‘Project Hospital’ is A Great Way to Understand Our Broken Healthcare System

My father has always been a doctor, at least as far as I’m concerned. He was the director of a rural New York hospital for a decade, and he worked in family practice since before I was born. For all that, I never really understood all that much about his job, what it was that actually filled his days and occupied his thoughts when he wasn't with patients. The incomprehension was mutual, over time: most of the games I cover and talk about in my chosen profession bead off his consciousness like water off a duck’s back. So when I discovered Project Hospital, I was excited to show it to him—it was that rare opportunity for a video game to provide a means for us to connect across our different professions and interests.


This is a companion discussion topic for the original entry at https://www.vice.com/en_us/article/wjvxk5/project-hospital-is-a-great-way-to-understand-our-broken-healthcare-system
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This is a very good piece, but it’s very specifically hell of a thing to read right now, as I sit next to my wife who is dozing in a hospital bed for the second day in a row. It really does feel like we’re little Sims moving through an agonizingly slow and expensive pipeline.

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This was a good but deeply harrowing read.

Very good read!

I’m wondering where this idea of socialized medicine having longer wait times comes from. I’ve lived in the Netherlands, the UK, and am now in the US…and wait times here are ridiculous. My GP usually has a two week backlog! Plus they are a 15-20 minute drive away, because that’s the nearest one that will accept our insurance. I still haven’t even been to them. I always end up having to go to urgent care a 15-30 min drive away and waiting 3 hours to be seen if I am not feeling well.

In the UK I could usually get a same day or next day appointment at my GP, who was never more than a 15 minute walk away. In the Netherlands there is a neighborhood doctor system, and our doctor had an hour or two starting at 7am where you didn’t even need an appointment to get seen.

Perhaps maybe the more lucrative things are faster here in the US, like seeing a specialist? I know wait times in the UK it depends on how severe they deem your case is. One of my room mates in the UK had a 3 month wait to see a specialist after he had a strange episode where he collapsed out of nowhere. At the emergency room they couldn’t find anything wrong with him though, and he never had anything like that again while I was there.

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Personally, my thinking is:

Americans read “socialized medicine” and think this = COMMUNIST SOVIET UNION which = people waiting in lines for bread and gruel = HARD-WORKIN’ 'MERICANS FORCED by THE GOVERNMENT to WAIT for MEDICINE.

Combined with generations of the American right-wing drilling into peoples’ heads that literally anything run by any sort of government agency = HORRIBLY INEFFICIENT AND TOO EXPENSIVE AND FREEDOM-HATING, unlike Your Friend And Mine, Capitalism

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Yeah, the bread line is the longest-enduring and simplest symbol of the evils of communism that Americans have. When people are afraid of communism, they think of bread lines.

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The irony of the bread line example of course is that here in the US they would rather have people starve to death than wait in a line. There was that recent case of people being arrested for feeding the homeless. Not to mention all the food deserts.

Which is pretty much the same with Healthcare too.

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I’m very surprised that people can see the phenomena of diabetics rationing insulin doses due to skyrocketing prices or cancer patients launching crowdfunding drives to pay for care, and then scoff at Soviet bread lines with straight faces. You’d think the cognitive dissonance would be physically painful, but somehow they manage to pull it off.

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YMMV but I have Canadian friends who do tell me sincerely that for things like major surgeries, Canada’s system is slow. Of course, it’s simplistic to say that – the US is faster if you can pay exorbitant premium prices, and slower (like, people have pain and decide they can’t afford to go to a doctor) if you can’t.

I live in Korea and people who’ve emigrated to the US or Canada will always try to come back to Korea for medical procedures, because it’s (insanely) cheaper than the US and (quite a bit) faster than Canada. The problem here is that the national insurance fund is (or at least I am told) bleeding money – partially because people who’ve emigrated and aren’t paying into the fund via taxes are siphoning money from it, probably! :wink: I don’t have much expertise in this area, but as far as I can tell, Korea is in a pretty good place for healthcare-wise for patients right now, but my friends in the medical profession do tell me that they worry about the sustainability of the system.

Which is all to say, I doubt there’s a “perfect” system, but there is definitely better shit out there than the US system basically telling people who can’t pay for healthcare that they might as well die.

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I mean in some cases it is quite a bit slower, especially for non-emergency surgeries. I needed knee surgery in Canada and it took about 2 years from my first appointment with a orthopedic specialist to the actual surgery. Had a similar surgery in the US and it took about 3 months start to finish. It also cost my over 5000 dollars even with my University health plan so I absolutely regret getting it and I should have just waited until I got back to Canada.

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My wife is from Korea and I have so many stories I could tell in this thread that would make Americans’ jaws drop when it comes to how efficient and unbelievably cheap socialized healthcare can be.

It’s like night and day. I could go over to Korea uninsured to have a major surgery and even with airfare the price wouldn’t come close to cracking what you’re likely to pay for it in the US.

I am fascinated, that apparently a Czech studio randomly reinvented the American healthcare system? When their personal experiences with receiving healthcare are probably not like that at all?

As you might imagine Czech system is very different, and has a completely different history - for one the insurance companies should all be paying the same money for the same procedures. Even though we no longer have one universal insurance company (thx capitalism) that shouldn’t impact emergency procedures. Even more, within the entire EU citizens have right to get emergency procedures done and covered as if they were insured within the country (which I uh, had plenty of experience with, when I was unwisely living uninsured in Czech republic)

Wonder if they’ll patch in an NHS mode? My parents both worked in medicine, my dad was a consultant in A&E like Ian’s Dad. But maaaannn… after everything I’ve heard about management in UK hospitals, don’t think I’d ever want to play as one in a video game. But still, seems like another valuable opportunity for a game to map out the real life complexities of running an institution such as a hospital.

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I have only played this a few times and I already have a love-hate relationship with it. I’m mad that the doctors all go down the list of every single diagnostic procedure like automata, even the super pro specialist doctors; it’s annoying that I can’t move the ambulance stop point; I think it’s weird that patients only have one condition at a time; the campaign seems weirdly paced… it feels just not done, I left a shitty review on Steam… and then I flipped over to Sandbox mode and I played something like 10 more hours obsessively. (Yeah, I will fix my Steam review.)

Then I had one patient die, for the first time, after spending all of this time trying to assemble basically the ideal hospital, lots of staff, single-patient rooms, all the trimmings, TV to watch in bed and a little dresser for your stuff… and this patient, a woman in her 50s, I think her name was Alice, presumably otherwise healthy (especially in this game), had some stomach pain, came in, collapsed in the hallway. Rushed to the trauma center and stabilized - ruptured pancreas - scheduled for an operation asap, but it was 7:55pm, day shift ends at 8pm. The surgery nurse wasn’t available to start, so “asap” was going to mean the next morning.

I furiously watched the surgeons pack up in the general surgery on-call room and head home. Alice was checked into the general surgery HDU (high dependency unit) as the day staff filtered out. This wasn’t a very big hospital. The brand new ambulance-ready trauma center annex had just been opened, a little rushed and over budget. In the general surgery department – used to overnight stays, routine surgery – there was only one nurse on nights for 10 beds, along with an intern to help with pushing stretchers around, not qualified for patient care. There was no night operating team. There had never been a need for one.

I flipped over to management mode and spent thousands of dollars trying to find qualified operating staff to come in for the night shift. I found some, and they came in… and they sat there. Right. Operations need surgery nurses, and there’s only one in the department, and she’s busy doing regular rounds on 10 beds. Ok. Let’s have another nurse come in and take over so she’s free.

Time passes. I stare at Alice’s chart again waiting for a doctor to show up. Or something. Where is at least the basic on-call doctor for the ward? She seems to be fucking around on her computer? Writing reports, I guess it says. What the hell is wrong tonight? Is it the shift change? I have a haunting vaguely bad feeling about something my ex-girlfriend the CCU nurse said about incidents at shift changes…

Somehow the operating room still isn’t set up. Or something. Her status says “waiting for surgical team”. I literally don’t know what to do. I am waiting for someone to do something. I want to yell at this simulated hospital staff. Was she assigned to the day surgeon? Is there some schedule you guys have that I don’t understand or know about? Do you see this says “pancreatic rupture”? What the fuck?

Minutes pass. Hours. I watch the nurse intern push a few stable patients around for some basic exams. I start wondering if there aren’t enough stretchers, or enough interns. He comes and sits at his desk. No, it’s not that. Is the game bugged? How would I know?

I stare longer. It starts to sink in that Alice isn’t going to get operated on until the morning and there’s nothing I can do about it. Ok. Well maybe they know what they’re doing, but this doesn’t look right to me. I hit the ICU button. At least then she won’t be one of ten on a general ward with only occasional checks, in an apparently dysfunctional department. The notification goes through to the scarlet-scrubbed ICU nurse in charge on the night shift. She starts the walk over to the elevator and gets about halfway before the code is called and she has to break into a run.

Alice is fast-transferred onto the stretcher by the ICU nurse and whoever was walking by, rushed down the hall and into the ICU. The ICU doctor on tonight is the head of the unit, a brilliant 67-year-old woman critical care specialist, and she sprints to Alice’s side. Septic shock. Alice’s system is shutting down. And somehow basic drugs to allay the fever, intense pain and nausea hadn’t been prescribed or delivered since the trauma unit visit. Antipyretics, analgesics, antibiotics all get pushed into the IV line. Alice is intubated, the short casual medical term for the last-ditch painful process of inserting a respiration tube into a patient’s airway to keep enough oxygen in the bloodstream (and CO2 coming out) when patients’ bodies become too weak to do it themselves.

Now it’s about 3 in the morning. Every half-hour, an ICU nurse walks the 20 feet over from their station to Alice’s side and checks her. The doctor visits a couple of times to do regular examinations to make sure nothing has gotten worse.

Around 5:30, it’s still dark, though the sun should be up soon. Day shift starts at 7. The alarms start going off. Alice is crashing. The ICU team sprints over. The doctor grabs the defibrillator paddles. Medicine is pushed. They try what they need to try. It only takes a few minutes. Alice is dead.

The lead ICU nurse, in her scarlet scrubs, in the bright tiled red and white ICU room, walks slowly, almost glacially, across to the water cooler and fills up her paper cup with some water. She hasn’t had anything to drink or eat in hours.

A notification pops up, canned text that twists the knife as if it was written just for me: “A patient has died. Would this have happened at a more efficient hospital?”

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