Reading this, my takeaway was less about the pump and more about how every part of the medical system is disconnected from every other part.

There were some mistakes made but they were all pretty reasonable decisions. But the situation that caused this in order:

1. The support line for the pump won't suggest sending it to where you are because you say you have a backup plan.

2. The support line also isn't a doctor; they can't evaluate how good or bad your backup plan is, just how to deal with the pump.

3. You message your GP. But the message system doesn't connect you live to the on-call practitioner; that's a phone number that is not easily findable.

4. Your GP fills a prescription for the backup pen and sends it to the closest pharmacy.

5. The pharmacy takes the prescription, but they don't actually know if they can fill it until later. They also can't find a pharmacy farther than 25 miles away from the current location.

Each issue is reasonable by itself, but the end result is that the patient had to call 2 different people, go to a pharmacy, and still wasn't able to get what they needed. The gaps that could have (theoretically) been patched are:

1. Support could have known the possible workarounds. I realize that legally it could have been dicey, but the "fix" suggested on Reddit seems like something that could have been mentioned as an interim solution.

2. Your GP could make it more obvious which communication method reaches the office on a weekend.

3. The GP should be able to talk to the pharmacy to ensure they have the medication in the prescription.

4. The pharmacy should be able to search farther than 25 miles to find a medication for a prescription they've been sent.

It should be much more difficult for a patient to hit every edge case like this, especially when just being able to talk to each other would have stopped some of these.

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cperciva 2 minutes ago | parent | next [-]

One issue here which is obvious to me is that access to insulin should not be gated on paperwork. I can walk into any pharmacy in Canada and say "I'm diabetic and need insulin" and the pharmacist will sell it to me. They'll ask questions of course since this is not the usual path but my doctor's office being open will have no influence on whether I get it -- just on whether it's a 5 minute process or a 15 minute process, and potentially whether I have to pay myself or have it covered by insurance.

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bonyt 4 hours ago | parent | prev | next [-]

> Each issue is reasonable by itself...

The problem of many hands - when responsibilities in a group that collectively does harm are divided between many people, who can be held accountable when each person individually acted reasonably?

I think organizations are, more and more, siloing roles in this way intentionally (or at least emergently), such that blame can only ever be collective if they do harm. Since it's so much harder to redress collective blame, this can be effective in avoiding consequence entirely.

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jerf an hour ago | parent | next [-]

I think it's mostly emergent. I can even point to a plausible mechanism, which is that if you think of an organization as a network of people and how they are connected together, you can think of "responsibility" as something that arcs through an organization like electricity and burns out whatever it courses through, prompting the creation of alternatives to avoid getting zapped the same way in the future.

It isn't completely inevitable, I think it's possible for relatively strong leadership to understand that the processing of responsibility through an organization is a necessary feature and people handling it without external forces conspiring to make it even more like that it will "burn out" a part of the org is a necessity and a good thing. But it's really easy for an organization to just default to burning out the path and evolving ways to avoid it in the future, and it is very motivated to make it happen.

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testaccount28 4 hours ago | parent | prev | next [-]

the correct answer here is that they are all accountable. there is not some fixed quantity of blame to divvy up: each malfunctioning leg is responsible for the outcome.

	▲	close04 3 hours ago \| parent [-]
		They all contribute but they can’t all have the same degree of accountability.

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cucumber3732842 33 minutes ago | parent | prev | next [-]

>The problem of many hands - when responsibilities in a group that collectively does harm are divided between many people, who can be held accountable when each person individually acted reasonably?

"You can't justify hanging us all from the overpass" is the magic of the system.

And not just the medical system.

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s1artibartfast an hour ago | parent | prev [-]

Liability laws incentives play a big part. Good faith effort and patient care increase the surface are for attack.

	▲	FireBeyond 20 minutes ago \| parent [-]
		Potentially. However, depending on the nature of the interaction, abandonment is equally a concern for a provider. If I'm treating or begin care of a hypoglycemic patient (and I'm not saying that in this case, such a thing has happened), then legally, I can be found guilty of abandonment if I don't transfer care to a higher level provider or conclude the course of treatment or intervention planned. I can't just say "I can't do anything for you, you're on your own."

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throwaway173738 4 hours ago | parent | prev [-]

The pump manufacturer is at fault a few different ways. They have a responsibility to make pumps that don’t break, and they should probably issue a recall. They shouldn’t rely on the availability of a product they don’t supply as a backup unless they can guarantee somehow that the patient always has access. Their staff should ask where you want the thing shipped to and include options like receiving the replacement at a Fedex or UPS location. Their staff should be trained to ask “are you traveling or otherwise away from your home address?” And finally they should train staff on follow-up questions for a patient’s plan and confirm the patient has enough insulin on-hand to cover executing the plan.

	▲	s1artibartfast 3 hours ago \| parent [-]
		Why is any of that their responsibility? Their staff did ask if they would be fine without the new pump and op said yes. They were fine. They could have gone to a hospital. They could have gone to Walmart and bought some insulin syringes for their supply