Readit News logoReadit News
esoleyman commented on It's just a virus, the E.R. told him – days later, he was dead   nytimes.com/2025/10/05/we... · Posted by u/wallflower
gnfargbl · 3 months ago
esoleyman · 3 months ago
I have been in the informatics space for some time and none of these ML generated sepsis alerts are helpful in the ED.

We can readily tell who has sepsis when confronted with patient appearance, vital signs, and workup.

The issue is trying to find a signal in all of this data where they have an occult condition that we are not yet observing. These folks get sick real bad and real quick and we often do miss this!

Trying to find that signal with our current medical technology is difficult but there are some immune markers that could potentially alert us. These tests are now coming online and should be prevalent within the next few years. Hopefully, more research will show whether they are helpful or not.

Sometimes, even the best tests or calculators or ML generated alerts do not measure up to physician gestalt.

esoleyman commented on It's just a virus, the E.R. told him – days later, he was dead   nytimes.com/2025/10/05/we... · Posted by u/wallflower
sr-latch · 3 months ago
2-3% error is too high, this is something we _should_ be scrutinizing, and healthcare _should_ be more expensive if the reason it's expensive is that we're pouring more resources into it to get diminishing returns on reducing mistakes.

Costly healthcare due to scrutiny is not the problem with healthcare in the US. The problem is drug monopolies, medical (mal)practice without a license by insurance companies, and the lack of taxpayer funded healthcare-as-a-right.

We need to create an environment where someone like Terblanche feels comfortable advocating for himself without feeling like he's being a burden on the ER, and physicians don't feel like they're wasting time by investigating seemingly trivial cases. Such a situation exists because we are not pouring enough money into healthcare in this country.

esoleyman · 3 months ago
https://pmc.ncbi.nlm.nih.gov/articles/PMC10121120/

The study performed by AHRQ used incorrect methodologies and datasets to extrapolate its findings.

The ED is far more accurate with a much lower error rate than the study found.

esoleyman commented on It's just a virus, the E.R. told him – days later, he was dead   nytimes.com/2025/10/05/we... · Posted by u/wallflower
esoleyman · 3 months ago
There’s a thread about how emergency physicians are paid. It varies from group to group:

Physicians can be salaried and receive benefits from their group or hospital

Physicians can be 100% productivity based meaning that they will only get paid by the amount of patients they treat but they receive no other benefits from the group or hospital

In between these two groups, there is a wide variety of compensation Packages that are complicated to discuss in this comment.

Nonetheless, the overwriting factor for all emergency physicians is that we triage patients, not only after triage, but internally as well, including those patients at reside within the treatment rooms and those outside in the waiting room.

The question is, can we see less patients and spend more time with them and the answer is yes but to the detriment of the entire department and possibly not seeing a patient who is sick and who hasn’t been seen yet. Do you have to be able to tell who you can spend five minutes with and who needs 30 minutes.

Through put his king, but quality is queen, so there’s always a trade-off between seeing patients fast enough and to see enough patients through your shift, but to also how they were with all to determine which patients will require more time and more due diligence.

Every shift is a pull and push between these two dichotomies and it’s never easy and there are multiple decisions that have to be made.

esoleyman commented on It's just a virus, the E.R. told him – days later, he was dead   nytimes.com/2025/10/05/we... · Posted by u/wallflower
esoleyman · 3 months ago
The ED is specifically attuned to these presentations but the sepsis alerts and algorithms in place are horrendous and will fire off even for this with viral illnesses and syndromes.

Sepsis alerts are meant to find bacteremia in patients who present with a set of vital signs and laboratory findings indicative of it and even those definitions are not readily agreed upon.

The ED is highly accurate with its diagnosis and treatments despite everything that has been said.

Trying to find a zebra in the hoof beats of horses when the number of patients quickly outstrips your department’s capabilities is a fools errand because if the workup require will overwhelm throughout to the point that the delay in care will put other patients at risk.

There is a fine line between doing enough and doing too much that will grind your department to a halt and then have your waiting room backing up.

Unfortunately for this patient, his occult condition didn’t manifest itself within his two ED visits and we don’t have prognostic capabilities to tell who will and won’t decompensate. We all make value judgements and treat the patients in front of us

esoleyman commented on As Firefox turns 20, Mozilla ponders how to restore it to its former glory   techcrunch.com/2024/11/09... · Posted by u/Digit-Al
blibble · a year ago
> What I love about Firefox is that it really provides users with an alternative choice of a browser that is just genuinely designed for them

they can't seriously think this can they?

who was asking for telemetry, mr robot, pocket, VPN ads, "use our email" (relay) ads, "check your accounts!!" (monitor) ads and built-in AI slop generators

and soon, more built-in ads: https://www.mozilla.org/en-US/advertising/

I don't think a single user wanted any of that

at least Chrome doesn't actually show you ads directly throughout the browser's interface

esoleyman · a year ago
How else would you like for Mozilla and Firefox to diversify their revenue and remain relevant?

You can’t complain about them advertising their own services while still producing a leading browser.

esoleyman commented on AI tool cuts unexpected deaths in hospital by 26%, Canadian study finds   cbc.ca/news/health/ai-hea... · Posted by u/isaacfrond
swyx · a year ago
this was excellent and necessary context on all fluff pieces like the OP. how can we automate this kind of analysis?
esoleyman · a year ago
You can't automate it. You have to look at the data and charts to figure out the specifics you want and then you plug and chug. I haven't looked deeply at this though but whenever researchers use relative risk and it shows a profound effect, I always calculate the absolute risk to make sure that the intervention is effective.

Many researchers go to relative risk because it shows better results!

esoleyman commented on AI tool cuts unexpected deaths in hospital by 26%, Canadian study finds   cbc.ca/news/health/ai-hea... · Posted by u/isaacfrond
esoleyman · a year ago
I don’t like relative risk and relative risk reduction because it tends to overestimate the effectiveness of the intervention.

In this case, the absolute risk when measuring for death in the GIM pre-intervention and GIM post-intervention are 0.0215 (2.15%) and 0.0146 (1.46%) with an absolute risk reduction of 0.0069 (.69%).

While the relative risk is 26% across the pre- and post-intervention, the absolute risk reduction is only 0.69% with a NNT (number needed to treat) of 1/156. Which means that 1 patient in 156 was helped by this intervention.

In addition, they had 2 false alarms for each true alarm and could suggest that interventions were performed in patients who did not require it — more tests, medications and possibly increased risk from said interventions.

This shows that the CHARTwatch ML/AI is not helping at all that much clinically.

esoleyman commented on New York medical school eliminates tuition after $1B gift   bbc.com/news/world-us-can... · Posted by u/verve_rat
HDThoreaun · 2 years ago
Doctors also massively profit off the back of patients. They make far more and live a far more lavish lifestyle than doctors in other countries. I have multiple doctors in my family, they all work less than 30 hours a week and make more than 300k. And theyre not even in the lucrative specialties. Most are family physicians which Im sure you know is the worst paid doctor.
esoleyman · 2 years ago
Doctors are paid by the patients that they treat. As an emergency physician, I treat 20-25 patients per shift on average and I am paid by approximately half of them due to not having insurance or money to pay for my services. I am paid roughly $120 per patient. Is that excessive in your opinion?

I would say that doctors in other countries are not paid accordingly and are UNDER-paid. See the UK NHS strikes as an example.

You should be complaining about is the excessive charges and reimbursement that hospitals receive for the care that they give. It gives me pause that despite having multiple physicians in your family that you do not understand the difficulty of their practice or work environment.

Most white collars jobs including doctors, engineers, and administrators make multiples of our European counterparts. I would say that Europe underpays its workers.

Again, I am a highly paid worker just like the rest of you. If I don’t work and treat patients then I am not paid anything whatsoever.

I would be further much ahead financially if I had stuck to being an engineer 18 years ago and not have put off earning an income for 7 years and going into massive debt. This was a risk because I come from a blue collar, lower middle class background without a safety net.

What is the point of your diatribe?

esoleyman commented on New York medical school eliminates tuition after $1B gift   bbc.com/news/world-us-can... · Posted by u/verve_rat
bradleyjg · 2 years ago
You have the right to complain and I have the right to point out that your industry, along with the housing and education industries, has stolen the entire productivity gains of a generation of Americans. I’m not concerned with your work life balance.
esoleyman · 2 years ago
Your complaint should be directed towards the hospitals, for-profit insurance companies, and others who profit massively on the backs of patients.

My "industry" is only myself as I am beholden to my patients. I work and am paid by each patient who I treat and receive reimbursement by 50% of them at best.

If you don’t care about my work-life balance and lump me in with the rest of the healthcare system, then there’s nothing much to discuss.

esoleyman commented on New York medical school eliminates tuition after $1B gift   bbc.com/news/world-us-can... · Posted by u/verve_rat
ElFitz · 2 years ago
esoleyman · 2 years ago
You may be right about the work hours. I possibly mis-remembered an article from several years ago when they compared income and work hours.

u/esoleyman

KarmaCake day107June 2, 2023View Original