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_thoracic




ER tech/EMT/nursing student.

Climber/hiker/BC skier.

When not taking care of people who just got themselves hurt, I'm out in the woods getting myself hurt.


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One of the most frustrating things about working in healthcare, for me, is the assumption of conspiracy. The idea that because I wear scrubs and hand out bandaids, I'm in on some grand scheme that entraps people into unnecessary/harmful treatment, (or purposefully denies them necessary treatment) is a recurring theme among patients and the public. It's incredibly frustrating.

    Part of the reason it's incredibly frustrating is that I too get the gut feeling that there are bad actors in the healthcare system. Hell, it's not even a gut feeling, it's frequently proven to be true (Looking at you, Purdue, Mylan and Kaleo).

      But because the average person's contact point with the healthcare industry is a primary care doc, ER staff or EMS personnel, and not insurance or pharma execs, us grunts get tarred with the same brush. And let me tell you, we didn't go into these jobs because we have a sadistic interest in hurting you for cash. There are more lucrative jobs that are easier, require less training, and involve much less poop.

        To get around to my point: Please don't treat the American College of Cardiology and a thuggish life insurance company as the same entity. Believe me, those of us on the other side of the stethoscope think insurance companies suck too. The cardiologists who worked on these revisions have doubtlessly each had countless conversations with patients trying to convince them that cutting some salt and going for a run once in a while will literally extend their lifespan, and have seen most of those conversations go nowhere. So now they're trying harder.

          “We're recognizing that blood pressures that we in the past thought were normal or so-called pre-hypertensive actually placed the patient at significant risk for heart disease and death and disability,” said Robert M. Carey, co-chairman of the group that produced the new report. “The risk hasn't changed. What's changed is our recognition of the risk.”

        The intent here pretty clearly appears to be to try and get Americans to pull their heads out of the sand a bit and realize that we treat our bodies horribly. Hell, taking lower levels of hypertension seriously might even lead to stopping serious cases before they start, possibly reducing the number of new prescriptions!

          Will insurance companies find a way to profit off of this? Probably yes, because they're run by scum. Is your average practitioner happily skipping hand-in-hand with them as they do so? No. And as mentioned:

            The four main classes of drugs for blood pressure have generic versions and can be as cheap as a few dollars a month.

          Probably not gonna be an oxycontin-style surge of scummy marketing for these drugs any time soon. And if the sudden surge in prescriptions you posit does come to pass, and some Shkreli type buys them and jacks the price, you can believe that among the first groups to yell about it will be docs and nurses.

            It's not as simple as "Oh, hey, let's make more people hypertensive and write more scripts so that our buddies at Cigna can buy another boat". It's easy to play the cynic here and to plaster over the truth in the nuance, but sometimes healthcare providers do things because they care about people's health.

            Fourth paragraph in:

              But the report's authors predicted relatively few of those who fall into the new hypertensive category will need medication. Rather, they hope that many found with the early stages of the condition will be able to address it through lifestyle changes such as losing weight, improving their diet, getting more exercise, consuming less alcohol and sodium and lowering stress.

            Further down:

              The guidelines suggest that doctors recommend lifestyle changes for people found to have elevated blood pressure. Those with Stage 1 hypertension should be assessed for their 10-year risk of heart disease or stroke under the parameters of a widely used matrix for cardiovascular health. Those with more than a 10 percent chance, or other complicating factors, should try medication.

              “An important cornerstone of these new guidelines is a strong emphasis on lifestyle changes as the first line of therapy. There is an opportunity to reduce risk without necessarily imposing medications,” said Richard Chazal, the immediate past president of the American College of Cardiology.

            A revision of hypertension guidelines with an eye towards encouraging better early lifestyle intervention seems like a pretty solid idea to me. I'm not seeing the drive towards greater prescription of antihypertensives that you are here. Frankly, with the amount of deaths from cardiovascular problems in this country (not to mention the preventable load on the healthcare system they create), giving cardiologists and general practitioners more leeway to tackle hypertension sounds like a great idea.

            Thank you! Glad you enjoyed it.

            “This is what it’s like” says your instructor, watching you carefully for mistakes

                    Training you on bandages, splints, and the cruel rhythm of chest compressions

            Teaching you what kills right away, and what takes a while longer.

            Telling you that sometimes all you can do is hold a hand and say something kind.

            And you listen, wide-eyed.

            “This is what it’s like” says your crew chief, pulling you up into the ambulance.

                    Showing you streets, the bad stretches of interstates, the homes of frequent fliers. 

            Reminding you to check pockets for knives and arms for track marks.

            Relaying experience’s thousand little lessons, unteachable in the classroom.

            And you listen, working hard to show your worth.

            “This is what it’s like” say your patients, pointing to where it hurts.

                    Screaming with pain, clutching an extremity turned the wrong way. 

            Groaning and sweating, grabbing at their chest saying it’s just like the last one.

            Lying still and silent, unknowingly trusting a stranger with everything.

            And you listen, replying with soothing words.

            “This is what it’s like” says your gear, speaking in clicks, beeps and error messages.

                    The defibrillator whines its way up to 300 joules, saying it’ll try but no promises. 

            The ambulance growls, bouncing and rattling over potholes as you try to start an IV

            The BVM whooshes, fighting to push breath into a ruined airway.

            And you listen, hoping that together it’ll make a difference.

            “This is what it’s like” says the notch in your shears, bearing witness.

                    Reminding you of that one, the one no one could have saved. 

            Pulling you back into the dirt and blood of the scene, unbidden.

            Making you feel old, far older than you should be by now.

            And you listen, wishing you didn’t have to.

            “This is what it’s like” says the calendar, slowly passing time

                    Marking out your shifts, 12-hour gambles on what’ll come your way. 

            Quietly telling you it’s almost time to renew your license again.

            Studded with anniversaries you’d prefer not to remember, but can’t quite forget.

            And you listen, stunned that it’s been this long.

            “This is what it’s like” you say to the newbies, watching them carefully for mistakes

                    Training them on bandages, splints, and the cruel rhythm of chest compressions

            Teaching them what kills right away, and what takes a while longer.

            Telling them that sometimes all you can do is hold a hand and say something kind.

            And they listen, wide-eyed.

            If you aren't one of the people that Trump-ism threatens, then no, there's probably no tangible benefit to following his moves in detail.

            But you should still do it.

            I'm also tempted to greet the next four years with cynicism, and to reject the political game as worthless. That really doesn't cut it though. The Trump presidency presents an affront to so many ideals I hold dear that to ignore it out of fatigue would be to pretend I didn't hold those values in the first place. Given your reaction above, I'm assuming that Trump somewhat irritates you as well. Good. Don't let go of that. Don't ignore that.

            Beyond doing it for yourself, there's also a duty to it. There's a duty we owe to the country; that we care for the institutions we've benefitted from all our lives, and that we pay attention so as to keep them honest and doing their jobs. Ignoring the news shirks that. Theres's a duty to other citizens, especially those who may be targeted or abused under a Trump administration. By choosing disgust over determination, we give up our power in the system and abandon them to whatever fate Steve Bannon thinks befits them. Lastly, there's a duty to keep others awake. To remind people that this isn't normal, and to keep making noise, even if it's screaming into a void. Because if you silence yourself, then you've done Trump and his kind's work for them.

            So, at a bare minimum, please keep following the news blackbootz. Because it's not about any one of us anymore. Not to be too melodramatic, but the future of the country(possibly the world) could change drastically in the next four years. That's too important to tune out.

            _thoracic  ·  link  ·  parent  ·  post: Sci-fi club no. 11

            I agree with you. To me, the basis of being a person is being able to choose and not being a slave to instinct. Further, I think life is a whole lot easier to deal with when you get to make your own choices and forge your own purpose.

            That being said, people are far from ideal and some will choose poorly. But I still think they shouldn't be forced to choose better, because who can objectively say what 'better' is?

            _thoracic  ·  link  ·  parent  ·  post: Sci-fi club no. 11

            Thanks, glad it made an impression!

            _thoracic  ·  link  ·  parent  ·  post: Sci-fi club no. 11

            Copy and pasting my misplaced reply from the last post.

            About The Giving Plague:

            Reading between the lines of his unreliable narration, you can see Forry getting more and more altruistic throughout the piece, matching/exceeding the infected. But it's clear this behavior arises from a very conflicted inner process, in sharp contrast to the biological imperative that ALAS places on its hosts. This is underscored by Forry's final line, that suffering for others is what he chooses to do.

            This presents a neat dichotomy between conflicted, cynical and extremely reluctant altruism, and altruism that's born of an unquestioned dogmatic drive. It seems to me that Brin's asking us which is better. If the behavior is the same, does it matter whether it arises by choice or by default?

            By setting Forry up as a savior, it seems that Brin's saying choice is the better option. Then again, Forry is only a hero due to circumstance. If CAPUC hadn't cropped up, his choices would have instead led him to being a murderer and a thief. In contrast, the ALAS carriers contribute to civilization reliably and unfailingly, rain or shine, for years. So perhaps the message is that you need to have both. Dogmatic altruism can keep society slowly improving for years, but when shit hits the fan, you need the determination and drive brought by those who have CHOSEN to fight for their fellow humans.

            I'd love to hear other people's thoughts! If you had the choice to keep ALAS contained or help it grow to a pandemic, which do you think you'd choose?

            _thoracic  ·  link  ·  parent  ·  post: Seattle's $20 Epipen replacement

            Devac, b_b, you're both right. Prepping an IM Epi injection isn't super difficult, and some AlS(AEMT and paramedic)providers I know say basics should already have it. Five minutes to mastery is low-balling it though.

            Where the difficulty would likely arise is in training a state's worth of basics on a new skill that involves sharps and one of the more powerful meds we keep on the truck. Given the potential complications like Devac mentioned, you want to be well practiced at it. Lots of my state is covered by volunteer EMS services that don't get a ton of calls, and even fewer anaphylaxis calls. Staying sharp with your sharps can be a little difficult in that kind of situation, but it will probably be ultimately doable.

            _thoracic  ·  link  ·  parent  ·  post: Seattle's $20 Epipen replacement

            The cost of epipens really is hitting some ambulance services hard. In my state, advanced EMTs and Paramedics can draw up and administer Epi from ampules like this, but basic EMTs only have epipens.

            There's some rumors floating around that our state protocols may change to let basics do it, mostly because an amp of Epi + an IM needle is ludicrously cheaper than an epipen.

            I'm a basic and I'll welcome it if it goes through, but it's sad to see our protocols change based on med prices and not research.

            _thoracic  ·  link  ·  parent  ·  post: Scifi club No. 10

            Ah, my bad. I'll get into the next thread when it shows up.

            Good point on the 'true altruism' thing. That may have been what the author was going for. Funny what different people can get out of the same text.

            _thoracic  ·  link  ·  parent  ·  post: Scifi club No. 10

            Just got through The Giving Plague, I'll take a crack at Allamagoosa tomorrow.

            Warning, some spoilers for TGP follow

            Reading between the lines of his unreliable narration, you can see Forry getting more and more altruistic throughout the piece, matching/exceeding the infected. But it's clear this behavior arises from a very conflicted inner process, in sharp contrast to the biological imperative that ALAS places on its hosts. This is underscored by Forry's final line, that suffering for others is what he chooses to do.

            This presents a neat dichotomy between conflicted, cynical and extremely reluctant altruism, and altruism that's born of an unquestioned dogmatic drive. It seems to me that Brin's asking us which is better. If the behavior is the same, does it matter whether it arises by choice or by default?

            By setting Forry up as a savior, it seems that Brin's saying choice is the better option. Then again, Forry is only a hero due to circumstance. If CAPUC hadn't cropped up, his choices would have instead led him to being a murderer and a thief. In contrast, the ALAS carriers contribute to civilization reliably and unfailingly, rain or shine, for years. So perhaps the message is that you need to have both. Dogmatic altruism can keep society slowly improving for years, but when shit hits the fan, you need the determination and drive brought by those who have CHOSEN to fight for their fellow humans.

            I'd love to hear other people's thoughts! If you had the choice to keep ALAS contained or help it grow to a pandemic, which do you think you'd choose?

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