- > Paracetamol is the most common cause of liver failure in the US.
This is also a bit misleading, it’s the most common cause of acute liver failure which is overall quite rare in developed countries. The most common need for transplants are still by far progressive chronic liver diseases leading to cirrhosis.
- Probably a little nostalgia. The SMS sound chip is one of the cheapest and most primitive jellybean sound chip of the era (only 3 square waves, noise and no envelope generator either). That isn’t to say appreciating the art of doing more with less isn’t valid. It’s sort of like a MS Paint type of thing though.
- HSAs are triple tax advantaged retirement accounts. Not taxed on contribution, gains, or withdrawals for qualified expenses. In the worst case it becomes like a pretax IRA because after age 65 you will not pay a penalty on non qualified expenses - but qualified expenses tend to increase with age. For many it should be their primary retirement account. Even for people with certain chronic conditions (not in perfect health), depending on how good/expensive the PPO offered by the employer, it might still work out better to do HDHP/HSA. You can get as many basically free HSA accounts from Fidelity.
An FSA really has nothing to do with an HSA.
- Nah, dishwashers are pretty light too. With a muscle mass of 1% I usually just flip it over to work on it. This is just peak HN, PhDs still phased by something requiring an 8th grade level of education. In the US, the supply is usually a screw on, the drain a clamp and if the wiring isn’t already a quick connect just throw some Wagos on.
- > People also don't want (their loved ones) to suffer, especially needlessly.
You might be very surprised how family actions very often are not consistent with this supposed desire. 98 year olds in the hospital with multiple end stage illnesses - full code, happens all the time. Ask any healthcare worker in the US, pretty classic the elderly rotting away in a nursing home, rarely visited, then they get admitted and their healthcare proxy wants “everything done”. Often seems to be a reflection of their own guilt. Sometimes it’s just poor healthcare literacy.
But no, regardless of what you think these people may
> In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.
This is basically false. Most large systems have comfort care order set, with opioid drips. Transition to hospice is readily available. Usually the barrier to these are patients themselves or their families.
Also even the US, the principle of double effect prevails in palliative care.
- One example was already given. Epic dates back to 1979, certainly they were doing something prior to 2009 (as was Cerner and Meditech). Other than HITECH, what other major regulation in the US are you referring to?
https://international.kaiserpermanente.org/wp-content/upload...
Both UPMC and Cleveland Clinic were early adopters around 2001. Meditech has been partnered with HCA since 1994.
- I dunno, QuadraMed that was used by at least NYC H&H for years before their imperiled transition to Epic prominently displayed “Revenue Cycle Management” on the splash screen of its decrepit provider facing frontend.
Both of you are overstating your cases. That said, it’s hard to overstate how heavily charge capture and billing are prioritized to the detriment of other aspects.
> I can think of zero instances where an organization switched to EHR without being forced by a deadline from an outside source.
There were major EHR deployments in the 80s through early 00s, before most government mandates. Surely later mandates were an incentive This reflects a lack of tenure.
- How? On descent you can trade some of your altitude (potential energy) for kinetic energy, but then you can’t land the plane. For descent on an approach you’re going from low energy to even lower energy. In emergencies and with enough runway you can futz around with this some, but wiggle room on an airliner is not great, negligible to what will be expended on a go around.
- Maybe I’m misunderstanding what you’re calculating, but this math seems wildly off. Sincerely don’t understand an alternate numerical point being made.
> Given a 16-bit, 512 x 512 x 100 slice CT scan, you're looking at 2^16 * 26214400
65536^(512*512) or 65536 multiplied by itself 262144 times for each image. An enormous number. Whether or not assume replacement (duplicates) is moot.
> That's 100 * 26214400 = 262,440,000
There are 100^(512*512) 512x512 100-level grayscale images alone or 100 to the 262144 power - 100 multiplied 262144 times. Again how you paring down a massive combinatoric space to a reasonable 262 mil?
- https://pubmed.ncbi.nlm.nih.gov/28060228/
MI, HF, sepsis, pneumonia, respiratory failure are among the most common reasons for inpatient admission, not fringe.
Equating acute decompensation of chronic illnesses requiring inpatient admission to "knocking on death's door" is a bit simplistic.
No data has been provided showing how the relevance of outcomes based on institution of first presentation (not definitive management) for breast cancer, that is usually managed outpatient on an elective basis, has anything to do with outcomes for the "overwhelming majority of things people to go to the hospital for".
Even pre-pandemic the life expectancy of Hispanics was not as high as billionaires. Speaking of "deaths door" perhaps at least QALY, or something else is a more appropriate metric.
- Maybe I should have said 5%. 90% was a made up threshold. How close are we to even a basic “level 5”, ED doc puts in order for indication: “concern for sepsis, lol”, rad tech does their thing and a finished read appears, with no additional human involved except for maybe a review but not even 50% of the time is any addendum needed.
- "can competently treat cancer, they can certainly treat the overwhelming majority of reasons"
No this claim, just because, is not weight-bearing. Extraordinary claims require extraordinary evidence. And I don't understand the motivation to make such a tenuous link when at a bare minimum one can look up direct data like joint commision and MPSMS safety data and related publications. There is tremendous variability in serious hospital safety events inter-institution for bread and butter admissions. One can further just examine CMS and NHS data for mortality and readmission for "mundane" MI, HF, sepsis, pneumonia, respiratory failure. OB/GYN outcomes are their own thing.
The flaw in reasoning here is that quality of care and outcomes is strongly related to the simplicity of diagnosis. A further flaw is the belief that care is "commoditized". Treatment protocols vary widely across institutions and health systems, often times based on cost factors. Certain basic things can not be done at night, or even the day for fully accredited hospitals. There's a big difference somewhere with 24 hour anesthesia airway and in-house surgery and not just an intensivist "on call" 600 miles away and staff that can't even do RSI. Transfer is not always an option, there's a reason critically ill people die more frequently in the sticks. If one is admitted to a regional hospital, they are unlikely to be accepted for transfer to a safer hospital unless they truly need an intervention that absolutely cannot be provided where they are, not simply because there is better backup provider support and a higher standard of safety. They will still remain at that higher risk for sepsis, or outdated care because the community physician group doesn't keep up with guidelines, or that hospital only offers the inferior treatment (or a limited formulary) for cost-cutting reasons.
Breast cancer and most cancers are not even typical inpatient encounters. Breast cancer is generally not managed on an inpatient basis, in fact one may never even have to visit an inpatient hospital campus for breast cancer. Upgrades for cancer are usually different than acute inpatient care. Breast cancer does not usually involve abdominal, intrathoracic or orthopedic surgery. Breast cancer does not usually involve advanced interventions like endarterectomy, ECMO. Cancer is a special case. Regardless of complexity, extrapolating cancer treatment to even the most "mundane" acute inpatient or surgical care really is beyond ridiculous.
This is a complex subject and this is a silly hot take.
- Two registry cohort papers on breast cancer outcomes, one only in Los Angeles county "provide extensive evidence for my claims"
The claim: For the overwhelming majority of things people to go to the hospital for, where you go doesn't really matter.
You win, as always.
https://www.ahajournals.org/doi/10.1161/01.atv.0000111245.75...
https://pubmed.ncbi.nlm.nih.gov/3056758/