I think that’s a bit harsh. The discomforts described by people here are the same in Australia and always have been, including in well funded private and government hospitals.
Much of the problem is that given competing priorities between “this is the optimal, least medical risk thing to do” and “it will decrease patient comfort” the former always wins out, in hospital-land. In a perfect world, you would be able to say to the hospital “I’m happy for you to not do X, Y & Z for the sake of my current comfort, and I’ll bear full responsibility if my choice goes wrong”.
We all know how that would turn out.
Their attitude (which I’m not saying is wrong) is always that the discomfort will pass, but if your health is compromised that could have wider ramifications.
Not the same level, no. They’d be in much bigger wards, and receive less personal physician time, and stuff like X-rays or other tests would take longer to get. But they also wouldn’t be paying for it.
I don’t have any points of international comparison, but by definition a service that doesn’t tie revenue to individual patients has no incentive to vary standards of care accordingly.
Which is not to say that there aren’t instances of individual and institutional prejudices and presuppositions leading to bad practice and poorer outcomes for some people - especially if coupled with professional arrogance and/or stress resulting from staff shortages and consequent overwork. There are more and more instances of that coming to light in the NHS, particularly in maternity services.
And then there’s this shower of a government’s "hostile environment’ policy for irregular migrants, which among other things forces NHS hospitals to check patients’ immigration status and charge if they don’t have the right Home Office documentation - when the Home Office is prone to error, to put it mildly. Too many people who came legally to the UK as children but never acquired the required documentation (because they didn’t then need it, never having left the UK) ended up facing NHS bills and various other indignities.
My last experience of hospitals is years old, from my father’s final illness. He certainly complained about noise at night from the nurses (mostly agency temps, even then), and I had my own run-ins over his pyjamas, which they would snatch up into the communal laundry collection and store. On which topic, I recall that the information sheet on the end of his bed didn’t really allow for much personalisation, so much so that the only place for the nurse to write “Likes to wear own pyjamas” was in the oddly large box headed. “Sex”. Such is institutionalisation.
We don’t have private hospitals in Ontario, but our current government is pushing more privatization in health care. This will likely end up in a fight between the federal government (provides funding under the Canada Health Act) and the province that is responsible for delivery. My comment may have been cynical, but correct.
I don’t think so. My mother’s a nurse so I had the benefit of her explanations for various discomforts. I don’t remember specifics but I do remember that much of the time the answer was “because it has to be in a form that can be sterilised” or “because if there’s an emergency it would get in the way” or “because there is a tiny chance that if we don’t wake you in the middle the night to test X, we might not realise that you had [whatever]” or other reasons similarly motivated.
While I appreciate your mother’s role in healthcare delivery, I speak as someone who was a director of a hospital foundation for 5 years and had to deal with the battle in our health care system between CapEx and OpEx. Raising $100M for a capital upgrade campaign can be easier than getting hospital gowns that don’t open unexpectedly.
“Person whose role in healthcare as a volunteer charitable foundation director and donor who had spent 2 months in the associated hospital and then another 4 months as an outpatient and joined the board to try and fix many of the problems he had encountered as a patient with little success”. Fixed it for you.
Do you actually deny that reasons such as those I outlined are reasons some uncomfortable aspects of hospital stays are as they are, or just going to argue from alleged authority?
Your initial post came across as driven by extreme cynicism rather than a position from which you would reasonably deviate. You still come across that way.
I agree that those are some of the reasons, but at the end of the day my government - I have no opinion of your healthcare system - will spend the least amount of money possible for an optimal outcome. As an example, they are trying to move away from sedation during colonoscopies because the medical outcome is the same even if the patient is less comfortable.
Our Universal Healthcare system is not great, but I believe it is the best of the alternatives. Emergency Departments here are going through rolling closures due to lack of staff, from support staff to physicians. My cynicism is directed at our political leaders, especially over the mess of Covid, who have done a piss poor job.
Speaking as a patient who fights to get procedures done without sedation, it’s a lot cheaper for the patient, too. You don’t need to find someone else to drive you there and home. You don’t need to do nothing at all for the rest of the day. And for many people (certainly including me) Colonoscopies are a little uncomfortable, but not at all painful. And most of it isn’t even uncomfortable.
I think doctors like sedation because they don’t enjoy being watched by the patient.
I think sedation should be an option for those who are frightened, or have had a painful one on the past. But i think the default ought to be no sedation.
(And the studies i read suggest the medical outcome is slightly better without sedation, as there’s a slightly lower chance of perforating the colon. Because the patient says “ouch” before it’s too late.)
I had my first 2 years ago (thanks 50!) and I was pretty happy with the sedation, but I also had a vasectomy under only a local. I’ll let you know in 3 years.
I’ve had at least 13 operations in my life, and last week had a cardiac ablation. I was sedated but out. Not general anesthesia. I did have a brief moment of awareness during the procedure but went out again. The post op nursing care was outstanding. I wasn’t comfortable because I had 2 IVs, monitors on 2 fingers of my right hand, monitors beeping, at least 3 blankets, and worst of all I had to be flat on my back for 3 hours. Flat. Couldn’t even lift my head. But the post op nurse checked me every 10 minutes, did an emergency EKG when my HR was 120, faxed the results to the physician’s office. The physician’s NPs were there within 5 minutes of receiving the fax.
The physicians and nursing staff were outstanding. My discomfort came not from the hospital facility, but from doing what was necessary to make sure I was safe.
For some values of luck, I suppose. The pain from the anesthesiologist trying and failing to put the needle into my back was excruiating. Like he was directing lightning from my back and down my leg. He got kind of snippy with me like he was annoyed that I had asked him to do something and was putting him out if I didn’t let him finish. After 3 tries, I just could not sit there and let him try again though.
Several years later, I was induced with my son. It was the time of COVID and hospital restrictions did not allow patients to have more than one visitor every 24 hours. My husband was there for part of my labor, but had to go home to be with our daughter when she wasn’t in daycare or summer school. So, I was laboring by myself, having stalled at 7 cm after nearly 24 hours and in horrendous pain. The nurse said they couldn’t do another round of stadol and, after trying a few tricks to help the baby move down, she recommended an epidural. I lost my damn mind. I was so traumatized by the last time that I could not imagine going through trying and failing again. The nurse and my doctor talked me down and I consented to an epidural. They were great this time. The anesthesiologist this time sweet and patient. She gave me good feedback on how to actually hold my back and when it was important to be still and when she was going to stick me. It still took 3 tries and it still hurt like a bitch but the anesthesiologist caring about me made all the different. Once the epidural kicked in, I laid down and rested. An hour and a half later, he was born at 2:22 am.
I say all this to note the thing that made the biggest difference. The second doctor treated me like a person, not a task. And because she took the time, I didn’t get traumatized, even though they both hurt the same.
I was a bit flippant - not addressing the pain of the needle insertion (which I definitely understood - given my own experience). I was focusing on the fact that the epidural might well not have worked - especially since it sounds like you might have had similar issues / similar “skill” level on the part of the anesthesiologist.
I had an epidural with my daughter’s delivery, several years later. Different hospital. C-section - urgent but not emergent; I was in the hospital already due to pre-eclampsia and had literally gone from “imma send you home with nurse monitoring” to “welp, gotta delivery baby as soon as your husband can get here” over the course of 10 minutes. So the anesthesiologist had time to do it carefully - very weird sensation. But it worked… er, mostly (my bladder was NOT numb). Despite not-quite-working, it was a much less painful experience than with the other delivery.
So sorry you got stuck in the situation you did with your second child :(. At least I had my husband with me, during my labor from hell - that must have been beyond soul-destroying.
I can vouch for the epidural letting things move along - with my son, during the brief 40 minute period when they managed to numb that one still-agonized area, I went from 4 to 10 cm.
I still regret hitting the doctor that one time.
Not hitting her, per se… I regret I only hit her the one time. I have a problem with doctors who think that a patient asking questions is a reason to slap the patient down, verbally, and don’t mind lying to the patient if it suits them. I also regret that the anesthesiologist was still able to pee standing up. Likely he was saved by the fact that he was behind me, and I was busy getting yelled at by the nurse for screaming in agony. Sadly, my mouth was not all that near her ear. Bitch.
A couple years back, during our Month Of Orthopedic Surgeries (seriously: I found out on a Thursday that I needed somewhat urgent wrist surgery; it was scheduled for the following Tuesday; in the meantime, my husband broke his knee), I was with my husband in pre-op, and the anesthesiologist said he’d be given an epidural. I did not react well. Had it been ME that needed that surgery, I’d have walked out the door. OK, I’d have limped out the door.
I still cannot drive by the hospital where my son was born without getting the shakes.
Recently was in for quite some time.
The beds were mechanized and automatically moved around the mattress pressure points at intervals. I see the point. But they kept waking me. One was defective. It would go from comfortable, to placing what felt like a basketball under my back.
I’d be interested in seeing those studies, if you have links. I don’t doubt you - it makes sense - but I’m curious like that. With sedation tending more toward being “conscious sedation” (where, supposedly, you can respond… you just don’t remember it), I wonder how that affects things?
I think offering sedation as a standard should continue, though perhaps without the same difficulty in refusing it for those who wish to do so. But for something like a colonoscopy - where a big part of the reluctance is the experience of having the Chrysler Building going where skyscrapers do not normally go, if sedation is offered, it might help get some refusers onto the table. This being a topic near and dear to my… heart, I’m all for anything that helps get people screened.
Some procedures may be more difficult to perform without at least something to relax the patient - I would think that an upper GI would be a bit tough on a patient who is tense and twitchy. I know cataract surgery can be done without sedation… but oh HELL no. Dental work - for which sedation is NOT the norm - would be nearly impossible for some patients if some kind of sedation were not available: I’m one of those due to a long history of Very Bad Experiences. First time I saw a new-to-me dentist, she needed to do a filling. I asked for nitrous. She looked surprised. I assured her it would make it easier on BOTH of us if I was loopy.
The bit about the cost is very valid. I’ve vented in the past about a friend whose daughter had a colonoscopy - and the anesthesiologist was out of network, and billed 4,000 dollars for a 20 minute procedure. That’s triple what my practice’s anesthesiologist bills, and about 15 times what they actually collect from insurance. So you’re paying for that, you likely have longer prep time (since an IV is required), longer time in recover, and as noted, the logistics of getting home afterward.