tag:blogger.com,1999:blog-24021163.post6500762545487906713..comments2024-02-18T01:56:38.508-06:00Comments on M.D.O.D.: Reasons I'm Leaving Emergency Medicine (number 3)911DOChttp://www.blogger.com/profile/06466669111561150174noreply@blogger.comBlogger45125tag:blogger.com,1999:blog-24021163.post-29655952323762607792010-04-12T21:12:51.958-05:002010-04-12T21:12:51.958-05:00Remember, patient charts aren't for patient ca...Remember, patient charts aren't for patient care. They're for coders, lawyers, bureaucrats, & high-heeled nurses who can't start IVs.erdoc85https://www.blogger.com/profile/06373340227068589953noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-79593512591599170382010-04-04T01:33:30.383-05:002010-04-04T01:33:30.383-05:00My clipboard wrote me up for using @ v.s. spelling...My clipboard wrote me up for using @ v.s. spelling at in my nursing order. JCAHO doesn't approve the use of @ or bid, tid, po, qd, ac, pc, ou, od,qod,andanything apothecaries is totally out.I DON'T KNOW HOW TO WRITE REGULAR! Ms Clipboad knows where she can put it @.daytripperhttps://www.blogger.com/profile/12332471637188672909noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-9968841496933403452008-10-15T07:12:00.000-05:002008-10-15T07:12:00.000-05:00I'm an OR nurse and I can't figure out... are you ...I'm an OR nurse and I can't figure out... are you for us or against us? We too would like the process to hurry up. I've waited countless hours to do cases because of the ER's inability to transfer the patient.Anonymoushttps://www.blogger.com/profile/13684720999131302948noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-65832288768173157122008-09-08T17:05:00.000-05:002008-09-08T17:05:00.000-05:00Seaspray: I am not an expert, and I do not claim t...Seaspray: I am not an expert, and I do not claim to know all of the answers to your very astute question, but I think that I can explain one part of the reason why doctors, nurses, techs, et al are loosing control of healthcare. It is not the only reason. It is probably not the most important reason. However, it is part of the problem, and something I have never heard mentioned, except by me. So, for what it is worth, here goes:<BR/><BR/>There is a fundamental contradiction between the culture of medicine and the culture of administration and law (hereafter referred to as forensics). In medicine, we see the world as an objective reality that is the way it is because of immutable natural laws. If I give my hypotensive patient intravenous dopamine in a certain concentration, at a certain rate, and his serum pH is not too low, and he has adequate volume and ejection fraction, and there is nothing preventing the binding of the drug at the target receptors, his blood pressure WILL increase. No negotiation. No authority to appeal to. No legal contest. No discussion of how some special interest group feels about it. That is just how the physical chemistry of dopamine interacts with mammalian physiology. Period. That is a snapshot of my world (nursing).<BR/><BR/>The forensic world is very different. In the forensic world, things are true because an entity with jurisdiction over that aspect of life has said so. When the entity changes (through attrition, negotiation, persuasion, compromise, bribery, intimidation, or whatever) then the truth changes with it. To those of us with scientific backgrounds, this is silly and trivial. And, it is how human institutions (like hospitals) are run. Consequently, we medical types are locked in eternal conflict with the forensic types: administrators, lawyers, TOFKAJCAHO, the whole wretched lot of them. Because we have different cultural foundations, we rarely communicate effectively with each other. Each side knows that its position is sensible, and the other groups’ is ridiculous. In fact, neither is ridiculous and neither is sensible. They are just different because they arise from a different set of beliefs about what constitutes the real world.<BR/><BR/>For centuries, it did not matter much because medical types did medicine and forensic types did administration and law. Now, however, we have medicine beholden to mulyiple administrative entities, and to government and the results are disastrous and getting worse. This is why all the talk about healthcare reform is so futile; because it does not resolve the irresolvable cultural conflict between the players. The solution is to return healthcare to the healthcare providers. However, we live in a time of profound distrust of authority figures. (Wow! We made it full circle to the original topic of paternalism, didn’t we!) And so, because a lot people do not trust the medical experts who know how to provide the care that is needed, we will get more and more administrative, legal, and governmental incursions into medicine (all in the name of “fixing the broken system”), worse care, and lots of otherwise smart people who never figure out that they are sending medicine straight to Hell even as they do what they think will save it.<BR/><BR/>I fear for our children, and more for their children.CountyRathttps://www.blogger.com/profile/10228262536418983673noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-77866244973701492582008-08-22T20:55:00.000-05:002008-08-22T20:55:00.000-05:00I heard once at a conference(and coming from a doc...I heard once at a conference(and coming from a doc) that uniting doctors is very similiar to herding cats. feral cats. Makes me laugh!<BR/>Thought this might make you laugh...heard today from one of our "Quality Control" RNs who has to check the documentation (and HATES JCAHO)that our State Board of Nursing has come out with a new regulation(equals law) that our signatures must be legible in all and any charting 100% of the time--like when I'm transfusing those 14 units of blood in one hour for my little GI bleed guy. They have a hotline where an RN can be reported for illegible signatures. I kid you not. I think we should be reported to a hotline for LOOKING hot, or where to see hot nurses. The world as we know it has gone completely nuts.Anonymoushttps://www.blogger.com/profile/15238905633085051322noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-41216058721419976782008-08-22T12:52:00.000-05:002008-08-22T12:52:00.000-05:00Thank you 911 Doc.Shame on your national organizat...Thank you 911 Doc.<BR/><BR/>Shame on your national organizations for not being better advocates.<BR/><BR/>Too bad y'all can't find one little bite to unite on and sink your teeth into and eradicate that one inane thing that should never have been imposed... and then so on. <BR/><BR/>We need you guys and gals and I hope it gets better. :)<BR/><BR/>Thanks for your answers. :)SeaSprayhttps://www.blogger.com/profile/07906503090688697222noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-42102017392617447822008-08-22T01:32:00.000-05:002008-08-22T01:32:00.000-05:00dear seaspray, your answers follow....Why don't do...dear seaspray, <BR/>your answers follow....<BR/><BR/>Why don't doctors unite? I DON'T KNOW. I POSTED ON THIS UNDER THE TITLE 'GEORGIA O'KEEFE'. I ALSO THINK IT'S NOT IN OUR NATURE... WE ARE DOCTORS, FOR THE MOST PART, BECAUSE WE LIKE TO DO MEDICINE. MOST OF US CAN BARELY SQUEEZE IN A VACATIoN MUCH LESS A MARCH ON WASHINGTON. ALSO, OUR NATIONAL ORGANIZATIONS DO NOT ADVOCATE FOR US VERY WELL. THEY MIGHT NOT LIKE EMTALA BUT NONE OF THEM OPENLY ADVOCATE FOR ITS REPEAL. <BR/><BR/>Do they not all agree? NO, WE DO NOT ALL AGREE. I THINK THE CURRENT CRISIS IMPACTS HOSPITAL PHYSICIANS PRIMARILY AND THERE ARE PLENTY WHO HAVE PRACTICES THAT ARE SEPARATE FROM THEIR TOWN'S HOSPITAL SO THEY DON'T FEEL THE IMPACT OF EMTALA. AH, DERMATOLOGY! ALSO, THERE ARE QUITE A FEW PHYSICIANS WITH LEFTIST LEANINGS BUT THEY DO TEND TO LIVE IN AREAS THAT SERVE PREDOMINANTLY WEALTHY PATIENTS AND THEREFORE MAKE GOOD MONEY. ALSO, THERE ARE PLENTY OF 'TRUE BELIEVERS' WHO WORK AT HEALTH CLINICS FOR LOW PAY AND ARE QUITE HAPPY. MY ONLY QUIBBLE WITH THE LATTER IS A PHILOSOPHICAL ONE BUT I SAY 'GOD BLESS 'EM".<BR/><BR/>Are the truly powerless? WE ARE NOT POWERLESS BUT WE BELIEVE WE ARE, AND WITH HUNDREDS OF THOUSANDS OF DOLLARS OF DEBT OUT OF RESIDENCY IT'S A BRAVE YOUNG DOC WHO WILL LAY IT ON THE LINE.<BR/><BR/>Or is it all just too big and everyone is just trying to make there way? THIS IS SAD BUT TRUE FOR MOST DOCS.<BR/><BR/>You can't eat an elephant all at once...but you can eat him one bite at a time. :) I'M READY FOR A FEAST.<BR/><BR/>Sincere questions. SINCERE ANSWERS.911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-137287287837730582008-08-21T17:58:00.000-05:002008-08-21T17:58:00.000-05:00This comment has been removed by the author.SnowLitehttps://www.blogger.com/profile/10038130985826021865noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-6655649814052245572008-08-21T15:37:00.000-05:002008-08-21T15:37:00.000-05:00911 just kidding about the chicken dinner, althoug...911 just kidding about the chicken dinner, although very sweet of you to offer.Amelia Ameshttps://www.blogger.com/profile/17296224743117560163noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-83439205206224546712008-08-21T13:12:00.000-05:002008-08-21T13:12:00.000-05:00p.s.grey goose.p.s.<BR/>grey goose.Unknownhttps://www.blogger.com/profile/14432477563187010259noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-63343408601210273592008-08-21T12:59:00.000-05:002008-08-21T12:59:00.000-05:00actually.. scratch the tofu..vodka sounds much bet...actually.. scratch the tofu..<BR/>vodka sounds much better.. esp. after a few of my non-compliant * charts were audited..<BR/>those frickin' signatures are soooo hard to get from these patients circling the drain...<BR/><BR/><BR/>yours in the struggle.Unknownhttps://www.blogger.com/profile/14432477563187010259noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-7900662223624849662008-08-21T12:23:00.000-05:002008-08-21T12:23:00.000-05:00dear seaspray,too tired right now to answer all bu...dear seaspray,<BR/>too tired right now to answer all but TOFKA = The Organization Formerly Known As ...911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-150599243939374752008-08-21T11:51:00.000-05:002008-08-21T11:51:00.000-05:00What does TOFKA stand for?Why don't doctors unite?...What does TOFKA stand for?<BR/><BR/>Why don't doctors unite?<BR/><BR/>Do they not all agree?<BR/><BR/>Are the truly powerless?<BR/><BR/>Or is it all just too big and everyone is just trying to make there way?<BR/><BR/>You can't eat an elephant all at once...but you can eat him one bite at a time. :)<BR/><BR/>Sincere questions.SeaSprayhttps://www.blogger.com/profile/07906503090688697222noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-30601870582942316302008-08-21T09:51:00.000-05:002008-08-21T09:51:00.000-05:00dear maki, sorry for the late response. your thank...dear maki, <BR/><BR/>sorry for the late response. your thanks are appreciated and let me emphasize that it has always been my position that the large majority of physicians went into medicine to care for patients and make a difference in a real way. sure we have our fair share of money-grubbing a-holes, but less, perhaps, than other professions.<BR/><BR/>hey kr, <BR/>good to have you back.911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-35174983165771175552008-08-21T09:48:00.000-05:002008-08-21T09:48:00.000-05:00dearest lilly, if you just got out of some bs comp...dearest lilly, <BR/><BR/>if you just got out of some bs compliance meeting then you may have whatever you want. <BR/><BR/>dear brethren, we are all united in our recognition of TOFKAJCAHO as the incarnation of the beast. isn't that enough? if not, tofu coming in mail soon.911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-6267058721285363232008-08-21T09:42:00.000-05:002008-08-21T09:42:00.000-05:00911doc..hey it's me, lily!don't i get something.. ...911doc..<BR/>hey it's me, lily!<BR/>don't i get something.. tofu dinner, whatever??<BR/>i came up with the * a-hole symbol up there..<BR/>please?<BR/>i need some recognition since i just had to sit through some bs meeting about central line insertion and compliance with patient consent forms.<BR/>yeah.Unknownhttps://www.blogger.com/profile/14432477563187010259noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-25652175453295280782008-08-21T03:20:00.000-05:002008-08-21T03:20:00.000-05:00no worries! i think you will like number 2. it is ...no worries! i think you will like number 2. it is really number 2.911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-5420879649431362262008-08-21T02:50:00.000-05:002008-08-21T02:50:00.000-05:00Thank you once again for putting into words how I ...Thank you once again for putting into words how I became the way I am. <BR/><BR/>911- I am contemplating printing out all your reasons at the end and getting on my soapbox at the next med staff meeting.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-68358730667377248562008-08-21T02:31:00.000-05:002008-08-21T02:31:00.000-05:00EMTALA. PASSED 1985. THAT KILLED IT ALL. SEARCH SI...EMTALA. PASSED 1985. THAT KILLED IT ALL. SEARCH SITE FOR EMTALA AND YOU WILL GET THE IDEA.911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-35646587036334247792008-08-21T02:04:00.000-05:002008-08-21T02:04:00.000-05:00I really hope things turn around for the better.It...I really hope things turn around for the better.<BR/><BR/>It is disturbing to hear all these things and other issues providers have.<BR/><BR/>How about just being able to treat the patients and getting paid fairly for your work?<BR/><BR/>Why does everything have to get so complicated?<BR/><BR/>I am curious about something. When did it all begin to change...noticeably change toward the dark side?<BR/><BR/>Once upon a time... didn't doctors call the shots with their patients and didn't they get paid well for their efforts? Bygone days.<BR/><BR/>What actually happened.<BR/><BR/>Why don't doctors unite and stick up for what is right when the new rules are presented before they have a chance to snowball into more?SeaSprayhttps://www.blogger.com/profile/07906503090688697222noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-3959249939553021742008-08-21T01:45:00.000-05:002008-08-21T01:45:00.000-05:00The motto at the hospital that I USED to work for,...The motto at the hospital that I USED to work for, comes straight from "management"* <BR/>"If you don't like it here, work somewhere else*"<BR/>If you point out problems in a staff meeting, or speak your mind about the B.S. that is going on, or point out valid reasons that inhibit your ability to do your job efficiently and safely, you are labeled a trouble maker and the quote above is all you get* <BR/>Took me a while to figure out the reason why*<BR/>Department managers and even directors are spineless little puppets with absolutely no authority to do anything including make decisions on their own* <BR/>Even though the great and powerful OZ hasn't a f*#king clue what goes on in your dept. if it isn't fattening his multi million dollar bonus, it ain't happening, doesn't matter who you are* And to hell with patient care, that is just a fluffy little catch phrase that OZ likes to feed to the media*make mine traumahttps://www.blogger.com/profile/18149160428613740527noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-75961863956333846692008-08-20T23:49:00.000-05:002008-08-20T23:49:00.000-05:00your reasons for leaving emergency medicine so par...your reasons for leaving emergency medicine so parallel my reasons for leaving education...in one word? bureaucracy.lauren.https://www.blogger.com/profile/11980889107329315606noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-45132913534752408032008-08-20T22:31:00.000-05:002008-08-20T22:31:00.000-05:00doodette, send me your address and i'll send you a...doodette, <BR/>send me your address and i'll send you a chicken dinner. i promise not to add you to a whole bunch of mailing lists and solicitation calls.911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-86860296417760728662008-08-20T22:18:00.000-05:002008-08-20T22:18:00.000-05:00Nice anus 911. Yours?Dude, where's my chicken din...Nice anus 911. Yours?<BR/><BR/>Dude, where's my chicken dinner?Amelia Ameshttps://www.blogger.com/profile/17296224743117560163noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-21217912013882202512008-08-20T21:29:00.000-05:002008-08-20T21:29:00.000-05:00OMG...another hilarious post! As one required to d...OMG...another hilarious post! As one required to deal with some of the enormous amount of information generated in a patient encounter, I see the results of being required to basically over-document everything done to and for a patient. <BR/><BR/>And the * as the new symbol idea rocks! JCAHO is merely another symptom of bureaucracy run amok. Too much "playing by the rules" and not enough opportunity to really provide for patients. Maybe it's a good thing I didn't make it to med school after all...I see enough of the insanity as it is, and I think it would have been an endless source of frustration if I'd been trying to practice medicine as I thought it ought to be.Anonymousnoreply@blogger.com