It's a tough situation, and I'm glad his father is finding help.
I've spent a fair bit of time in ICU's on both sides. I think the observations and conclusions show misunderstandings. Generally, opinions are not ignored, nurses don't go wild, the patient population makes sense for an ICU, the institutional memory is actually fantastic, etc.
And most importantly: "There’s no sense of a scientific method, reasoning from first principles, or even reasoning from similar cases though" This is complete and utter hogwash, borne of a difficult experience.
They key idea is this: in complex cases, doctors have to identify the condition that matters most, and prioritize that. Collaboration is necessary to get the picture and give care, and perhaps to consider alternatives, but it's not how you make decisions.
It's hard to see symptoms ignored or under-treated. But it's very likely that delusions do not make a difference in the patient's recovery, but something like lung surfactant matters most. So everything from fluid intake to drug dosage and activity are direct accordingly. Unless they're symptoms of the main issue, discomforts can be prioritized later after the main issue resolves.
"Identifying the main condition" means understanding the actual insult and the healing process for this patient; understanding how symptoms, labs, and imaging reflect all the conditions i.e., how it presents (and skews labs or self-perception); and understanding how all the interventions may interact with the disease/disability states, from drug interactions to liver and immune-system complications, etc.
It's not uncommon for other doctors and nurses and patient advocates to have some slice of this complex picture, but it's the attending who has it all, and the experience of other cases and knowledge of the underlying conditions and interventions.
And, for the most part, the attending is not responsible for explaining their understanding or reasoning to anyone. They do offer reasons and make records, but there's no place or time or even audience for comprehensive account of why other alternatives weren't considered or followed.
Science, and medical trials, try to isolate single factors to get reproducible outcomes. Medicine in the ICU has to accommodate multiple factors, by focusing on the main disease/healing process and optimizing for that.
As for value to society: good ICU attendings are key to good outcomes for patients and their families. It takes decades to get good. They produce far, far more value than they're paid, largely because they do it as a mission. If they see people, particularly those who enjoyed the benefit of their dedication and service, disrespecting and misunderstanding them, it's likely to dissuade them from continuing or dissuade others from their difficulties.
So complain all you want about digital advertising and go full-disruptive to fossil fuels, but please be very, very careful when attacking health care. Otherwise we'll end up with Russian hospitals where you bring your own materials and pay your friends of friends for side work.
I've spent a fair bit of time in ICU's on both sides. I think the observations and conclusions show misunderstandings. Generally, opinions are not ignored, nurses don't go wild, the patient population makes sense for an ICU, the institutional memory is actually fantastic, etc.
And most importantly: "There’s no sense of a scientific method, reasoning from first principles, or even reasoning from similar cases though" This is complete and utter hogwash, borne of a difficult experience.
They key idea is this: in complex cases, doctors have to identify the condition that matters most, and prioritize that. Collaboration is necessary to get the picture and give care, and perhaps to consider alternatives, but it's not how you make decisions.
It's hard to see symptoms ignored or under-treated. But it's very likely that delusions do not make a difference in the patient's recovery, but something like lung surfactant matters most. So everything from fluid intake to drug dosage and activity are direct accordingly. Unless they're symptoms of the main issue, discomforts can be prioritized later after the main issue resolves.
"Identifying the main condition" means understanding the actual insult and the healing process for this patient; understanding how symptoms, labs, and imaging reflect all the conditions i.e., how it presents (and skews labs or self-perception); and understanding how all the interventions may interact with the disease/disability states, from drug interactions to liver and immune-system complications, etc.
It's not uncommon for other doctors and nurses and patient advocates to have some slice of this complex picture, but it's the attending who has it all, and the experience of other cases and knowledge of the underlying conditions and interventions.
And, for the most part, the attending is not responsible for explaining their understanding or reasoning to anyone. They do offer reasons and make records, but there's no place or time or even audience for comprehensive account of why other alternatives weren't considered or followed.
Science, and medical trials, try to isolate single factors to get reproducible outcomes. Medicine in the ICU has to accommodate multiple factors, by focusing on the main disease/healing process and optimizing for that.
As for value to society: good ICU attendings are key to good outcomes for patients and their families. It takes decades to get good. They produce far, far more value than they're paid, largely because they do it as a mission. If they see people, particularly those who enjoyed the benefit of their dedication and service, disrespecting and misunderstanding them, it's likely to dissuade them from continuing or dissuade others from their difficulties.
So complain all you want about digital advertising and go full-disruptive to fossil fuels, but please be very, very careful when attacking health care. Otherwise we'll end up with Russian hospitals where you bring your own materials and pay your friends of friends for side work.