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Are we intervening too much?

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On 7/28/2019 at 9:53 PM, vimmie said:

Babies have been weighed at homes and in hospitals for a long time, definitely 1950s onwards. Everyone always wants to know the baby’s weight! 

Oh, yes, baby scales!  Every mother had one it seemed.

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No, it wasn't.  Just an article to support "watchful waiting" as an alternative to unnecessary treatment.  The statement above it is from my own experience at my own clinic.  In health care, most of us know evidence-based practice but many still go to an office visit demanding treatment that is not evidence- based.

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I was informed by my medical assistant that a doctor she works for still does pap screens on his patients ONCE A YEAR, regardless of results!

'Nuff said🎤

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Of course we intervene more than what is normal common sense. The reason this is done is because if the patient has a 1% chance of a certain diagnosis and we don't do testing for it and then the patient has it, then here come the lawyers.  There are many laypersons who believe that medical people should be perfect, attorneys who think they have a case and can make some money and patients who are sue happy.  

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PollywogNP has 41 years experience as a ADN, BSN, MSN, LPN, NP and specializes in Med-Surg/Tele/ER/Urgent Care.

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On 7/28/2019 at 7:53 PM, vimmie said:

It’s easy and fairly accurate to date a pregnancy using a woman’s last menstrual period date. Ultrasounds are also not perfect- estimated due dates have a margin of several days either side. 

Babies have been weighed at homes and in hospitals for a long time, definitely 1950s onwards. Everyone always wants to know the baby’s weight! 

D

 

On 7/28/2019 at 7:53 PM, vimmie said:

It’s easy and fairly accurate to date a pregnancy using a woman’s last menstrual period date. Ultrasounds are also not perfect- estimated due dates have a margin of several days either side. 

Babies have been weighed at homes and in hospitals for a long time, definitely 1950s onwards.

EDC is only an estimate based on when the patient “thinks” she had her last period. My comment was that most likely this was not the case in the aunt. Birth weight would help ascertain premature birth. My first job in 1977 was in labor & delivery before ultra sound existed. Heck there’s even a TV show about women not knowing they were pregnant until  some are close to delivering. I repeatedly am told when taking newborn history about “ oh yeah he is a premie born at 35/36 weeks “, and my 2 older siblings were born n at home. No weight for the first one in 1951, as it was female relatives helping with the birth. My sister might’ve been weighed the doctor did home birth, 1954.

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JBMmom has 6 years experience as a MSN and specializes in Long term care; med-surg; critical care.

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On 7/27/2019 at 9:12 PM, traumaRUs said:

Hmmm....I care for very ill patients for whom death would never be "unexpected." Yes, I do feel that sometimes we do "too much." That said, I also believe in self-determination. If, after I have very bluntly explained the risks, possible complications, degree of discomfort and/pain, they accept the proposed treatment/procedure, then I do my very best to provide them the best care possible. 

There are sometimes though, that I think we might offer "too many choices."

Working in critical care, I often see patients that are admitted with a very poor prognosis, often after receiving ongoing treatments for specific illnesses. When the subject of palliative care or comfort measures comes up there are family members that say we are going to "kill them", if we start those measures. We can prolong life to the point that quality has been sacrificed for quantity, and it often takes some explaining to show that withdrawing care is not the same as actively killing someone. We speak of patients being on ventilators because "life support" is an outdated term, and I have had some family members makes comments like "at least grandma isn't on life support", and being shocked when it was clarified that the ventilator was, in fact, keeping them alive. There are times where providers tell family members we can use certain measures to keep them alive, but we don't always clarify what those decisions mean. It can be sad and frustrating to see someone restrained on the ventilator that it has been said wouldn't have wanted that, but no one in the family wants to let them go.

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traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

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Its best to be completely and sometimes brutally honest with family members:

"CPR is not a benign process - we will break Grandma's ribs"

"There is only a 6% chance of an out of hospital arrest being successful as in the pt leaves the hospital."

"Sudden cardiac death while receiving dialysis is real." 

Among patients with ESRD, the leading cause of cardiovascular mortality is sudden cardiac death (SCD), which is defined as death resulting from the sudden, unexpected cessation of cardiac activity with hemodynamic collapse. SCD is the leading cause of death in hemodialysis patients.Jul 25, 2016

Arrhythmias and sudden cardiac death in hemodialysis patients

 

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babyNP. has 12 years experience as a APRN and specializes in NICU.

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Yeah a 32 weeker is not physically developed enough to bottle feed let alone breastfeed and would have starved to death without gavage feeding. More likely to be a late preterm baby 35-36 weeks that was on the smaller side.

I have found people can be unreliable historians when it comes to how premature their infant in today’s world...I imagine moreso in the era before routine ultrasounds were done.  

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