medgremlin @ medgremlin @lemmy.sdf.org

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2 yr. ago

These birthing centers are just a small step above home births in the grander scheme of things. The regulations being imposed are absolutely necessary for the centers to actually be better options. Even if the pregnancy has had no complications and is very low risk, things like uterine hemorrhage, neonatal hypoxia, or other unpredictable complications can occur. When those things happen, being an hour away from proper emergency care is very likely to be lethal. The 30 minutes away from the hospital by ambulance rule isn't even taking into account the time it takes to recognize the problem and the time for the ambulance to arrive in the first place.

If these centers are going to exist and claim to be a safe option, they need to have adequately trained staff, appropriate facilities, and viable access to emergency care in case of unpredictable complications.

Not to oversimplify, but they could build these birthing centers 20 minutes away from the town and 25 minutes away from the hospital rather than in town and 45 minutes away from the hospital. They could also pivot to offer assistance to mothers in the form of facilitating transportation, doulas, and help setting up pre- and peri-natal Medicaid.

There is a lot more to this article that you left out that provides very important context. The state health department is imposing really quite reasonable regulations on the birthing centers for the health and safety of the mothers. Some of the requirements include formal nursing education for midwives (who can otherwise calls themselves midwives after taking barely-regulated online courses), proximity to a hospital that has obstetrics and pediatrics in case of emergency (must be within 30 minutes by ambulance), and building requirements that allow for things like ADA compliance and appropriate medical facilities at the birthing center.

The article does also address the significant systemic problems that mothers, particularly black mothers, face in many hospital settings, as well as the black maternal fatality rates. While these issues are important to discuss and address, inadequately staffed and equipped birthing centers 45 minutes away from the nearest hospital by ambulance are not the answer here. In my professional medical experience working in such a hospital, I've seen transfers from birthing centers like the ones discussed in the article that were unable to address maternal uterine hemorrhage and neonatal hypoxia. Luckily, they were close enough to proper hospitals that could care for the mother and newborn, but if they were 45 minutes away by ambulance, the mother and newborn very likely would have died.

If you don't fit the typical mold of "perfect" you have to step outside your comfort zone and take some risks if you really intend to pursue your goals in spite of arbitrary rejection.

I'm in DO school, and in my first year, the neuroanatomy course was my highest grade for some reason. As in, the only in-class exam I got an 'A' on was the one that covered all the basics that one would need to know for neurosurgery. I'm still a little confused about that one.

For the overly sheltered K-MD kids, my belief is that working for a year as an EMT/CNA/RA/etc. should be a pre-requisite to application. The fact that people are allowed to apply to medical school without a history of hands-on professional patient care experience is actually quite galling. You can always tell which doctors have never had to clean up human poop (not counting infants).

You are correct. This problem is caused by administrators and managers. If you got rid of all the unnecessary middle management and paid the executives reasonable wages instead of the grossly inflated pay they have now, healthcare would be a heck of a lot cheaper. The health insurance companies and the medical supply companies/pharmaceutical companies aren't helping either. There are literally life-saving drugs that can cost up to $100k for one dose.

Maybe edit the meme to be about hospital administrators and health insurance companies. They're the real problem.

I was on a different side of that equation when I was a clinic assistant in a surgery practice. A decent chunk of my job was fighting with insurance companies to get them to cover medically necessary procedures. It was a plastic surgery practice that was part of an oncology group, so one of the surgeons mostly did melanoma surgery and the other mostly did breast reconstruction after mastectomy, and they both did some cosmetic and general plastic surgeries here and there. The insurance companies would do idiotic things like not need a formal prior authorization for a melanoma excision, but because the skin graft needed to repair the excision site technically counted as a "plastic surgery" by its CPT code, they would require a prior authorization for that.

One of my favorite things is when I got the insurance companies to cough up for medically necessary panniculectomies following drastic weight loss which heavily subsidized the "upgrade" to a tummy tuck/full abdominoplasty. The patient basically just had to pay the difference instead of paying for the whole thing. Our surgeons were really good at planning and coding procedures like that to help patients as much as possible.

It's definitely not the same as combat situations, but in my experience in emergency medicine, you really do learn to love boring. I'd much rather sit around doing crossword puzzles, playing solitaire, and meticulously restocking the department than have 3 back-to-back codes in a pediatric level 1 ER.

I'm hoping to do my residency in a pretty urban area and move out towards the rural part of the state further down the road. When I was working as an ER tech before starting medical school, I was on straight nights and picking up a ton of overtime. I was averaging about 50 to 60 hours a week, and doing that as 12's and 16's actually worked out pretty well for me. I'm more susceptible to burn out on a normal M-F 8-5 schedule, honestly.

It's actually one of the only specialties without on-call time unless you're on-call to cover another physician calling in sick. As for the schedule, I'm naturally nocturnal, so straight nights would be awesome.

When I was a clinic assistant at a surgery practice, a solid half of my job was obtaining prior authorizations for every procedure our surgeons performed. That experience is one of many reasons I want to go into Emergency Medicine. I hate appointment schedules, I hate prior authorizations, and I hate being told how to do my job. I know that I'll have to play the game and do the stupid metrics for all my lower acuity patients, but at least for the codes and stuff they won't really be able to give me a hard time about it.

Speaking as a former ER Tech and medical student, doctors are the most likely to just "forget" to bill for the random bullshit that admin wants tracked to an obscene degree. There are some ERs (mostly HCA run ones) that have to scan your patient barcode and the cabinet to track giving you an ice pack. I've really only worked in community hospitals and intend to keep it that way, and doctors are the most likely member of a care team to just do whatever is necessary and fail to document it. I've also seen doctors down-code visits and procedures to make it easier to get insurance to pay for things.

PS: I'm intending to go into emergency medicine and/or critical care at community safety net hospitals or critical access hospitals and I will raise hell to increase the number of social workers in the department to help patients get the resources they need.

Adding on to this: if you've had negative experiences with psychiatrists in the past, first off, do not let NPs be the primary managers of your care, and secondly, consider seeking out a DO physician psychiatrist. I'm currently a DO student, and while the medical education is equivalent to an MD program, the philosophy is more "person" oriented than "patient" oriented. There's a strong emphasis on treating your patients as whole people and taking advantage of the body and mind's abilities for self-regulation and healing. A DO will absolutely prescribe medications when necessary and DO's are not "holistic" quacks, but they do have more emphasis in their training on helping you find non-chemical solutions if medication is not the best answer to the question or if you are hesitant about medication.

Apparently Georgia has some pretty draconian means-testing to qualify for a public defender. I remember reading something like 250% of the federal poverty line or thereabouts. (Which works out to about $36k per year, by the way.) They should really look into fixing that.

Oh, that makes a lot more sense because the comment I see these replies attached to is both fairly innocuous and entirely unrelated to what the responses are talking about. I thought they had just edited the original comment.

They must have edited their comment because the one I see now is fairly innocuous.

The judge's response to that was the polite legalese translation of "lol, no".

Alcohol addiction is honestly a much bigger problem than most other drug addiction simply because of the potentially lethal withdrawal of you try to quit without help.

New (street) opiate users usually come from people who have had mismanaged chronic pain conditions because of the absolutely horrific campaign by the pharmaceutical companies to push opioids. If we had better, non-pharmaceutical pain management programs involving stuff like physical therapy and mental healthcare, then there would be more viable options than opioids. Also, modifying the medical system to be more accessible so people can get care before something becomes a chronic pain problem would be helpful.

The other necessary modification is to change the system so that doctors can spend more than ten minutes with each patient, but that would require an overhaul of the medical education system from undergrad through residency to create more physicians.