Wednesday, November 09, 2011

JCAHO the Pusher

Yeah JCAHO, that's you he's singing about. Dumbass bunch of paper pushing clowns. Here is a JAMA bit that is so vague I can't tell if it is tongue in cheek or not, but let's see if we can draw any conclusions from the JCAHO mandate to 'adequately treat pain'.

What has been the impact of this policy from the very awesomely smart, still clinically practicing, doctor-geniuses at the JC (which has been de rigeur for over a decade now)?

Well, there's the idea that by asking someone if they are in pain and by putting their answer on a graph that we have done science and/ or medicine. This idea has been soundly debunked, but it does not keep ER doctors from getting called on the carpet by dirtball narcotic seekers who don't get their oxys when they hit their third ER of the day. I should know, I've been called on the very carpet I speak of, and a collegue lost his job because of too many of these complaints. So go have carnal knowledge of yourself, JCAHO.

Besides that, well, there's this, and this, and this  I'm no detective, but I think, in that last link, that what they are discussing is illegal, and I can't believe there would be many who would do that, can you?

And I understand correlation does not prove causation, but I do know that if I tell a patient, 'no, I am not refilling or supplying you with narcotics', that, depending on how "JCAHO" the administration is, that my job is at risk.

So, once again, screw off JCAHO, you are pushers and hacks and you have blood all over your hands. You should consult your handy 'guidelines for blood-spills' laminated card. It will probably keep you out of hell. I mean, I would like to see you present it in an effort to stay out of hell.... would pay a lot of money to see that.


  1. Palliative Care Doc5:51 AM, November 10, 2011

    What many docs in my town don't realize is that while a physician is obligated to address pain issues, that doesn't necessarily mean that you have to do what the patient wants. As long as you document that you feel PT/muscle relaxers/aromatherapy/etc. would be effective in that particular situation, you have addressed the pain. I get consults for pain mgmt from the ED frequently. In my case, we have a great many Osteopathic physicians at our hospital, and even have a consult service, so instead of doling out narcotics, I address these complaints with OMT. I have found fewer repeat customers coming to the ED, because they are learning that the ED doc will consult me, and I will consult for OMT, and they will be sent out with a recommendation to visit their primary/pain mgmt physician. Do the patients leave pissed? Yep, but they can't say I haven't addressed their pain.

  2. Doc "addressing pain issues" as you suggest, in the ER, is impossible. First, we've got about two minutes to spend with people who are not sick enough to be admitted. Second, when a " self pay" frequent flier drug seeker can file a complaint which says " I didn't get narcotics" and the complaint ACTUALLY gets me in trouble or puts my job in jeopardy then I become a candy machine. Of course if you are willing to take referrals from the ER...

  3. C'mon 9-11
    Who doesn't love coming up with their own idea of what a "10" pain level would be?...
    "So, Mr Murray, if a "10" would be the pain you'd feel if 2010 Lombardi Award Winner Nick Fairley was to pile drive your face into a 3 foot high fire ant mound, how would you rate your pain level?"
    reminds me of that strange kid everyone hated in 3rd grade, you know, Me. The one who'd talk about sliding naked down a razor-blade-tipped-stair-railing-naked-and-plopping-into-a-barrell-of-rubbing-alcohol...


  4. U go 911!! Tell 'em for me!! And what might also be said is that these pts are also smart enuff to know that they shouldn't say he didn't give me Vics but will make up another reason, like he was just mean and didn't care I was in pain! I told them I was allergic to Tylenol and NSAIDs and he said he wouldn't help me!

    And on it goes..

  5. Palliative Care Doc9:37 AM, November 10, 2011

    I actually do take referrals from the ED. I'd help you out if I could.

    If you seriously get in trouble for the complaint "I didn't get narcotics," then I am in awe. That is some serious bullshit.

  6. OK, its time for one of my Andy Roony-esque rants...
    Why can't Black people be quiet at the movies.....
    I mean,
    Hey "Palliative Care" Doc...
    and I used Quotation Marks for a reason.
    Palliative Care isn't a specialty.
    I mean, can you do residency's in Palliative Care? Fellowships? get a Board Certificate?
    And even those are sketchy, like my framed "Doctor of Sexology" diploma...
    and I don't know where you Mal-practice, but 9-11's dealing with heavily tatooed Mexican Narco-terrorists who go through fentanyl patches like I go through a bag of Doritos..
    And thats just the Nurses...(Rim Shot)
    Seriously, you try a good old fashioned HVLA on one of these scumbags and you'll counterstrain your OWN crown jewells...

    Frank "Bringin Sexy Back" Drackman

  7. Franks knowledge of omm techniques makes me smile....but are you saying that I have to take "dr of love" off of my business cards? 'cause that was a legit online course I took...same site where I could have clicked thru to earn my N.P., too!


  8. Ummm MS1..
    and shouldn't you be a MS2 by now?
    could I get that NP site??

    and heres where I got my S.D.


  9. MS1, you'll most likely be doing residency at Wal-mart. JCAHO-who?


  10. I'm constantly battling with the QA people because I refuse to use the useless 1-10 pain scale. I won't use it because of exactly the reason you state, it's entirely subjective. A 2 to me is a 10 to someone else. Pain, being a symptom is impossible to quantify. That seems to be too complex a concept for many people, including those at JCAHEIEIO.

    Speaking of which, does any of what they do remind you of a protection racket?

    "Nice ED you have here, doc. It would be a shame if anything happened to it's accreditation."

  11. funny you should mention that acronymn-medic-man.... the following might interest you....

    stupid thing wont allow me to hyperlink....