[wat0n]

America is pretty fucked up.

What @XogGyux has said, was exceedingly believable and typical.

I don't believe you are American.

His descriptions of the system completely jived with common sense, for those in the shithole country, America.

I'm not American but I live here.

Now you tell me how exactly did they schedule my 2nd shot if the CDC didn't keep the record of my first one...

[Rich]

To tie it back to the topic:

In a Marxist society, vaccinations are free. In a capitalist society, you have to pay for it.

So Britain is a Marxist society.

In a Marxist society, hospital stays and other medical treatments are free. In a capitalist society, you have to pay for it.

So again Britain is a Marxist society

So, in terms of triage during a pandemic, people will not be turned away simply because of an inability to pay.

OK so we've definitely established that Britain is a Marxist society. The gold standard for capitalism is pre Marion Rome. The fighting forces, the military leadership, the electorate, the judiciary, the lawyers, the government and the priesthoods were all dominated by the owners of capital. And the more capital you had the more influence you had. I don't support capitalism myself, but there is an undeniable beauty and elegance to the pre Marion system.

Marius was the Marxist revolutionary who brought the system down, with such Marxist nanny state notions that troops should have their equipment paid for by the government, by the tax payer. This is why I get so annoyed with Conservative hypocrites who criticise Julius Caesar for bringing down the Republic but make no attempt what so ever to reverse the Marion reforms. From a capitalist perspective, these veterans that so called Conservatives guff on about are nothing but parasites. Yes its fine to be a Navy Seal or what ever, with all your latest night vision goggles, telescopic sights and high tech parachutes, but don't expect me the tax payer to fund your expensive life style choices. Julius Caesar and Augustus it should be noted are considered by many to have been the rightly guided successors or Caliphs to Marius.

Of course it didn't stop with Marius, if I remember correctly, I think they even ended up with a tax payer funded fire service. Jesus what have we come to when citizens can't even take responsibility for their own fire protection. Now Marius's reforms allowed Rome to survive for another 1500 years, thats OK as long as you don't mind living in a Marxist nanny state society so devoid of personal responsibility.

[Crantag]

I'm not American but I live here.

Now you tell me how exactly did they schedule my 2nd shot if the CDC didn't keep the record of my first one...

They scheduled it by scheduling it.

That little card they gave you is the only record.

[late]

So Britain is a Marxist society.


So again Britain is a Marxist society


OK so we've definitely established that Britain is a Marxist society. The gold standard for capitalism is pre Marion Rome. The fighting forces, the military leadership, the electorate, the judiciary, the lawyers, the government and the priesthoods were all dominated by the owners of capital. And the more capital you had the more influence you had. I don't support capitalism myself, but there is an undeniable beauty and elegance to the pre Marion system.

Marius was the Marxist revolutionary who brought the system down, with such Marxist nanny state notions that troops should have their equipment paid for by the government, by the tax payer. This is why I get so annoyed with Conservative hypocrites who criticise Julius Caesar for bringing down the Republic but make no attempt what so ever to reverse the Marion reforms. From a capitalist perspective, these veterans that so called Conservatives guff on about are nothing but parasites. Yes its fine to be a Navy Seal or what ever, with all your latest night vision goggles, telescopic sights and high tech parachutes, but don't expect me the tax payer to fund your expensive life style choices. Julius Caesar and Augustus it should be noted are considered by many to have been the rightly guided successors or Caliphs to Marius.

Of course it didn't stop with Marius, if I remember correctly, I think they even ended up with a tax payer funded fire service. Jesus what have we come to when citizens can't even take responsibility for their own fire protection. Now Marius's reforms allowed Rome to survive for another 1500 years, thats OK as long as you don't mind living in a Marxist nanny state society so devoid of personal responsibility.

That would have worked better as satire..

[wat0n]

They scheduled it by scheduling it.

That little card they gave you is the only record.

Then you tell me how do they keep track of the vaccination rate if they don't keep other records.

Again, I use this data for my job.

[XogGyux]

And you do, this is what the information sheet they gave me when I got my first shot says about immunization recording:



I actually know about the IIS and the type of info there because of my job (I won't elaborate further). If it is not being used to let anyone query this sort of info in real time is due to HIPAA and other privacy laws, that is, due to the fact that society has thus far valued privacy the most (understandable, if anything, yet a pandemic caused by a new disease probably counts as an exceptional time). But that the material possibility exists to do so, well it does exist.

Ok, but please note what it says:
"the vaccination provider may include your vaccination information in your state/local jurisdiction's immunization information system or another designated system."

This is as vague as it can get. Who is in charge of entering the data? "The provider"... well I am a provider and I just found out this information, I promess you none of my colleagues even knows of this but I'll ask them to see if they do just out of curiosity. And then where? "state" or / "local" or "other designated system". Let's be realistic, the drive-through vaccination site is not jumping hoops to accurately track people.
At best you'd end up with fragmented databases at the state level.
Now the information might be good enough for epidemiological investigations and/or tracking of side effects. But I highly doubt that it would be useful for identifying such patients when they get hospitalized for the purposes of giving them differential care.
There is already one such databases for opiods, using it is cumbersome, time consuming and somtimes we cannot trust the information in the system. When I get a patient with prescribed opiods I need to check the database and even whe I do find the patient, sometimes their prescriptions are not fully updated because they are given at some sort of treatment center that do not report it (e.g. suboxone) and in such cases I have to directly call the place that gives this medication to the patient, wait in the answering machine, talk to a person, adn eventually confirm the information. I cannot describe you how much of a nightmare it would be to have to call a dozen different providers when the person that provided the vaccine to Mr Jon Smith entered John Smith in the database, Or when Juan Ortega Perez (two last names) was entered as Juan Ortega-Perez (a single compound last name) or as Juan O. Perez (Ortega as a middle name). At this point, you might as well just go ahead and implant chips on people so that we can keep track.
My shifts are 12 hours, my census is 20 patients daily. That leave little over 30mins per patient and ideally this 30mins should be enough to do anything and everything this patient's care requires. Meaning, this time should be enough for me to walk to the patient, talk to the patient, review the patient's chart, prior hospitalizations, current labs/imagining, write today's progress note, place my orders, discuss the case with other consultats, the patient's nurse. 30mins.... some people take longer to drink a cup of coffee, just putting and removing the PPE in front of the patient's room takes ~5mins.
Again, it is not practical.

[wat0n]

Ok, but please note what it says:
"the vaccination provider may include your vaccination information in your state/local jurisdiction's immunization information system or another designated system."

This is as vague as it can get. Who is in charge of entering the data? "The provider"... well I am a provider and I just found out this information, I promess you none of my colleagues even knows of this but I'll ask them to see if they do just out of curiosity. And then where? "state" or / "local" or "other designated system". Let's be realistic, the drive-through vaccination site is not jumping hoops to accurately track people.
At best you'd end up with fragmented databases at the state level.
Now the information might be good enough for epidemiological investigations and/or tracking of side effects. But I highly doubt that it would be useful for identifying such patients when they get hospitalized for the purposes of giving them differential care.
There is already one such databases for opiods, using it is cumbersome, time consuming and somtimes we cannot trust the information in the system. When I get a patient with prescribed opiods I need to check the database and even whe I do find the patient, sometimes their prescriptions are not fully updated because they are given at some sort of treatment center that do not report it (e.g. suboxone) and in such cases I have to directly call the place that gives this medication to the patient, wait in the answering machine, talk to a person, adn eventually confirm the information. I cannot describe you how much of a nightmare it would be to have to call a dozen different providers when the person that provided the vaccine to Mr Jon Smith entered John Smith in the database, Or when Juan Ortega Perez (two last names) was entered as Juan Ortega-Perez (a single compound last name) or as Juan O. Perez (Ortega as a middle name). At this point, you might as well just go ahead and implant chips on people so that we can keep track.
My shifts are 12 hours, my census is 20 patients daily. That leave little over 30mins per patient and ideally this 30mins should be enough to do anything and everything this patient's care requires. Meaning, this time should be enough for me to walk to the patient, talk to the patient, review the patient's chart, prior hospitalizations, current labs/imagining, write today's progress note, place my orders, discuss the case with other consultats, the patient's nurse. 30mins.... some people take longer to drink a cup of coffee, just putting and removing the PPE in front of the patient's room takes ~5mins.
Again, it is not practical.

I don't think opioids are treated in the same way, but my understanding is that the whole point of the IIS is to centralize data collection - even more so since vaccines require a specific schedule. Also, some (but not all) jurisdictions have specific mandates to report the vaccinations to the IIS.

[XogGyux]

I don't think opioids are treated in the same way, but my understanding is that the whole point of the IIS is to centralize data collection - even more so since vaccines require a specific schedule. Also, some (but not all) jurisdictions have specific mandates to report the vaccinations to the IIS.

Well, in a hypothetical scenario that this information might be the difference between getting care or not... you better have a damn good database with minimal errors and easily accessible. But even my most optimistic self understands that this is unrealistic. Reality is, people that live in the borders of states might have gotten their vaccine in one state but end up hospitalized in another. People with complex last names might have their info poorly entered. "Snowbirds" (old people that live in northern states such as NY, Illinois, etc that come to south states such as FL, Arizona, Texas), these are the people likely to have their vaccine given by their doctors in NJ and then spend 6 months down in florida where they get hospitalized... now you have the FL doctor in charge of tracking who gave the vaccine in NJ to decide whether this patient gets intubated? Dude, it is a logistic neightmare. If you are comfortable doing this sort of resource control and distribution, don't make it so complicated, just mandate the stupid vaccine and cut the middle man.

[Pants-of-dog]

Public systems are inherently more centralized which helps when tracking infection vectors and vaccine scheduling in a pandemic.

Also, during a pandemic where triage might become an issue, public systems can more easily transfer resources and patients between hospitals to redistribute resources more effectively. A private system cannot. This makes triage issues more likely in a capitalist system.

[Potemkin]

That would have worked better as satire..

He's using the British ironic mode. And I agree with everything in his post. Socialised medicine is not, in and of itself, socialist, any more than having a state-owned fire service is socialist. Some things are just more efficiently run by the state rather than by private enterprise (examples: the armed forces, the fire service, the postal service, the health service, &c.). Admitting this fact does not make one a Marxist, any more than having the NHS makes Britain a Marxist society.

[wat0n]

Well, in a hypothetical scenario that this information might be the difference between getting care or not... you better have a damn good database with minimal errors and easily accessible. But even my most optimistic self understands that this is unrealistic. Reality is, people that live in the borders of states might have gotten their vaccine in one state but end up hospitalized in another. People with complex last names might have their info poorly entered. "Snowbirds" (old people that live in northern states such as NY, Illinois, etc that come to south states such as FL, Arizona, Texas), these are the people likely to have their vaccine given by their doctors in NJ and then spend 6 months down in florida where they get hospitalized... now you have the FL doctor in charge of tracking who gave the vaccine in NJ to decide whether this patient gets intubated? Dude, it is a logistic neightmare. If you are comfortable doing this sort of resource control and distribution, don't make it so complicated, just mandate the stupid vaccine and cut the middle man.

The IIS DBs do account for those people who vaccinate in a different state, again, I know this because of my job.

The CDC website also mentions the IISs are individualized:

https://www.cdc.gov/vaccines/covid-19/r ... stems.html

[XogGyux]

The IIS DBs do account for those people who vaccinate in a different state, again, I know this because of my job.

The CDC website also mentions the IISs are individualized:

https://www.cdc.gov/vaccines/covid-19/r ... stems.html

Where can I go to check my own personal status, I want to try it out.
I am not trying to be fastidious or contrarian, if there is a system I can use to check my patient's status I really want to know as I do care about proper documentation. Not that I would consider at any point giving subpart care based on this, OBVIOUSLY.

[wat0n]

Where can I go to check my own personal status, I want to try it out.
I am not trying to be fastidious or contrarian, if there is a system I can use to check my patient's status I really want to know as I do care about proper documentation. Not that I would consider at any point giving subpart care based on this, OBVIOUSLY.

Contact your state - they are the ones who keep the individualized records.

[Crantag]

Then you tell me how do they keep track of the vaccination rate if they don't keep other records.

Again, I use this data for my job.

I largely plead ignorance, except on the basis of experience.

What @XogGyux has presented makes a lot of sense.

And from experience, I am pretty sure there is no kind of central record keeping at all. As Xog explained.

For example, one time when I got injured at work and I had to go get a tetanus shot, it was all self reporting as far as 'when did you last have a tetanus shot?'

But, Xog has explained it pretty thoroughly, and I believe his account to have been correct.

[XogGyux]

Contact your state - they are the ones who keep the individualized records.

Isn't this the whole point? We have two people talking about the subject, apparently, you work in something related to IT and/or epidemiology, I work in the healthcare system, how come neither of us seem to know the exact same place where we can obtain such information if it exists?
Bureaucracy, disinformation, you name, but there is definitely quite a bit of friction to obtain such info. As I said before, we simply take the patient's word for it. That's all.

[wat0n]

Isn't this the whole point? We have two people talking about the subject, apparently, you work in something related to IT and/or epidemiology, I work in the healthcare system, how come neither of us seem to know the exact same place where we can obtain such information if it exists?
Bureaucracy, disinformation, you name, but there is definitely quite a bit of friction to obtain such info. As I said before, we simply take the patient's word for it. That's all.

It's part of the decentralized nature of American data collection. But the website I posted earlier does have the contact info for the states - the IISs are the same for both children and adults.

A different issue is if providers don't log the info with the IISs or some other CDC data source (the IIS is the main one, but there are others for COVID vaccination). But if they don't, how can they manage the two Pfizer-BioNTech and ModeRNA doses? The second ones needs to be given in a specific timeframe...

You know what the real obstacle would be here? Privacy laws, as it's illegal to share individualized healthcare records without the explicit consent of of the person involved. This is a federal law, so a policy like that from the OP would need to be defined at that level, i.e the Congressional level.

[XogGyux]

But if they don't, how can they manage the two Pfizer-BioNTech and ModeRNA doses? The second ones needs to be given in a specific timeframe...

At a local level it is easier to manage this. For instance, you come to my clinic, I place the first vaccine and tell you to come X amount of days into the future and give you an appointment for that. Your card has today's date, you bring it next time around and finally you are fully vaccinated. However, what happens if you get admitted to the hospital? The hospital does not have access to my clinic's EMAR. So even if I clearly documented it on my clinic, the hospital will not know automatically. They can request the information, they can ask the patient to sign a records release form, they can fax it to me, I'll print my patient's records, fax it to the hospital. As you can imagine, this does not happen very often. I am disgusted at the way electronic medical records information sharing works in the US on the 21st century and I suspect a great deal of what we spend on healthcare could be avoided by simply having this information being shared more easily with a system worthy of the year 2021.
That being said, the reality is that unless there is some sort of compulsory mandate to log the information and/or to retrieve it... chances are shit is going to fall through the cracks. If I don't know of the system and/or don't have a compelling reason to use it... i'll simply go with what my patient is telling me.

[wat0n]

At a local level it is easier to manage this. For instance, you come to my clinic, I place the first vaccine and tell you to come X amount of days into the future and give you an appointment for that. Your card has today's date, you bring it next time around and finally you are fully vaccinated. However, what happens if you get admitted to the hospital? The hospital does not have access to my clinic's EMAR. So even if I clearly documented it on my clinic, the hospital will not know automatically. They can request the information, they can ask the patient to sign a records release form, they can fax it to me, I'll print my patient's records, fax it to the hospital. As you can imagine, this does not happen very often. I am disgusted at the way electronic medical records information sharing works in the US on the 21st century and I suspect a great deal of what we spend on healthcare could be avoided by simply having this information being shared more easily with a system worthy of the year 2021.
That being said, the reality is that unless there is some sort of compulsory mandate to log the information and/or to retrieve it... chances are shit is going to fall through the cracks. If I don't know of the system and/or don't have a compelling reason to use it... i'll simply go with what my patient is telling me.

It's not just a matter of managing the dosage locally, as the CDC keeps track of both people who are partially vaccinated and those who are done with the schedule - which makes sense, for the most part. It's definitely relevant for the epidemiologists, and works for other inputs (again, I won't elaborate further as this begins to get closer to what I work on. I don't work at the CDC, by the way).

[Deutschmania]

I think that this article I just now read gives a good comprehensive , yet concise coverage of the issue .

Dr. Jason Valentine, a family medicine physician at the Diagnostic and Medical Clinic Infirmary Health in Mobile, Alabama, informed his patients this month that, effective Oct. 1, he would no longer treat those who hadn’t been vaccinated against Covid-19. Around the same time, a leaked memo indicated that the North Texas Mass Critical Care Guideline Task Force was considering whether to take Covid vaccination status into account in deciding who gets ICU beds when more of them are needed than are available.

Can either of these actions be considered ethical? In short, it depends. Determining when it’s ethical for doctors and hospitals to refuse to provide their services, including considering whether a patient has adhered to public health precautions, such as vaccination, rests on the intentions of those turning people away and whether their decisions are consistent with professional norms and established practices.

It would be unethical if a doctor were to refuse treatment because of anger, resentment or frustration, including over a patient’s decision not to get vaccinated. Doctors, and health care professionals more broadly, are bound by moral obligations to prevent illness and restore health for anyone without regard to certain objections they may have about them. These obligations stem from the foundations of medicine established since antiquity, current social structures supporting the health professions and cultural expectations that demand that everyone have equal access to health care without prejudice. Thus, anger and frustration with people whose actions, even if they’re potentially provocative, don’t themselves prevent a doctor from providing effective treatment in a safe environment don’t make refusing services ethical. ovid vaccine refusers are turned away at hospitals and doctor offices, is that ethical?

If Covid vaccine refusers are turned away at hospitals and doctor offices, is that ethical?


It would be unethical if a doctor were to refuse treatment because of anger, resentment or frustration, including over a patient’s decision not to get vaccinated.

Determining when it’s ethical for doctors and hospitals to refuse to provide their services, including considering whether a patient has adhered to public health precautions, such as vaccination, rests on the intentions of those turning people away and whether their decisions are consistent with professional norms and established practices.

It would be unethical if a doctor were to refuse treatment because of anger, resentment or frustration, including over a patient’s decision not to get vaccinated. Doctors, and health care professionals more broadly, are bound by moral obligations to prevent illness and restore health for anyone without regard to certain objections they may have about them.

These obligations stem from the foundations of medicine established since antiquity, current social structures supporting the health professions and cultural expectations that demand that everyone have equal access to health care without prejudice. Thus, anger and frustration with people whose actions, even if they’re potentially provocative, don’t themselves prevent a doctor from providing effective treatment in a safe environment don’t make refusing services ethical.

But when actions that cause anger and frustration do interfere with doctors’ ability to meet their obligations to provide safe and effective treatment, refusing services can be ethical. For example, taking vaccination status into account is ethical when it’s intended to protect health care staff members and patients and to select patients for scarce ICU beds who have the best chances for survival.

Valentine’s explanation for what he’s doing, while perhaps understandable, isn’t defensible from an ethical point of view. According to news reports about a Facebook post he made, he said he decided not to treat unvaccinated patients because “Covid is a miserable way to die and I can’t watch them die like that.” While his reasoning expresses compassion, it seems to have more to do with sparing himself emotional pain than with protecting patients and staff members from infection. (NBC News hasn’t verified the authenticity of the post. Neither Valentine nor representatives at the medical clinic where he works provided comment.)

The North Texas task force’s consideration, however, is on sounder ethical grounds. The memo says the expectation of better outcomes in vaccinated patients is a reason to consider vaccination status in allocating ICU beds. As a general principle of medical ethics, when there’s not enough of something for every patient in need, those who are most likely to survive and live the longest are generally given higher priority.

Furthermore, the task force explicitly implores its member hospitals not to consider anger and frustration in their decisions. One can argue about how important vaccination is to better outcomes for those who need ICU care, as we are still learning about how vaccines and Covid work. But to the extent that hospitals believe it can be helpful, prioritizing vaccinated people for UCU beds is ethically plausible. (After the memo was reported in The Dallas Morning News, its author reversed course and said vaccination status shouldn’t be a factor in assigning ICU beds.)
There is also a broader question about what physicians can do to encourage vaccinations in the first place and specifically how threats to refuse service come into play. Encouraging vaccination as a condition to keep unvaccinated patients might seem ethical on its face, but it is easily revealed as coercive. However, when such inducement is made to protect family members of the unvaccinated, other patients, schoolmates and office staff members from Covid infection, it can meet ethical requirements, because it’s being done to prevent illness for others.

Still, physician practices can’t ethically refuse to treat their unvaccinated patients to protect their patients and staff members if they can create safe environments and implement supporting procedures. When this isn’t possible, practices must give their patients adequate notice of any change in policy and help them make the transition to other practices. Valentine did precisely that. Before physician practices give this notice, however, they must be sure they have made good-faith efforts to persuade the recalcitrant to get vaccinated, and they must ensure they can’t reasonably accommodate a small number of patients who can’t or shouldn’t be vaccinated for justifiable reasons, such as earlier severe vaccine reactions or ongoing cancer treatment.

Hospitals making ICU bed allocations don’t have as much room for mitigation. And if all else is equal between two patients who need one available ICU bed except for their Covid vaccination statuses and if vaccination is known to determine better outcomes, then vaccine status could be a reasonable factor in allocation decisions. But rarely is all else equal. In acute clinical situations that permit no time for investigations, a legitimate reason for a patient not to be vaccinated against Covid can be difficult to discern. That could be reason enough to disregard it as a factor in ICU bed allocation. No laws prevent physicians like Valentine from excluding unvaccinated patients from their practices. In fact, medical professionals have long dismissed patients, and they have established policies and procedures. These set out expectations about how to dismiss patients so they aren’t abandoned and left in precarious situations. For example, the American Academy of Family Physicians procedures and communication templates to facilitate justifiable and safe dismissals.A 2016 survey of 794 primary care practices found that nearly half of them had dismissed patients for not following treatment plans.

Pediatricians, reacting to the acceleration of anti-vaccination campaigns during the last decade, have become particularly accustomed to dismissing families that refuse vaccinations, often over concerns about the preventable spread of infections in their facilities. A 2019 survey of 303 pediatric practices showed that about half of them adopted management policies permitting the dismissal of families that refuse routine childhood vaccinations. The survey also reported that 18 percent of parents who refuse vaccinations often or always changed their minds and agreed to be vaccinated. Half sometimes did . ICU beds have been sufficiently scarce over the years that triage and allocation methods have long been in place. What’s new here is the science of Covid vaccinations themselves and whether vaccination status contributes enough to outcomes to allocate ICU beds based on it.

We know that ICUs or private practices that ethically turn people away must be motivated by the right intentions, applied with comprehensive and safe management protocols, implemented in good faith with an eye toward the best science and conveyed with compassion toward patients and families.

https://www.nbcnews.com/think/opinion/if-covid-vaccine-refusers-are-turned-away-hospitals-doctor-offices-ncna1277475 That just about sums up the issue , as far as I can tell .