Comment by kom107 | Hacker News Reader

Comment by kom107 | Hacker News Reader

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My personal experience leads me to hypothesize that it's just simply how fast patient requests are fulfilled and how well their questions are answered. A LOT of that comes down to nursing. The doctor may explain things incredibly well, but frequently patients turn and ask the nurse questions after the doctors leave the room, because they didn't quite understand what was being said. Also, it's the nursing staff that's toileting patients, getting and administering their meds, walking with them, talking with them about their condition, etc.

Pain management comes into it as well, but I also think that's something that could be added to improved patient education in this country (per my commentary below). For example, when people talk about their family members being in the hospital, and how their pain is bad, I ask why they don't get palliative care involved. 9/10, I get 'well they're not at end of life, so why would I do that?' Pallitive care focuses on quality of life at any point, and a large part of that is pain management. Most people don't know that, however, and the system is unfortunately set up such that patients and their family members often hold this (incorrect) belief on what palliative care does.

> patients turn and ask the nurse questions after the doctors leave the room, because they didn't quite understand what was being said.

This makes me extremely curious as to how hospitals in the US work. Why does the doctor leave the room and leave the patient there? What's the doctor doing elsewhere? What's the patient doing in there?

So the way inpatient (hospital) settings work here in the US is that patients have their own rooms (occasionally shared rooms, with one or maybe two other people, but by and large patients have a private room). Usually the doctors round in the morning, meaning they stop in to the room, talk with and examine the patient, and then update the plan of care as necessary. The nurses then execute the plan of care--the nurses administer medications, explain processes, etc. The nurses cannot diagnose a disease (officially), nor can they prescribe medications (officially). Typically, conversations patients and nurses have result in the nurse suggesting a doctor look at a specific cluster of symptoms or test for a specific diagnosis, and/or prescribe given things. Nurses are supposed to be advocates for patients. Doctors plan the care. Excepting surgeons, doctors rarely actually administer the care.

The inpatient system works this way because it is easier to scale--our nurses often have bachelors degrees, with an emphasis on biosciences: pharmacology, pathophysiology, anatomy and physiology, etc. The providers (doctors, hospitals) are reimbursed based on what is prescribed (the procedures) and (this is key) how many people they see. So, it makes the most sense, financially, to have the doctors see each patient for, say, 10-15 minutes only, and then have the nurses carry out the plan of care. If you have a good working relationship between the doctor and the nurse, the doctors will often rely on what the nurse thinks to decide on what tests to order and/or what meds to prescribe. How does it work in your country?

Huh, that's quite interesting, thanks for the thorough explanation.

I live in Argentina, and it works quite differently. Patients wait outside the doctor's office, the doctor will call them in, examine, and prescribe any study, treatment or medication necessary. The patient leaves and the doctor remains in the room.

If the patient needed some study (eg: some scan, blood test, etc), they'll need to head to the hospital's lab with the order and get it done there (or you can go to another hospital if you prefer, though I don't think this is common at all). If there's a medicine prescription, then the patient will have to go to a pharmacist and get it himself, again, with that order.

Private hospitals are paid by each patient they see (and studies are paid separately), either by the patient or their health plan. Public hospitals are free, though they may charge some studies/supplies. Some public hospitals won't attend you for free if you have a health plan and will instead force you to use it instead.

I'm not sure which system is faster, but there's no nurse involved in general when just seeing the doctor, which must make a difference (eg: less personnel), and it's the patients who move around instead of the employees.

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