled off the unit to deal with other full-blown arrests. I have a patient who is still in our unit but is awaiting transfer to one of our floors, and she is on her call bell constantly. Asking every five minutes if she can eat, for instance, when I explained at length when and why she wasn't able to safely eat and what was necessary for me to put in an order (she needed to be cleared to swallow by a speech therapist). Anyhow, we're trying to transfer her, which means I need to pull out the central line in her femoral vein. I spend twenty minutes in her room explaining why, explaining what I would need to do, and explaining that I was going to have to hold pressure for a long time to prevent her from bleeding. I explained to her what the vein was, if she had any questions, and was yelled at for my time because I wasn't getting her the cake she wanted. Anyhow, so after I'm holding pressure on her groin (which needs to be hard because a) she had minor coagulopathies and B) its your goddamned femoral, she starts telling me that I'm hurting her and need to stop because I'm being mean. She starts trying to physically remove me, hit me, punch me, and spit at me to get me off. This is, by the way, despite me taking the time I didn't have to explain in detail what I was about to do to partially try to avert something like this. Later, she'd filed a report about me because I was "torturing her." The patient relations rep's response was to ask me if next time, I could hold pressure less hard.

So yeah, explain to me how that would work, Commodore. If I'd backed off, she could have developed a nasty bleed or a hematoma. Here's the thing: if she'd died, she didn't have family to write up a bad review. Instead, my institution would have a bad review, completely devoid of context, that we torture my patients because I held pressure on a femoral bleed. People do not know what good care is. This already incentivizes nurses to spend time trying to find the patient's favorite pudding instead of any of a billion other things that probably have a more significant health effect for the patient that they'll never know we're doing. And its not like I don't want to find their favorite pudding. I love it when I have the time to go in and give them a really, really nice bath. When I can sit down with a razor and give my men a good shave, or braid my patient's hair. Its great when I have the time to sit down and just talk to them or their families, or, yes, find their favorite pudding. But there's no fucking way I'm taking the time to do that when the patient next door is crashing, or I need to go to a CT scan, or I need to give antibiotics on time, or or or. There are priorities, and those priorities are often not the patient's comfort. Medical care can hurt. It can be uncomfortable. We can take away your food or water if you're going to aspirate on it. We're going to put uncomfortable catheters in. We're going to draw blood when you don't want it. We're going to give you medications that make you feel awful. We're going to do a bunch of things that you find awful, and you're going to yell at us for doing it and then yell at us for why you're not getting better faster or why you don't have the exact type of cookie you want.

And I want to help you, I really do. I don't want to cause you pain, but if I don't cause you pain, you could bleed out, choke, get pneumonia, or a worsening diabetic complications, or fall, or or or or. And I'm going to do my damnedest to make your life as comfortable as possible while you're under my care, but that comes after I make sure you (and everyone else) actually keeps that life.

[DanteGabriel]

Good rant, Merentha. Mrs. Gabriel is a nurse midwife. I hear similar stories.

You shoulda let the Unerring Invisible Hand of the Free Market keep the pressure on that femoral bleed.

[Kalbear]

Holy fuck, Merentha - you're working in ICU? I remember when I met you and you couldn't even legally drink yet and you were just starting college.

[MerenthaClone]

Holy fuck, Merentha - you're working in ICU? I remember when I met you and you couldn't even legally drink yet and you were just starting college.

Yeah, Kal! Its been a long time. Took me a while to actually find what I wanted to do, but I think I got there in the end. I hope so. I'm not any better at pool, but at least I've got a beard and can drink beer now.

[Swordfish]

I'm assuming when you say "that business" you're talking about the people that develop/produce the drugs, and are not including the healtcare workers who actually take care of the patients.

he's also blatantly ignoring the fact that some sort of magical cancer cure would be absurdly profitable. S the notion that 'they don't want to cure cancer because... Money....' is just wildly insane conspiracy stuff.

And that's in addition to the fact that has already been pointed out, which is that we do, in fact, cure a lot of cancer already.

[BloodRider]

Rand Paul is not really for the Rule Of Law

http://nymag.com/daily/intelligencer/2014/12/rule-of-law-maven-rand-paul-ignoring-law.html?mid=outbrainrc

[OnionAhaiReborn]

Rand Paul is not really for the Rule Of Law

http://nymag.com/daily/intelligencer/2014/12/rule-of-law-maven-rand-paul-ignoring-law.html?mid=outbrainrc

I'm going to do something that almost physically pains me, and defend Rand Paul here. That headline is not justified by the article's content. There's just a bare possibility of Paul choosing to simply attempt to defy Kentucky election law at this point, I seriously doubt it will happen.

My prediction: he stays off the Kentucky primary ballot for President, doesn't get the Presidential nomination anyway, and runs for reelection to the Senate.

[aceluby]

This sounds like Mike Adams the Health Ranger talking. You should sign up for his newsletter. :)

(but be advised that this could lead you to start threads about the terrible, terrible killing of the almonds)

Because skepticism of our for profit health industry is SO weird and just like being an anti-vax conspiracy kook.

Except, yes that is what you did do. You gave a bad review to the people who HAVE ACTUALLY WON MANY BATTLES AGAINST CANCER. This is precisely why I claimed that making medicinal decisions at the individual level is really bad for a society.

I can't deny the "looking for profit" part - But calling developers of Chemo and radiation therapy "quacks" is again exactly why we in the human race are not capable of assessing aggregate effects.

Chemo has been around for 75 years. I don't think the developers are quacks at all and never claimed such, but I do find it weird that over 75 years we're still bludgeoning the body with poisons to counteract cancer despite the havoc it does on the body. You don't think it's odd that we're still treating cancer in the same way we treated it when doctors were sponsoring brands of cigarettes? It's not like the method is fool-proof.

With that being said, I would go through it if I had cancer because it's the only real treatment available. I just think there isn't a whole lot of effort to make better treatments because there's so much money to be made with the current way we deal with it, so why would the powers that be look to change a money maker?

[Swordfish]

Because skepticism of our for profit health industry is SO weird and just like being an anti-vax conspiracy kook.

Chemo has been around for 75 years. I don't think the developers are quacks at all and never claimed such, but I do find it weird that over 75 years we're still bludgeoning the body with poisons to counteract cancer despite the havoc it does on the body. You don't think it's odd that we're still treating cancer in the same way we treated it when doctors were sponsoring brands of cigarettes?

What's odd is how little you seem to know about the topic you are ranting about.

[aceluby]

And I'll just leave this here. Take it as you will, there are hundreds of examples of stories like this.

http://www.sfweekly.com/sanfrancisco/miracle-cannabis-oil-may-treat-cancer-but-money-and-the-law-stand-in-the-way-of-finding-out/Content?oid=2825695

[MerenthaClone]

And I'll just leave this here. Take it as you will, there are hundreds of examples of stories like this.

http://www.sfweekly.com/sanfrancisco/miracle-cannabis-oil-may-treat-cancer-but-money-and-the-law-stand-in-the-way-of-finding-out/Content?oid=2825695

I can link you to Dr. Oz if you want. He's got miracle cures to sell you too.

[TrueMetis]

Because skepticism of our for profit health industry is SO weird and just like being an anti-vax conspiracy kook.

Chemo has been around for 75 years. I don't think the developers are quacks at all and never claimed such, but I do find it weird that over 75 years we're still bludgeoning the body with poisons to counteract cancer despite the havoc it does on the body. You don't think it's odd that we're still treating cancer in the same way we treated it when doctors were sponsoring brands of cigarettes? It's not like the method is fool-proof.

With that being said, I would go through it if I had cancer because it's the only real treatment available. I just think there isn't a whole lot of effort to make better treatments because there's so much money to be made with the current way we deal with it, so why would the powers that be look to change a money maker?

Vaccines have been around for 200 years, and yet the same basic rules still apply. Because like Chemo Vaccines have been improved immensely.

A more obvious example, this is like finding it weird that we still work metal by making it hot. You think the smelting industry is also not looking at other ways of working metal because of money?

[TrackerNeil]

Merentha's post: :thumbsup:

[Kalbear]

Because skepticism of our for profit health industry is SO weird and just like being an anti-vax conspiracy kook.

It does when you don't have the slightest idea of what you're talking about and appear to embrace ignorance instead of doing any research to educate yourself.

We still fire bullets from guns despite it being 500 years old tech. Heck, we still have knives. Tech doesn't disappear overnight. And even if it did, you'd still be wrong because cancer care and treatments have changed absurdly since they first started. Chemo itself is a hugely different thing than it used to be.

You're essentially saying that because you don't understand how cancer treatment works you believe it to be wrong.

[TerraPrime]

[mod hat]

Ahem. Topic? Politics?

[/mod hat]

[BloodRider]

And I'll just leave this here. Take it as you will, there are hundreds of examples of stories like this.

http://www.sfweekly.com/sanfrancisco/miracle-cannabis-oil-may-treat-cancer-but-money-and-the-law-stand-in-the-way-of-finding-out/Content?oid=2825695

I wondered what flavor of snake oil would be your sacred cow.

Look - if that stuff works then put it through the clinical trials find the appropriate dosage and the appropriate pathologies to treat. Figure out what the side effects are, and how it interacts with other medicine and go with it.

What I object to - and where you seem to side with Commodore (weather you realize it or not) is side stepping the process and marketing it directly to consumers. That is a sure fire way to end up with dead people, and hucksters getting rich.

Ask yourself why the makers do not take it to clinical trial. If they really want to save lives I can guarenfucking-tee you that a successful clinical trial will open their market to the thousands.

Ask yourself why it is marketed like buzzfeed clickbait "The cure they don't want you to know about". The only purpose of such shite is to get you to buy the product for reasons other than its merits.

Ask yourself why we get anecdotes and not substantiated recoveries. I mean we have the lady who sells the stuff for $2,500 a bottle saying she has "cured" 22 out of 26 patients. But she offers no proof of that. Wonder why she would make that unsustantiated claim. Then we have a few anecdotes - including several where the patient died anyway - ie they were not cured.

[mod hat]

Ahem. Topic? Politics?

[/mod hat]

I think this is extremely political. It is the agenda of one of the major US parties to destroy the organizations that check into these claims. In an effort to denude or destroy these institutions there is a campaign out there to pretend that each individual is an expert in every area, and that intellectualism and study is weak. This is a discussion around one aspect of that, true. But I would put forth that it is very political. YMMV.

[Aemon Stark]

Chemo has been around for 75 years. I don't think the developers are quacks at all and never claimed such, but I do find it weird that over 75 years we're still bludgeoning the body with poisons to counteract cancer despite the havoc it does on the body. You don't think it's odd that we're still treating cancer in the same way we treated it when doctors were sponsoring brands of cigarettes? It's not like the method is fool-proof.

With that being said, I would go through it if I had cancer because it's the only real treatment available. I just think there isn't a whole lot of effort to make better treatments because there's so much money to be made with the current way we deal with it, so why would the powers that be look to change a money maker?

In the spirit of being blunt, you are wrong and are simply ignorant of the current state of practice in medical oncology and malignant hematology.

First, to use your analogy, antibiotics have been around for 86 years. Do you think we haven't moved beyond Penicillin in 2014?

Second, "targeted" agents have utterly changed oncology and will only continue to do so in the future. There will always be a place for cytotoxic chemotherapy, but they now exist alongside agents like Rituximab - a monoclonal antibody against receptors present only on B cells, something that has allowed for better, more targeted, and less toxic therapies for non-Hodgkins lymphoma.

Breast cancer is no longer simply treated with cytotoxic chemo either. Many patients - even with metastatic disease - benefit from targeted agents like Tamoxifen or Herceptin, both of which target receptors expressed by tumour cells. Prognosis is substantially influenced by the expression of such receptors on tumour cells, and the development of these agents has been something of a paradigm shift.

As for the political angle of all this, I'd say it's fairly clear. Lunatic arguments about suspending regulation in favour of some hare-brained "caveat emptor" approach are the perfect examples of thinking without reference to reality. There is no substitute for science-based decision-making, and this applies as much to medical conspiracy theories as it does to people claiming that "market-based" solutions can be imposed on the singular basis of reality-bankrupt ideology.

Because that's what we're talking about here - people who are so convinced by their assumptions (and ignorance) that they think their simplistic prescriptions can be applied to everything and anything.

In medicine we all depend on working with colleagues whose skills and expertise can be trusted. A surgeon needs to be able to trust their anesthetist and vice-versa. You can't just use reality-bankrupt "competition" arguments to suggest we do away with licensing and certification, especially when people making these arguments invariably have NO experience with the training or practice. Of course, that extends to other fields as well.

Board/Royal College exams are challenging - people will often study for an entire year before sitting them. Our Royal College exams are comprised especially of oral exams, and the scope in any specialty is vast. There is absolutely no role for any layperson to comment on the qualifications implied by specialty certification, and the idea that these are in any way unnecessary is both insulting and ignorant.

I will also say that market assumptions only really hold under conditions of "perfect" information, a condition intrinsically inapplicable to health care and, indeed, a great many other spheres of human activity. One thing about medicine and health care generally is that we encounter people from every background, every income, every profession, and every state of living, from the couch-surfing IV drug user to the hermit in the woods to the CEO. In no way does the asymmetry in information or experience ever go away. How would it?

Often the most challenging patients are those with plenty of non-medical education, and the result is often a combination of unrealistic expectations, questionable judgement, and bizarre, unreasonable requests.

In any case - and this goes for politicians especially - there is often an attempt to ignore evidence and complexity in favour of soundbites and ideology. But that is intrinsically dangerous.

[ants]

What I find odd is that the health industry is treated as a single monolithic entity. Sure, a cure for cancer would mean many would lose money. The ones who figured out the cure would rake it in though. It's like saying there would never be an alternative to the CD player since the tech industry would lose too much money from that happening....

[Aemon Stark]

To take a specific example, we used to treat stomach ulcers surgically, but now that is much less common. We simply have better medications that have rendered gastric resections for ulcer disease mostly unnecessary. Yet there are still plenty of surgeons around. Along the same lines, angioplasty and stenting has greatly reduced the number of patients getting bypass surgery, yet cardiac surgeons aren't going anywhere.

Medicine changes a LOT, simply put.

[1918me]

Moving back to more politic-y politics, I guess, it looks like the Southern Democrat legislator is about to go extinct.

http://www.nytimes.com/2014/12/05/upshot/demise-of-the-southern-democrat-is-now-nearly-compete.html?partner=rss&emc=rss&_r=0

If Mary Landrieu, a Democratic senator from Louisiana, loses re-election in Saturday’s runoff election, as expected, the Republicans will have vanquished the last vestige of Democratic strength in the once solidly Democratic Deep South. In a region stretching from the high plains of Texas to the Atlantic coast of the Carolinas, Republicans would control not only every Senate seat, but every governor’s mansion and every state legislative body.