Unintended consequences

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The justification has always been, does it serve a greater good? By closing a program, is it better for the communities (patients and medical)? Most programs don’t have big numbers.... 1 death/10 vs 2/10. Your morality rate is increased 100%. We know poo happens, but do “they”? Patient is already dead, by being “alive”, maybe it can be a reminder of sort?
 
I saw this as a resident about 3 times over 4 years. Nobody talked about it, but we all knew. Like a slow moving funeral procession, administering the rite of Holy Prolongation.

The only people to blame are the bean counters who care about numbers but don't actually give a damn about the patients suffering.
 
Sometimes a picture of someone provides context.

“Need to keep him alive till June 30 at a minimum,” responded Dr. Mark Zucker, director of the hospital’s heart and lung transplant programs.

Zucker replied, “We haven’t refused anything they’ve asked.” He added, “We just haven’t raised withdrawing it.”

zucker.png



In all seriousness it really hard to predict the unintended consequences. Look at THI, I know they probably didn't have great outcomes. But somehow I don't believe not having that transplant volume in Houston is better for the greater good.

Put it another way, if I was the one brain dead on the vent in the ICU. And you asked my permission whether or not you could keep me on the vent for the good of the Houston transplant program. I'd say yes. Because i don't care what happens to me and it does a lot of good.

However, this picture isn't that simple. The Newark area is full of fully established transplant centers. This decision is more about making money by having a transplant center rather than saving lives and greater good....
 
Last edited:
dchz said:
Sometimes a picture of someone provides context.

“Need to keep him alive till June 30 at a minimum,” responded Dr. Mark Zucker, director of the hospital’s heart and lung transplant programs.

Zucker replied, “We haven’t refused anything they’ve asked.” He added, “We just haven’t raised withdrawing it.”

zucker.png



In all seriousness it really hard to predict the unintended consequences. Look at THI, I know they probably didn't have great outcomes. But somehow I don't believe not having that transplant volume in Houston is better for the greater good.

Put it another way, if I was the one brain dead on the vent in the ICU. And you asked my permission whether or not you could keep me on the vent for the good of the Houston transplant program. I'd say yes. Because i don't care what happens to me and it does a lot of good.

However, this picture isn't that simple. The Newark area is full of fully established transplant centers. This decision is more about making money by having a transplant center rather than saving lives and great good....
Click to expand...
This guy looks evil.
 
On a population basis, we all follow incentives. When the government starts penalizing for CLABSI and Press Ganey scores, hospitals will find a way to optimize their metrics, even if it increases patient harm. Our hospital doesn’t check catheter tips for cultures, hence we have no CLABSI. Insurance and government metrics can often pervert the practice of medicine, hence why it should be doctors and not lawyers making the rules
 
MoMoGesiologist said:
On a population basis, we all follow incentives. When the government starts penalizing for CLABSI and Press Ganey scores, hospitals will find a way to optimize their metrics, even if it increases patient harm. Our hospital doesn’t check catheter tips for cultures, hence we have no CLABSI. Insurance and government metrics can often pervert the practice of medicine, hence why it should be doctors and not lawyers making the rules
Click to expand...

Yes! Seen everywhere - CLABSI has basically been eliminated just by feint of hand.

The same is true of ventilator-associated pneumonia. Now nearly every intensivist will label it an aspiration to avoid that ding.
 
They claim that the community is irreparably injured by the closing of programs, yet this won’t decrease the number of transplants that occur. Those organs will still be placed in patients. There will still be fewer organs than there are potential recipients. There will simply be more transplants in the larger centers. This is probably ultimately beneficial for people as these specialized procedures can be focused in centers with the resources to focus more resources and attention on these patients.
 
Pharmado said:
They claim that the community is irreparably injured by the closing of programs, yet this won’t decrease the number of transplants that occur. Those organs will still be placed in patients. There will still be fewer organs than there are potential recipients. There will simply be more transplants in the larger centers. This is probably ultimately beneficial for people as these specialized procedures can be focused in centers with the resources to focus more resources and attention on these patients.
Click to expand...
Exactly. Smaller programs with poor outcomes should be closed with those patients being shunted to larger specialty centers. This is shown time and time again in the Pediatric congenital heart programs. Small programs often have crappy outcomes and patients are dying that could be saved if done at large specialty centers. Arrogance and administration cash grabs are killing patients, and they know it.
 
IlDestriero said:
Exactly. Smaller programs with poor outcomes should be closed with those patients being shunted to larger specialty centers. This is shown time and time again in the Pediatric congenital heart programs. Small programs often have crappy outcomes and patients are dying that could be saved if done at large specialty centers. Arrogance and administration cash grabs are killing patients, and they know it.
Click to expand...

Plus 1000. Plenty of examples in adult medicine too.
 
It’s just sad that, in the eyes of these doctors, this man transitioned from being a person to a piece of meat.
 
Did a case a couple months ago, forgot the type of case, was goin g to be 2-3 hours. Guy had to pee when we got him on the table ready to induce, I told him well empty your bladder after asleep. After induction I ask the nurse to straight cath, attending surgeon says absolutely no straight cath, prevent CAUTIs ....
 
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