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But your not being taken care of by a person. Your being taken care of by the system. The nice nurse goes home in 3 hours, the nice doctor has 9 other patients. The secretary relies on the information in The computer. The people may very well care a lot. The system does not.

Checklists have been demonstrated to improve care quality because when it's the not-so-nice nurse that's on shift, and the doctor's been awake for 60 hours straight, the stuff that's on the checklist still gets done.

“It’s the corporations, mahn!”

One can be forced to mindlessly perform ridiculously constricting duties that have everything to do with limiting liability and nothing to do with outcomes, while also caring about babies.

Have you seen the itemized bills for giving birth in an American hospital? They'll even try to mutilate an infant boy and charge you for it unless you emphatically opt out.

I want to see the criminals in the medical ethics community who ever greenlit this nonsense to have justice served upon them. Europeans would jail American doctors for what they do to babies here.

are you talking about circumcision? Do they do that automatically to all newborns?

It is not automatic, but it is default behavior.

They'll schedule it by default and often argue with parents who try to cancel it. It's about money for the hospital and they don't care about the suffering it causes, nor the completely unnecessary financial burden it places on young families.

For them to be so soulless when it concerns infants, you can be sure they aren't any better when they're just dealing with adults. Greedy psychopaths are overrepresented in the medical industry.

Re: Understanding the cynicism: For example it is intriguing that they insisted on using a wheelchair to get in the car, but not to get out. But what's even more revealing is that the child had to be in a car seat while on his mother's lap.

There are some circumstances where people don't realize they can just say "no".

I suspect this is one such case.

They didn't say that, they said the checklist is there for liability reasons and not for genuine care reasons.

The "won't let mom walk to the door" thing is a great microcosm of that—it's a blanket policy applied to all mothers regardless of need.

My wife had our youngest at home but we had to take her to the hospital afterward because her lungs were a little sticky and she needed a respirator for ~4 hours. I took our daughter in and my wife followed a few hours later, walking all the way into the hospital.

The NICU wouldn't discharge us for two days (which is a whole liability > care story of its own), but when they finally did they insisted that my wife—who had had the baby at home and driven to and walked into the hospital while mere hours postpartum—needed to be in a wheelchair to the curb.

We liked that shift of nurses, they clearly cared, but no one in that room looked at my wife standing by the warmer and thought "she needs a wheelchair". They had a checklist and they were going to be darn sure they followed it.

You can always refuse. They can't kidnap you or the baby if for whatever reason you don't want a wheelchair, and it's almost always illegal to block the exits without a court order or documented altered mental status.

After 48 hours of putting up with hospital rules in order to avoid an AMA discharge, we were just happy to be done. They certainly didn't frame it as optional, and it wasn't worth the fight.

I appreciate your willingness to push for your rights here. But the situation is surprisingly similar to refusing to let a cop search your trunk. You can say no, but that K-9 unit is going to take four hours to get there from the station 20 minutes away. They will make your life hell.

I've definitely been in hospital situations with my children where I was honestly afraid (perceived or real threat, I still don't know) that they were going to report me for child abuse if I took my kids home and refused care. People with authority are kinda scary, and while I love for us to all choose rights over security, sometimes I just don't want to have to fight for everything.

And this is where police states evolve from.

> You can say no, but that K-9 unit is going to take four hours to get there from the station

Holding someone for longer than the traffic stop requires to wait for a drug dog is illegal in the USA. That's not to say it never happens, but it's grounds to exclude any evidence found, and for a lawsuit.

https://en.wikipedia.org/wiki/Rodriguez_v._United_States

Over half the population doesn't have the funds to enforce that and effectively ultimately has no such rights in this situation and many like it.

Not to mention that proving that the drug dog didn't actually need to take that long would probably be extremely difficult.

How long the drug dog needs is irrelevant; if they want to use a dog without consent or probable cause to search, they need to get it there while they still have legal grounds to detain the suspect. A traffic violation is grounds to detain someone long enough to issue a citation, but not longer.

The judge won't be amused if the police say it took them 45 minutes to write a speeding ticket.

But for the judge to be amused would require the affected person to have the legal intelligence, moral fortitude and general life "legalness" (because maybe you doubt your US legal status even if your life is mostly above board) to pursue one shitty officer's stop.

I've definitely been detained for what seemed to me an acceptable amount of time for a traffic stop, but who's to say the cop can't come up with myriad reasons it had to take that long? Is 35 minutes too long? Is 38 minutes? Who's keeping time, and who's word is taken as truth?

I've been detained 12 hours or so without arrest, including imprisonment, by feds. Pulling my FBI report confirms no federal arrest record, so it was just a detainment.

Yes, police have a lot of power and can sometimes get away with doing illegal things. The probability increases when the victim is somehow marginalized. Most people won't bring it to court, but if the search is fruitful, it's guaranteed to end up in court.

The increased use of car and body cameras makes this particular abuse harder to get away with. A request to search denied followed by a call for a dog, followed by unusual delays recorded on dashcam leads to a challenge even the most overworked public defender would raise.

Why would this not be incredibly easy to get away with. Identify those in the target demographic by race, area, and value of car.

If its a black man in a poor part of town driving a cheap car your success rate in getting away with it will be 100%.

The success rate will not be 100% when the searches actually finds something illegal. Most of them will take a plea, but on occasion, one won't.

I'm not saying it never happens, but the legal risk is too high for most cops to do it often. They may try to get you to think they will, but it's usually a bluff.

None of what you said supports that checklist following is only for decreasing liability and not towards patient wellness. It may be the case but it doesn't really follow though.

The story doesn't prove "only" by itself, but it's a good example of the checklist doing something for liability and not wellness.

It doesn't prove anything, but I consider it to be a strong anecdote supporting the argument that individual wellness is not the primary motivation for these checklists.

I can see an argument that it's about increasing average wellness across all people ever taken care of by that NICU, but from the perspective of an individual patient there's no difference between the two motivations—the point is that your own care is not the important thing to the hospital at that time, what's important is the rules and regulations.

In our case, we both felt that our care was actually actively hampered by NICU discharge rules that were designed for premature babies and were completely inappropriate for our late-term baby. The wheelchair was just the last hurrah of the situationally-inappropriate hospital regulations.

Everyone in maternity wards is underpaid and overworked, and the checklist is there and rigorously followed so we don't have mothers with c-sections tearing open on the way out because no one brought a wheelchair.

I don't understand that one very much. If walking is going to tear them open, isn't it better to have that happen at the hospital instead of half an hour later at home? I don't think much healing is going to happen in between.

Is the risk sufficiently on a per-step basis to make that worth it?

Is go further and say that all doctors who work in those wards and perform male genital mutilation must hate babies, otherwise I have no explanation for how they can ignore the fact that their European peers would throw most American doctors in jail for the things they do to newborns.