I haven’t worked in an ICU for over 20 years but everything you describe bothered me back then and I am not surprised that it’s barely changed. Wish I had something constructive to say but the whole system is a mess.
And then, there’s the “Hospitalist,” a vague title for an even more vague job with undefinable duties. And this individual can never be found. Anywhere.
I feel for you after dealing with this over the past few years both parents and a spouse.
I hate taking my parents to the hospital. I've seen everything you talked about. Especially with my mother. As long as everything is going "by the book" they're fine. I think our knowledge of medicine is a lot more rudimentary than they would be willing to acknowledge. I thought my mother's delusions were a harrowing sign of a psychotic break, instead of the thing that happens to almost everyone. And the staff seemed to be completely caught off guards, like "this never happens."
“Older people consume a lot of health care” isn’t especially meaningful unless you also look at the context of who NEEDS health care. It’s not like they’re hoovering up specialty physicians because they want to.
Yeah, I'm not saying that they're in the ICU for fun. It's just a fact that a huge amount of our society's medical resources go to the elderly, and that we have a shortage of medical resources.
I am a retired OR nurse. I worked 40+hours until I was diagnosed with breast cancer at the age of just short of 73 years. I used up more medical care and attention in the next 12 months than I did the entire span of my life. Our health care costs rise as does everything else. One of the issues is our expectations of a long life. Years ago we didn't have the technology to cure many diseases nor the ability to perform many surgeries that were rare when I started in the OR but are now commonplace. Premature babies are alive today that would have died even 20 years ago. I don't know how we are suppose to fix this. We don't deny care to people who have put themselves in a crisis due to the way they have lived their lives and that is a huge part of in hospital care. We took care of Covid patients, exposing ourselves and our families. We didn't ask if they had been vaccinated, we just tried to keep them alive. What is the alternative? Our patients are sicker than ever. ICU used to be a quick in and out. Get them stable and move them out. Patients are on ventilators for long periods of time. They can't be transferred to an area where we know they will do better until they are off the equipment. In the midst of this are the care providers. We suffer from burnout. Some hospitals have a rule that you cannot work more than a 10 hour shift. Our families live with our schedules. One benefit of retirement is that I now celebrate family dinners on the day! I can tell you a large part of this in the input insurance companies have in health care now. There is duplication of services that is expensive. We used to do the open skull cases in one hospital and the open hearts in another. The expensive equipment and specialty staff was concentrated. Then the "out of provider" BS can along and everyone had to have their own equipment. The CEO's of the insurance companies call a lot of the shots based on "data" they have gathered and cherry picked. The doctors they have on staff are so far removed from patient care they shouldn't be considered experts anymore. I can tell you that we are going to have to realize that families are going to have to go back to caring for their members in the hospital just as they used to at home.
“Pretty much all these patients are on Medicare, which means your taxpayers dollars are making this happen.“ Don’t forget, this includes the taxpayer dollars that the patients themselves have paid over the decades of their working lives. Yes, we’re all paying for it, and we can all receive it when we get to that age.
The doc in charge needs to balance all the specialists' advice with everything going on in the whole body, mind, spirit. (It goes very badly when they don't.)
I'm a new ICU nurse. I've been a nurse for 5 years now and worked on a cardiac step down unit for 4 of those years, and you couldn't be more right. Leaving my patients alone when appropriate is something I try and do consciously because I know how irritating it is to be disturbed whenever I finally relax. You've noticed many of the same things I've noticed during my time as a nurse, and inconsistency and not listening to a patient or their families about what works and what doesn't really does affect a patient's outcome. Thanks for the input into my own practice, I'll try and keep your observations in mind as I care for my patients and try and be better at what I do.
Two comments. First folks in their 70’s are no longer in the last 5/10 years of their life. Folks regularly live well into their 80s and 90s.
Secondly I experienced something similar when my husband was in the icu due to complications following kidney stone surgery. I left my husbands side for 1/2 hour one day—and while I was gone the attending physician decided to give him a nose tube for more oxygen—causing major hemorrhaging since they didn’t know he had a history of major nosebleeds. Even though I asked them before I left whether anything was being done. Then he tried to pull out catheters so they sedated him. And their “protoccal “ would only allow sedation stopped when he could answer questions rationally? On sedation? Ultimately I told all doctors I wanted all sedation stopped, all tubes pulled and him placed in a regular room out of icu. 24 hours later he was back to normal and fine! The attending doctor did come in and tell be I made the right call even though they tried to talk me out if it! ICU’s are very dangerous!
During a serious physical illness, my 80 year old brother developed significant mental deterioration, which was exacerbated by the psychotropic medications intended to calm him. The hospital’s intention was to discharge him to a nursing home, but his wife insisted he be discharged home. The situation is extremely challenging, but his mental status has improved somewhat. But without her advocacy, he would have been placed in a nursing home, continued to deteriorate mentally, and given psychotropic medications intended to lessen his agitation, which in his case, made the situation worse. As a retired nurse, I strongly believe our health care system needs increased advocacy to help family members make informed decisions and be empowered to influence outcomes rather than just accept what is convenient for the hospital.
Trevor, we don't know each other, but as a nurse, family member, and patient -- you said some things that really needed to be said. As a health policy nurse, that goes double.
I get that it got specific, maybe too specific for a public blog. Still, it's an insightful bridge across the growing divide between healthcare and the public. I hope you republish with whatever edits you feel necessary.
PS. Did you know Morning Brew started a Healthcare edition? They're looking for contributions. I hope you consider submitting it. :)
We Westerners? Americans? seem to me to have an outlook on aging, health, and end-of-life that isn't all that...healthy. I'm an occupational therapist and I definitely feel quality of life needs to be considered in the mix with "best attainable health." But there are so many working parts here: medicine, law, commerce, and family love. A few years ago I read "Being Mortal" by Atul Gawande; it was a breath of fresh air. Highly recommended!
I’m an ICU nurse and agree with everything you said. I do wish people had the opportunity to see why we become so overwhelmed, but yes, I agree that less is more sometimes… but sometimes it’s not. Do I think family should take more of an active role in patient recovery while they’re in the hospital? Absolutely… specifically because you will have to help when they they get home anyway, and because you ultimately know them the best. (Like you said, you had to advise all of the providers about Haldol every day…. think about the patients who don’t have family there everyday…. It’s literally chaos as a nurse having to change assignments constantly and figure out what worked for someone and what didn’t… at this point I feel like families should literally participate in rounds)
But I do understand you’re paying a crap-load of money for a service (that you’d expect to be run flawlessly) so why should you have to participate that much… just kind of adding to your point in that it’s one of the problems with the way hospitals are run.
2. THANK YOU for spreading the word about sleep. I’m highly aware of this problem and am working on trying to bring it to the forefront of the in-patient world. The problem is that modern medicine is not in the LEAST bit “advanced” no matter how much money or resources an institution has. Medicine has just historically always been more on the Defensive rather than the Offensive if that makes sense. Doctors are professional skeptics and all suffer from huge Egos. It takes a lot for research to be: 1- conducted, 2- brought to the forefront, 3- turned into something useful, 4- agreed upon by everyone, and 5- adopted by everyone on a large scale. Sleep is also SOOOOO SUBJECTIVE. Like I said I’m trying to do my own research on it… but posts like these help a TON.
Anyway thanks…. Once again, agree with everything you said. Word of advice for anyone with a family member in the hospital— keep a diary/record of what happened and what meds were used…. And ALWAYS ask questions. “Annoying family members” are always the ones to get sh$t done. Nurses and doctors are more likely to provide you with answers if you’re pushy lol. Sad truth.
It seems that hospitals are designed for the ease and comfort of the medical staff, not the patient. It is not a place to go and get rest. Especially in the ICU. It is also common for ICU patients to get hospital psychosis which happens when a patient is in ICU for more than a couple days. The ICUs usually do not have a window the patient can see out of. There is no calendar to show the passing of time except for a clock and the date written on the white board. Because many ICU patients are sedated, they loose track of time and, in some cases, reality leading to the hallucinations. The psychosis usually goes away once out of the ICU. There are some wonderful people working in hospitals and ICUs and I am grateful for their choice of vocation. My experience with a family member in the ICU was similar to that of the author. After a patient has been admitted for a long time, the nursing staff becomes a bit complacent and while the family makes an effort to help, the nurses can't do much to adjust the meds without an order. There is a lot of risk management going on and that, while important for the hospital, slows things down and can become frustrating for the patient and their family. No easy answer. I was not aware in the past certain hospitals were expert in certain care while alternate experts were at a different hospital. I think that would save some costs although it may require some travel for the patient/family which is a small consolation for expert care. Not sure what the answers are. It crosses many domains such as costs, ethics, staffing, insurance, etc.
I haven’t worked in an ICU for over 20 years but everything you describe bothered me back then and I am not surprised that it’s barely changed. Wish I had something constructive to say but the whole system is a mess.
Great post.
And then, there’s the “Hospitalist,” a vague title for an even more vague job with undefinable duties. And this individual can never be found. Anywhere.
I feel for you after dealing with this over the past few years both parents and a spouse.
I hate taking my parents to the hospital. I've seen everything you talked about. Especially with my mother. As long as everything is going "by the book" they're fine. I think our knowledge of medicine is a lot more rudimentary than they would be willing to acknowledge. I thought my mother's delusions were a harrowing sign of a psychotic break, instead of the thing that happens to almost everyone. And the staff seemed to be completely caught off guards, like "this never happens."
As flawed as our system is, I am still extremely grateful for medical science and the people who dedicate their lives to helping the rest of us.
“Older people consume a lot of health care” isn’t especially meaningful unless you also look at the context of who NEEDS health care. It’s not like they’re hoovering up specialty physicians because they want to.
Yeah, I'm not saying that they're in the ICU for fun. It's just a fact that a huge amount of our society's medical resources go to the elderly, and that we have a shortage of medical resources.
I am a retired OR nurse. I worked 40+hours until I was diagnosed with breast cancer at the age of just short of 73 years. I used up more medical care and attention in the next 12 months than I did the entire span of my life. Our health care costs rise as does everything else. One of the issues is our expectations of a long life. Years ago we didn't have the technology to cure many diseases nor the ability to perform many surgeries that were rare when I started in the OR but are now commonplace. Premature babies are alive today that would have died even 20 years ago. I don't know how we are suppose to fix this. We don't deny care to people who have put themselves in a crisis due to the way they have lived their lives and that is a huge part of in hospital care. We took care of Covid patients, exposing ourselves and our families. We didn't ask if they had been vaccinated, we just tried to keep them alive. What is the alternative? Our patients are sicker than ever. ICU used to be a quick in and out. Get them stable and move them out. Patients are on ventilators for long periods of time. They can't be transferred to an area where we know they will do better until they are off the equipment. In the midst of this are the care providers. We suffer from burnout. Some hospitals have a rule that you cannot work more than a 10 hour shift. Our families live with our schedules. One benefit of retirement is that I now celebrate family dinners on the day! I can tell you a large part of this in the input insurance companies have in health care now. There is duplication of services that is expensive. We used to do the open skull cases in one hospital and the open hearts in another. The expensive equipment and specialty staff was concentrated. Then the "out of provider" BS can along and everyone had to have their own equipment. The CEO's of the insurance companies call a lot of the shots based on "data" they have gathered and cherry picked. The doctors they have on staff are so far removed from patient care they shouldn't be considered experts anymore. I can tell you that we are going to have to realize that families are going to have to go back to caring for their members in the hospital just as they used to at home.
“Pretty much all these patients are on Medicare, which means your taxpayers dollars are making this happen.“ Don’t forget, this includes the taxpayer dollars that the patients themselves have paid over the decades of their working lives. Yes, we’re all paying for it, and we can all receive it when we get to that age.
Great analysis. Makes great sense
> I think ICU doctors assume brain doctors generally don’t know what they’re doing
could anybody expand on this? is this a common assumption?
This is not accurate in my opinion. I think the writer means well, but is a little naive here.
Specialists advise on their part of the body.
The doc in charge needs to balance all the specialists' advice with everything going on in the whole body, mind, spirit. (It goes very badly when they don't.)
I'm a new ICU nurse. I've been a nurse for 5 years now and worked on a cardiac step down unit for 4 of those years, and you couldn't be more right. Leaving my patients alone when appropriate is something I try and do consciously because I know how irritating it is to be disturbed whenever I finally relax. You've noticed many of the same things I've noticed during my time as a nurse, and inconsistency and not listening to a patient or their families about what works and what doesn't really does affect a patient's outcome. Thanks for the input into my own practice, I'll try and keep your observations in mind as I care for my patients and try and be better at what I do.
Two comments. First folks in their 70’s are no longer in the last 5/10 years of their life. Folks regularly live well into their 80s and 90s.
Secondly I experienced something similar when my husband was in the icu due to complications following kidney stone surgery. I left my husbands side for 1/2 hour one day—and while I was gone the attending physician decided to give him a nose tube for more oxygen—causing major hemorrhaging since they didn’t know he had a history of major nosebleeds. Even though I asked them before I left whether anything was being done. Then he tried to pull out catheters so they sedated him. And their “protoccal “ would only allow sedation stopped when he could answer questions rationally? On sedation? Ultimately I told all doctors I wanted all sedation stopped, all tubes pulled and him placed in a regular room out of icu. 24 hours later he was back to normal and fine! The attending doctor did come in and tell be I made the right call even though they tried to talk me out if it! ICU’s are very dangerous!
During a serious physical illness, my 80 year old brother developed significant mental deterioration, which was exacerbated by the psychotropic medications intended to calm him. The hospital’s intention was to discharge him to a nursing home, but his wife insisted he be discharged home. The situation is extremely challenging, but his mental status has improved somewhat. But without her advocacy, he would have been placed in a nursing home, continued to deteriorate mentally, and given psychotropic medications intended to lessen his agitation, which in his case, made the situation worse. As a retired nurse, I strongly believe our health care system needs increased advocacy to help family members make informed decisions and be empowered to influence outcomes rather than just accept what is convenient for the hospital.
Trevor, we don't know each other, but as a nurse, family member, and patient -- you said some things that really needed to be said. As a health policy nurse, that goes double.
I get that it got specific, maybe too specific for a public blog. Still, it's an insightful bridge across the growing divide between healthcare and the public. I hope you republish with whatever edits you feel necessary.
PS. Did you know Morning Brew started a Healthcare edition? They're looking for contributions. I hope you consider submitting it. :)
https://www.healthcare-brew.com/subscribe?utm_medium=website&utm_source=global_footer&utm_campaign=mb
We Westerners? Americans? seem to me to have an outlook on aging, health, and end-of-life that isn't all that...healthy. I'm an occupational therapist and I definitely feel quality of life needs to be considered in the mix with "best attainable health." But there are so many working parts here: medicine, law, commerce, and family love. A few years ago I read "Being Mortal" by Atul Gawande; it was a breath of fresh air. Highly recommended!
I’m an ICU nurse and agree with everything you said. I do wish people had the opportunity to see why we become so overwhelmed, but yes, I agree that less is more sometimes… but sometimes it’s not. Do I think family should take more of an active role in patient recovery while they’re in the hospital? Absolutely… specifically because you will have to help when they they get home anyway, and because you ultimately know them the best. (Like you said, you had to advise all of the providers about Haldol every day…. think about the patients who don’t have family there everyday…. It’s literally chaos as a nurse having to change assignments constantly and figure out what worked for someone and what didn’t… at this point I feel like families should literally participate in rounds)
But I do understand you’re paying a crap-load of money for a service (that you’d expect to be run flawlessly) so why should you have to participate that much… just kind of adding to your point in that it’s one of the problems with the way hospitals are run.
2. THANK YOU for spreading the word about sleep. I’m highly aware of this problem and am working on trying to bring it to the forefront of the in-patient world. The problem is that modern medicine is not in the LEAST bit “advanced” no matter how much money or resources an institution has. Medicine has just historically always been more on the Defensive rather than the Offensive if that makes sense. Doctors are professional skeptics and all suffer from huge Egos. It takes a lot for research to be: 1- conducted, 2- brought to the forefront, 3- turned into something useful, 4- agreed upon by everyone, and 5- adopted by everyone on a large scale. Sleep is also SOOOOO SUBJECTIVE. Like I said I’m trying to do my own research on it… but posts like these help a TON.
Anyway thanks…. Once again, agree with everything you said. Word of advice for anyone with a family member in the hospital— keep a diary/record of what happened and what meds were used…. And ALWAYS ask questions. “Annoying family members” are always the ones to get sh$t done. Nurses and doctors are more likely to provide you with answers if you’re pushy lol. Sad truth.
It seems that hospitals are designed for the ease and comfort of the medical staff, not the patient. It is not a place to go and get rest. Especially in the ICU. It is also common for ICU patients to get hospital psychosis which happens when a patient is in ICU for more than a couple days. The ICUs usually do not have a window the patient can see out of. There is no calendar to show the passing of time except for a clock and the date written on the white board. Because many ICU patients are sedated, they loose track of time and, in some cases, reality leading to the hallucinations. The psychosis usually goes away once out of the ICU. There are some wonderful people working in hospitals and ICUs and I am grateful for their choice of vocation. My experience with a family member in the ICU was similar to that of the author. After a patient has been admitted for a long time, the nursing staff becomes a bit complacent and while the family makes an effort to help, the nurses can't do much to adjust the meds without an order. There is a lot of risk management going on and that, while important for the hospital, slows things down and can become frustrating for the patient and their family. No easy answer. I was not aware in the past certain hospitals were expert in certain care while alternate experts were at a different hospital. I think that would save some costs although it may require some travel for the patient/family which is a small consolation for expert care. Not sure what the answers are. It crosses many domains such as costs, ethics, staffing, insurance, etc.