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Comment by citizenpaul | Hacker News Reader

Its probably not PC but I think a huge part of this is the burnout associated with being forced to treat the same junkies day in and out. At some point you brain shuts off to possible alternatives and you just see everything as a "next, next,next"

The answer is unfortunately you cannot treat everyone equal if they don't want to help themselves.

I was at a ER for a bleeding puncture wound and was told to hold a bandage on it and wait while several 500lb people were seen because "they don't feel good". No $hit they weight 500lbs.

Also kids apparently are always first, but I can see why that one is needed. They don't have automy like the other people there that are the source of their own problems.

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The same experience happened to me, but it was even better – I was told I had a "little paronychia" and lanced without anesthetic. Her scalpel rubbing against two nerves in the nailbed of my thumb, the ER doctor lanced and scraped without so much as lidocaine (or even tylenol!)

The next day I almost lost my thumb, because this sadist that enjoyed cutting me open without any painkillers didn't bother to check whether the infection spread to my bone. I was also misdiagnosed by her, and would have lost it had my PC not found a hand surgeon in the nick of time.

Meanwhile, to curtains on either side of me at this hospital were people who were clearly homeless and had come in with some fentanyl withdrawal symptomps, but mostly so that they could sleep on a bed. When my partner tried to intervene and say that he's never seen me in this much pain, the doctor looked at me like I was a junkie, telling me that "it wouldn't hurt if I wasn't acting up."

I understand the "next, next" that happens from burnout, but this was next level sadism. No empathy; she actually seemed to enjoy my pain. No legal action was possible since this was an "emergency room environment" and she was only there "part time."

This was UCSF Saint Francis/ Dignity Health in Nob Hill. Please avoid this hospital if you're in San Francisco.

Sorry that happened to you. I personally will probably never go to an ER willingly ever again. If you land in an ER without someone that cares about you as an advocate to look over you....IDK I wouldn't want to be in that position.

This thread is filled with terrible people. Self righteous self aggrandizing zero real world experience "Justice warriors" I hope they all need an ER someday to see just how dire it really has become. Maybe that will shove some real world knowledge into their empty heads.

Neither of us is the villain here. The people massively abusing the system are.

I realize my comment is not "nice" but the people on here jumping on villainize my real life experience are terrible people. Both of us were wronged by a system. We did not do the wrong. We just noticed what was a large cause of it because we actually experienced it.

most people don't really go to the ER willingly really. In situations where there is an emergency i'm unsure what the alternative is.

I disagree. I think current medical technology and knowledge is just not equipped to handle a fast progressing, hard to diagnose case like this. Differential diagnosis usually takes a long time even when done by the best medical teams outside ER.

On the other hand, American health insurance is arguably the most aggressive in the world at punishing overweight individuals and smokers through penalty fees.

the fees are bought upon by the partakers of food and cigarettes.

do they realize the strain excess weight carries for organs? would it be cheaper in china or Europe to be that size? No. Logistically, other countries would not have equipment readily available and having your poor lifestyle choices subsidized doesn’t mean the cost isn’t there

My mom used to be an MRI nurse.

Patients that were so large would have to be denied and referred to the local zoo.

I wish I was kidding.

Obese individuals & smokers actually cost the system less money overall vs slim & healthy people because they die so much earlier - think of the 30+ years of savings!

Dutch researchers compared three cohorts (healthy-living nonsmokers, smokers, and people with obesity) from age 20 to death. They found annual costs were higher for obesity through midlife, but lifetime spending was highest for healthy-living people, lowest for smokers, and intermediate for people with obesity, due to shorter life expectancy in the latter two groups.

https://journals.plos.org/plosmedicine/article?id=10.1371%2F...

Another study found total lifetime costs were ~14% lower for the obesity cohort and ~26% lower for smokers versus healthy living peers, again because longer life spans among the healthy group accrue more late life costs.

https://www.researchgate.net/publication/5596865_Lifetime_Me...

“Punishing overweight individuals and smokers”, I’m sorry, while I wish America’s healthcare system was better in terms of cost, some things are choices/habits that have consequences in terms of health and subsequently the care required to treat..

Be the change you wish to see in the world: donate your "skinny person" poop to a needy fecal transplant recipient.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10381135/

That's incorrect. The US health insurance CAN NOT use anything but the current smoker status for pricing decisions.

That's why obesity was added as a medical condition a few years ago. Did anyone think it was added to help people rather than ring up extra bills?

Forget PC, its repugnant and incorrect.

You're just spouting dog whistles and fatphobic bullshit.

The system is broken because that's the design.

This sounds like a great way to decimate outcomes for marginalized people. Some significant portion of those perceived as "not wanting to help themselves" are going to just be "people who doctors don't give the benefit of the doubt and consistently second guess or underserve." Which is, statistically, women, minorities, and physical outliers (including obese and disabled folk). People already die because they're not believed, or important signs are missed, but I suppose making that incidence even more likely by giving every personally judgmental doctor the license to let their bias bleed into their professional conduct with impunity is just in line with the zeitgeist.

Per your anecdote: yes, the 500-pound people were likely to be dealing with some unknown ailment. Painful as yours likely was, I'm guessing it was simple to triage and determine that you weren't likely to bleed out imminently? While the people who went ahead of you might have been facing any number of life-threatening situations. You don't know, so you don't get to make that call. Duh.

But if we're going down this path, why not add ER fast passes and "tips" that rearrange care order a la Uber? That seems to be the next logical step.

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