what will Dr. Big Work Up do?*

Oh my.....now here's an interesting development (straight from whitecoats blog), it seems JCAHO is proposing a national patient safety goal around overuse of procedures, tests and treatments. Will wonders never cease? Here's the link.

National patient safety goals are things like patient indentification, preventing medical errors, preventing mistakes in surgery. Hospitals have to comply with JCAHO regulations or risk losing accredidation and with it money.
That's why months of preparation go into JCAHO visits to prep the staff to parrot what the surveyors want to hear.

Personally, I think this is great. Hospitals and doctors refuse to stop ordering all these ridiculous, unnecessary tests on people, so apparently the government has to step in and do it. And guess what they don't give a rats ass about all the unfounded fears about liability.

Medical malpractice lawsuits are a real concern for doctors, nobody doubts that but the concern are blown way out of proportion. It is used as an excuse to order all of these tests which bumps up the level of care and puts more money into the hospital and doctors pockets.

What is so fascinating are some of the examples they give which are major areas of profit for hospitals:

1) the myriad of CT abdomens that are unnecessary and could probably be replaced by an ultrasound.
2) Doing angioplasties and stents on people with less than 40% blockage. (How about doing CT angios on every Tom, Dick and Harry that walks in with chest pain?)
3) Inducing labor in women who are less than 39 weeks.

Oh, I just can't wait to see how this all turns out. At the very least, it should start a necessary discussion around overtreatment. That's an accomplishment in and of itself.

*hi nurse k

nurses are not superheroes

Medicine is changing. Hospitals are changing. It has become about business, money. There is no choice in the matter. Its reality.

There is so much emphasis on patient care satisfaction. On standardization of everything across the corporation. More and more complex procedures and polciies are evolving. Lost in all of this is the nurse.

I really wonder if there are other jobs that change as rapidly as nursing. It is constant, overwhelming change. Change it is hard to keep up with. I've given up trying to keep up with it. I try to remember the important stuff and ignore the rest.

Nursing has become a complex job with increasing complex technology and procedures. Nurses handle patients with LVADs, ECMO, hypothermia treatment to name a few. People are being kept alive today that never would have had a chance even ten years ago. Who is keeping them alive? Nurses.

With the emphasis on patient satisfaction, we are expected to handle a diversity of patients with all their perisonality disorders and neuroses with a smile on our face. When it comes down to it, we are expected to be superhuman.

With all the rapid change, emphasis on the bottom line, patient satisfaction - no attention is given to employee satisfaction. We are just expected to grind it out and be happy about it. The thing that is missing in all of this change in medicine is the lack of caring about the employee. What all of these hospitals fail to understand is that if the employees aren't happy, the patients won't be happy. The lack of understanding of that will be their downfall.

they'll eat you alive

Have you ever heard of the term "1,000 yard stare". It is sometimes used to describe combat soldiers who have seen too much, are always on alert and just trying to make it through til they go home. Well I think I am developing the ER version of this and its called the "1,000 yard scowl".

When I cross the line into the triage area, I feel a change come over my body and a sneer or scowl start to involuntarily take shape on my face. I try to stop it but it won't go away. I am defenseless against it. There is something about triage that just brings out the beast in me. I sit at the window and have the attitude of "go ahead, make my day"...sometimes I put a battery on my shoulder and dare people to knock it off..(anybody remember that commercial?)

I think deep down inside I am trying to scare people off. But I'll tell ya the people who present at the triage window are not easily scared away. You could be slumped over on the desk, gasping for air and they would still say "I wanna see a doctor". You can have a phone in each ear, a patient in both bays, one in a wheelchair, an ambulance stretcher whizzing by and a line ten people long....but still " hey you I wanna see a doctor...".

Those people at the triage windows are survivors. They won't take no for an answer. They are like the mailman - through rain or snow or sleet or hail nothing will stop me from telling my tale....and no matter how many times you say things like "weren't you just here last week?", "what's going on today Bob?" or when you're having a bad day "you're back again?",they will keep coming back.

If there was a nuclear bomb dropped on the city, like the cockroach they would survive and present in the same whiny voice: "I wanna see a doctor". Triage is like combat. You never know when there will be a surprise attack, you always have to be alert, wary...keep your guard up. If you let it down, they will surround you and eat you alive...they're just waiting for a sign of weakness...(Ok I'm getting carried away...).

I think its time for me to resurrect another symbol that we share with the combat soldier: the short timers calendar. Everyday I'll cross out a day that will bring me one step closer to retirement...

have a politically correct holiday season*

Fa la la la la lalalalalalala. It's that magical time of year when people frolic through the streets on their way to buy presents...even the hospital and the ER get festive when corporate puts up the generic holiday season display. It is the same throughout the hospital. Brown and gold. Regulation decorations. Politically correct decorations. Don't want to offend any non-Christmas celebratin' folk.

There will be NO traditional holiday colors. There will be NO individual department holiday decorations. EVERYONE will tow the corporate holiday season political line and smile while they are doing it OR ELSE.

Here's an example of the official approved holiday decoration: All lights will be white. NO EXCEPTIONS. Santa will not be making an appearance. There will be no carollers singing "inappropriate songs" espousing a particular religious view point. Any clothing displaying festive holiday decor are banned, along with pins, earrings, necklaces. Every area will be assigned a holiday watch person to catch any infractions of the official corporate holiday policy.

Oh yeah! I love the holidays. Time to throw in my guess for how many bulbs will be left on the "holiday" tree in the waiting room at the end of this holiday season. I understand there is a great prize for the correct guess this year....

*look closely at the picture to see what santa and mrs claus are looking at outside their window

STOP THE PRESSES!! FIBROMYALGIA BREAKTHROUGH!!

NEWS FLASH!! ATTENTION ALL HEALTH CARE WORKERS!!

In breaking news from the United States Department of Fibromyalogy, fibromyalogists (a new sub speciality) have after months of research discovered that it is possible to have fibromyalgia in just one part of the body.

Yes, we all thought that this was a general body disorder and that is true, however, apparently it can also concentrate itself in say the back, neck, abdomen. I recently had a woman tell me that her doctor told her she had fibromyalgia in her abdomen since he/she could figure out no other source of her chronic pain. And get this, apparently the doctor said this with a straight face...

What an advance in science. Now all of those chronic back pain, neck pain and all other areas of pain suffering folks can finally have a fancy new diagnosis that will finally legitimize their ER and doctor visits. What an "I TOLD YOU SO" moment for them.

The makers of Lyrica must be shouting "HOORAY!!" I wonder if I can get disability for my intermittent low back pain that happens after a busy shift...