actorartathleteauthorbizcrimecrosspostcustomerservicedirectoredufoodgaminghealthjournalistmedicalmilmodpostmunimusicnewsworthynonprofitotherphilpolretailscispecialisedspecializedtechtourismtravelunique

ScienceI am Rebecca Goldin, mathematician and the director of STATS.org, here to talk about statistics in the media!

Nov 21st 2016 by RebeccaGoldin • 21 Questions • 314 Points

I'm a 26 year old woman with about three years of experience working as a registered nurse. I started off working on a medical/surgical unit and then got a job in the emergency room and have been doing that for about a year and a half.

My Proof: http://tinypic.com/r/wumc7r/9

Q:

Hello Dr. Goldin, former student of yours here. Cool to see you doing an AMA on Reddit!

My question is: how can we improve the polling accuracy for elections? Days before the most recent presidential election, NYT had Hillary winning with 90% likelihood. Only one or two major news networks come to mind that predicted Trump's victory. What are the major shortcomings that led to this huge difference in expectations and reality?

A:

My boyfriend used to work in the ER as a scribe before he started medical school. He swore that on nights there was a full moon, weird things would happen. People would, for some reason, be more aggressive/emotional than usual, leading to strange or violent injuries. There was such a correlation, people (doctors, nurses, staff alike) would mark the date of the full moon on the calendar just so they weren't blindsided by an especially busy night. He always tried to get that day off, but of course, it wasn't always up to him.

My aunt, who's also an ER nurse in a different city, apparently swears the same thing. My mom's best friend, another ER nurse in another city, has also been remembered to say the same thing.

Have you noticed any correlation?


Q:

Fantastic question! Lots of people are opining on this one. One issue is the question of who pollsters were speaking with. Trump referred to "dirty polls" and made other disparaging remarks of polling, and polls were often linked to media (also disparaged). Perhaps some supporters didn't want to speak to pollsters. If we know how big this effect is, it can be corrected for... but it might have been a new wrench in the process.

A:

Yup! It's actually a really common superstition. I think it's probably all in our heads, but I swear we have the craziest patients, especially psych patients on full moons!


Q:

I read this novel about statistics and found it really digestible and interesting. If you read it you will basically understand how a normal distribution works, which makes you more knowledgeable about stats than 95% of the world.

https://www.amazon.com/Drunkards-Walk-Randomness-Rules-Lives/dp/0307275175

Also this book is probably the most famous "pop stats" book ever written. People reference the book and its author all the time in basically every quantitative field.

https://www.amazon.com/Visual-Display-Quantitative-Information/dp/1930824130

A:

Oh man, I'm an ED nurse and I would never go back to the floor. On the floor, if you get a fucking asshole patient, they are yours for 12 hours, and they will probably be there when you come back tomorrow too. Multiple doctors round and put in new orders all day, multiple meals, accuchecks, bed changes, baths, med pass for all of your patients scheduled at the same time and they all have 15 meds each. Oh, and did you need something? Have fun paging the doctor 20 times while your patient yells at you for not having the order yet. In the ED, you have that patient for maybe 4 hours. They can't eat or drink until testing is done and then you can throw them the one sandwich you have in stock if they want it. Don't like it, they can order once they get upstairs or get their own food when they leave. No bathing, limited toileting. You get your patient, you assess, draw blood, monitor, and provide meds as needed, then send them on their way. It's great.


Q:

Perhaps our brains are hardwired to believe there's a reason behind everything -- and we jump to the most obvious conclusions. You may enjoy this site with a lot of spurious relationships.

A:

100% agree. I don't think I could EVER go back to the floor. The only other area I could see myself in would be trauma ICU, but even that I'm not sure if I'd really enjoy as much as ED.


Q:

Hi Dr. Goldin, thanks for doing this. Let me preface this by saying I am not a conspiracy theorist in any way, and I am a professional statistician. My question is - given how widely all of the polls from the weeks leading up to the election were projecting Hillary to win, and how completely wrong all of them were, is there something to Trump's accusations that the polls were in fact "rigged"? It seems improbable to me that so many pollsters could be so completely wrong, in such a way that systematically favored one candidate over another, by pure chance. Thanks!

A:

How was work this week?


Q:

Systematic bias could definitely create the outcome we saw. Systematic bias would include anything that unexpectedly favored recording the opinions of Clinton supporters over Trump supporters.

Another factor may have been the estimates about who would actually vote. Pollsters had to predict who would actually show up to vote. If they (as a whole) over-estimated the likelihood of Clinton supporters voting, and under-estimated the likelihood of Trump supporters, we would also see this effect!

Finally, another contributing factor pertains to when people made their decisions. Earlier on in the election cycle, people who didn't like either candidate stated that they would not vote. Perhaps more of these people decided to vote, and vote for Trump, than expected.

A:

I worked an extra shift this week (I usually only work three 12 hour shifts a week) for overtime pay so I'm pretty exhausted. I work again tonight (I do night shift, 7pm-7am) and this will be my 5th night in a row. I try to do all my days in a row if I can get back on a normal sleep schedule during my days off.

It was pretty busy on and off the last couple of days. Saw a ton of sick kids and my first flu + patient of the season. We also had a lot of high acuity (sicker) patients.


Q:

When statistics are abused as you say or misconstrued do you think that's generally intentional or accidental?

A:

Are there any situations that you see on a regular basis that just make you want to say "oh no. Not another one"?


Q:

Well, it depends! Over the years, my sensitivity to this issue has introduced some additional nuance. Sometimes people believe something, so they cite statistics to support this view. At times, they abuse statistics, but it's hard to ascribe it as intentional or accidental. It may be accidental because it fits with an intentional belief system. This happens particularly with heated topics that really get people riled up.

But I believe most journalists are honest, and that their misconceptions (and abuse) are truly accidental. Learning math and statistics are huge investments; if you have limited time, you try to wrap your head around the piece of it you need, or try to express a concept in your own words, and it doesn't come out right. A lot of times, journalists don't have the time or expertise to wrap their heads around the big picture, so they just leave out important aspects or caveats that come from the statistics that they are using.

But I will say that many media sources are motivated not to dig deeper, because the story is better without doing so. This happens especially when media suggest that one thing causes another, "as explained in a recent study".

A:

Oh yeah, most definitely. One of the most annoying things I see is that soooo many patients treat the ED like a clinic, coming in for very minor issues that could easily be handled at an urgent care or could wait until a patient sees their primary care provider. It congests the whole department, drastically increases wait times, and makes it much harder for patients with true emergencies to be seen. What bothers me even more is when these patients fail to understand that they are NOT an emergency, and thus will have it WAIT. People refuse to understand when a sick patient is taken from the waiting room to a room before they are. I try to explain to these individuals that the ED does not work on a first-come-first-serve basis, and that the sickest patients are seen FIRST. I can't count the number of times people have yelled at me, cussed me out, or became aggressive due to the wait time - I work in a VERY busy ER. It's the most frustrating thing ever when people who aren't even that sick have such a sense of entitlement and don't give a fuck if someone else is dying and needs medical attention BEFORE them.


Q:

I am taking statistics online right now, how much would you charge to do my homework for me?

A:

Have you ever seen anything which was too gross for you to handle?


Q:

I'll give you a binomial distribution with p=0.0.

A:

I don't really have a choice to not do anything "gross". I really hate working with sputum and respiratory secretions but I have to suck it up and do it anyways. I usually just put on a mask/face shield if it really grosses me out. I once had to put a nasogastric tube (feeding tube that goes from the nose to the stomach) in a patient who had a small bowel obstruction. He had basically been puking up fecal matter and blood because of the blockage. The smell was probably the most disgusting thing I've ever smelled. He had also vomited all over himself and the ground. But I still had to do it anyways :(


Q:

What's your opinion on graphs in media that don't start at 0?

A:

How difficult is it to get a job in nursing?


Q:

Context is everything! You may have seen this video put out by Vox. It has some good material in it, though title is a little lacking :)

They point out that if you're graphing your temperature every day throughout the month, it would be hard to see any variation if you included a temperature-axis that starts at 0. The tiny changes from 98.6 to 101.2 would barely be visible! And of course it would be even worse if you graphed it on the Kelvin scale.

If context suggests not starting at 0, provided that the vertical axis exists and has clear labels, I am ok with that! The real issue is not to choose the units to make a point that is somehow misleading, such as suggesting huge changes when they are actually really small.

A:

As you probably know, there's a significant nursing shortage which is only projected to worsen in the near future. It's quite easy to find a job if you have nursing experience already. It's tough for newly graduated RNs out of school to find a job because it's REALLY expensive for hospitals to train brand new nurses and they pose a liability risk to the hospital since they are so inexperienced. Most hospitals have new graduate RN programs with several months of extensive orientation. It makes it even more difficult if you have an associate's degree rather than a bachelor's because there is a huge push for bachelor's to be the entry level degree for RNs even though RNs with associate's and bachelor's practice under the exact same scope of care and can do the exact same job.


Q:

How do we solve the problem of scientists falsifying their research results to make the data support what they're trying to prove in order to get funded for more research?

A:

Would having personal experience help? I had a daughter who had a brain tumor that ended up making it necessary for her to have a trach, gtube, and ventilator. She had episodes of respiratory failure when she got upset and needed to be bagged by whoever was with her which was almost always me, on top of the regular trach care and tube feeding and whatnot. I was basically her nurse for 3 years without actually going to school. Now the next logical thing seems to be nursing school since I already have so much experience. I know that experience will help me in school because she was such a complex patient but I've wondered if it'll matter when I need to find a job once I'm done.


Q:

I believe only a small proportion of scientists are actually falsifying research results -- and there are some cheaters in every profession that exists.

More generally, it would be nice if funding agencies appreciated the value of high quality work enough that it would trump large volumes of research. I'd like to see repeated, independent studies funded for high impact research. Replicability is grossly underfunded in my opinion.

A:

I'm so sorry to hear about your daughter :( I don't think it would hurt to mention your experience with your daughter, especially once you get an interview. I wouldn't go so far as to put it on your resume, since it's personal experience, but definitely mentioning it during the interview - and giving it as a reason for wanting to get into nursing - would help give you a step up above other candidates with no experience. I would DEFINITELY recommend trying to get a job as a CNA (certified nursing assistant) while you're in school though because having direct patient contact in an acute care setting makes you look much better from the perspective of the hiring manager. In my state, after you finish your first semester of nursing school, you can apply for your CNA license. Good luck!


Q:

Math major here! Do you have any advice for getting accepted into a graduate school? I am learning both SAS and R and have high grades in my undergraduate statistics classes. Any suggestions for resumé builders outside of class?

A:

If you know the show, how would you compare your view of doctors in the ER vs. the way things were portrayed on "Nurse Jackie"?


Q:

Research projects! Talk to your professors and ask how you can be involved.

A:

Out of all the "medical" shows I've seen, I think Nurse Jackie comes the closest to reality. I think that's due in part to the writers being nurses and actually working in the medical field. There are definitely still parts of the show that are unrealistic which is frustrating but it's far better than most other shows. I also have heard of some nurses who have gotten addicted to narcotics and fired after they were caught, but I heard it all second hand. It's a little bit difficult for me to compare the hospital Jackie works at to mine because All Saints is a trauma center, whereas the hospital I work for is not.


Q:

I'm not a nurse yet, and this won't answer your question, but I'm in nursing school and this type of question has come up, what do you do if you think they are drug seeking, etc. I know it has come up in the medical school too (my friends husband is a 3rd year med student at the same school as me). But across the board for my university, the answer has been to ALWAYS believe someone if they state they are in pain. If they are ordered pain meds, state they are in pain, and the order/timing is appropriate to give the med, then you can give it (unless medically contraindicated).

I'm sorry that people haven't believed you in the past, and hopefully it gets better. I like the motto of believing everyone when they say they are in pain, even if the drug seekers "get what they want" we are still helping those in pain who truly need the help.

A:

I'm not saying that if we suspect someone is seeking that we don't treat their pain. Pain is subjective so we have to assume that the patient is not lying about their pain. Narcotics are NOT always indicated. There are many other kinds of pain medications aside from narcotics that we can offer to patients as well as non-pharmacological interventions (positioning, distraction, heat/ice therapy, etc). Opiates are highly addictive and extremely over-prescribed in the US. The majority of the time, patients DON'T need narcotics to decrease their pain. It's my responsibility as a nurse to do what's in the best interest of the patient, and that includes not enabling patients who are reliant on opiates. I'm also not saying that we never give narcotics to these people. If appropriate, they will be prescribed to the patient.


Q:

Are all nurses (RNs and otherwise) always around blood? Are there jobs in nursing that don't involve giving shots and being in direct contact with patients?

A:

Yes and no. If you work in bedside nursing such as in a hospital, clinic, doctor's office, nursing home, etc. in direct patient care, then you can't avoid it. But if you work in an area such as case management, nursing informatics, or legal nursing then you don't have to work directly with patients - or if you do, then you're not physically touching them. However, 99 times out of 100, these jobs require multiple years of working as a bedside nurse and a more advanced degree before you can obtain that kind of job so that you have a solid understanding of nursing before you can work in a management-type position.


Q:

What's the funniest thing that has happened while you were on shift?

A:

I think probably some of the conversations with the drunk/intoxicated patients. We always get a kick out of messing with them/egging them on if they're really wasted (only works for the happy drunks - not so much the nasty ones). If we have someone in one of the hallway beds near the nursing station, and they're really drunk and they start talking to us we'll engage in conversation and it usually turns out to be pretty funny.


Q:

Have you ever had a patient who had something stuck up their butt?

A:

I haven't personally had a patient that has happened to. I've heard of a couple of nurses who have, but it's not very common. Though, I have had a couple of patients who've had a retained tampon or condom. It's much easier to get that out than something that is in the rectum! All the MD has to do it use a vaginal speculum and take out the object.


Q:

I work registration in the ED and there are actually a good amount of people who come in with stuff stuck up their butt. Usually its a vibrator, but we've also seen shampoo bottle caps, a hairspray cap, a plant stand leg...

A:

Jeez, I guess I lucked out that it doesn't happen at my ED too often!


Q:

Do you feel like your hospital has adequate equipment for lifting heavy patients?

Have any of your colleagues suffered back injuries?

A:

It's actually funny that you mentioned that, because last night one of my coworkers had a patient who ended up falling because she was morbidly obese (500 lbs) and tried to get up to walk to the bathroom (said she did it at home) and slid down the side of the bed. It took about 8 full grown men to get her back up on the bed. We can get bariatric beds from other parts of the hospital, but they're hard to come by. We also don't have any special equipment in the ED to lift big patients (such as hoyer lifts). After that, pretty much everyone who'd been helping out in that room came out sweating. And yeah I know tons of nurses who complain about back pain, including myself and I'm only in my mid 20s. Thankfully it's nothing serious (I've had an xray done and it was fine) but I worry about it worsening in the future.


Q:

I work at a hospital, too.

-Do you use epic? If so.. -Do you sit on your phone all day now that you have epic and let your pca do your work?

A:

The hospital I worked at previously when I did med/surg had Epic and I really liked it. I use Cerner (Firstnet in the ED) now and don't like it as much.


Q:

As an EMT, how much of our pt. report do you actually care about? And what extra could be be providing you that we aren't providing?

A:

It depends on how acute they are. If they're not that serious I can get most of the information I need from the triage info/chart and I'm gonna be talking to the patient anyway so just a chief complaint/any super pertinent info is good. If it's a patient coming from a NH or ALF, I can get history and meds, etc from the paperwork. I'm mostly interested in knowing the story, onset of symptoms, mental status at time of arrival vs baseline, meds given in the ambo, if they have a line established, and medical history pertinent to the chief complaint. I also wanna know if family's coming or has been contacting (if coming from NH).


Q:

As a foreigner: is it really like in movies, that patients are rejected is they don't have insurance?

A:

No. There's a law in the US called EMTALA that requires patients to be taken care of in an emergency setting regardless of insurance status. A good chunk of the patient population where I work is uninsured and many are undocumented immigrants.


Q:

Wow! I want to start off by saying thank you for all that you do! My question does not pertain to your experience working as an RN, but to your journey becoming one. I've taken 2 years of classes preparing for nursing school, but now I can't seem to find the motivation to actually apply. I spent two years as a hospice aide, and I loved the work, but I also realize there's no way I can do this forever. Are the applications as scary as I think they are?

A:

Thank you! I appreciate you saying that. I think you are already a step in the right direction by having experience in health care working with patients. I'm not gonna lie, nursing school is tough and it's a lot of work. I absolutely hated it and many times questioned if wanted to continue to pursue nursing. I'm so glad that I continued though because now I absolutely love it and find it so rewarding. I really feel like I am making an impact and putting some good karma into the world.

Getting into nursing school isn't really the hard part. There are tons of programs out there and I'm sure you'll be able to get into one if you have decent grades and ambition. You just have to make nursing school a priority and really work hard. I'm sure you'll be fine :) Good luck!!!


Q:

Why is it that trips to the emergency room always end with me getting a fist full on OxyContin?

A:

I dunno, are you asking for oxy?


Q:

Do you currently have a dedicated pharmacist in the er? Whether you do or not, what are your thoughts on having one?

A:

We do, but only from about 1pm-2am which tends to be the busiest time. We have two awesome ED unit pharmacists so I really love it when they're there. I can ask them if I have questions about any of the meds I'm giving or if I have a med to give that needs to be mixed or if I need something from main pharmacy, they will go grab it for me so I don't have to wait for it to be tubed. They also pull meds during our codes. I just wish we had someone 24/7.


Q:

How often do people come in with things stuck in their asses? What's the weirdest thing you've ever witnessed or heard of being pulled out of an ass?

A:

I already answered this question above