smackingly

Yeah it was kind of an inside joke, as urine output is really important in critically ill patients and I have to constantly remind my residents and nurses of that.

As for the VA's campaign: yes, I remember it. And it's why we have those emoji scorecards all over the hospital. Which doctors never use. My subjective opinion is that we still vastly under-treat pain in the acute-care setting.

And I could talk all day long about how stupid the VA health system is.

Yeah, but I'm not sure how much of an effect it has on the quantity of opioids prescribed. Drug lunches probably influenced which drug I prescribe (for some reason Norco was the most popular oral opioid in our hospital, maybe because it only has 2 syllables). Though I've never attended an opioid lunch.

5th vital sign is urine output :)

What is actually driving this is that income (and other hospital measures) is tied to patient satisfaction. Don't want to lose 30k/year because I didn't give the patient what they want.

I'm an inpatient physician (ICU), so I never prescribe chronic opioids, but I am pretty liberal with them in the hospital. And no, I've never received a Panera lunch for the privilege of hearing about OxyContin.

It's an extremely complex and difficult problem. I think doctors are taking too much of the blame. Maybe we should simply ban the use of chronic opioids for non-cancer pain (or other similar etiologies). When I was a resident, I made all my patients sign an agreement that I would not prescribe chronic opioids unless they had metastatic cancer, were otherwise in a hospice facility, or I made a special exception. Don't sign? Then you find another doctor.

I realize that will evoke some strong emotions from some of you, but you don't see the everyday begging from patients for more opioids when they obviously don't need them. Some people with legit use-cases will suffer under such a scheme. And that could drive up the use of heroin.

There's no easy solution to this problem.

Yeah, I know, I was just trying to show that I have a broad set of interests and enjoyed learning Go and C++. I use "rclone" for most of the backup-related things.

I have an interest in technology. This place has a good offering of technology news and discussion that I can't find elsewhere.

Also, a significant number of my investment gains originated from stuff I read here (bought a bunch of Monero when it was $0.45/unit, for example).

Finally, I learned a little programming (mostly Go and C++) to automate some stuff at work and home (reports, backups, email notifications and things like that). HN is a reasonable litmus test for what people are using to do stuff like this.

Maybe I'm biased because I'm a no-name physician at a community hospital, but the "best doctors" in my eyes are the ones with the best outcomes, lowest utilization, highest efficiency and highest patient satisfaction. These measures don't correlate well with the physician's credentials. I learned this in residency, which I did just down the street from a "top" university hospital. We out-performed that place on every level except our doctors went to "lesser" medical schools. They simply spent more money (on wild things like ECMO, which makes everyone feel they're making more of a difference even though the outcomes are the same without it).

Our profession is moving toward identifying these doctors and promoting their behavior to the entire field.

There's a study that showed lower heart attack mortality when all the "top" cardiologists were out of the hospital attending a cardiology meeting. Too many confounders to make any real conclusions from that, but it lines up with my point.

Of course, if your child has a serious life-threatening and/or rare disease, then you want her to be treated at a vanguard institution like the one you took yours to. No dispute from me on that one.

But in the system as a whole, we make the most difference reducing complications of cardiovascular disease, sepsis, pneumonia, COPD, and kidney disease (which are orders of magnitude more common). And we're starting to find out how to identify doctors that do it better, with fewer complications, and with much higher efficiency than others. I think those are the best doctors and it's what I'm striving to be.