Tuesday, February 1, 2011

(Dumbing Down)(Dumbing Down)

One of the concerns that we have had in the surgeons lounge is whether the new resident work hour limits have "dumbed down" the residents education. It is hard not to think that by decreasing the work 50% that you wont decrease the experience by 50%. On top of this, is that concern that we are further dumbing down our care by replacing residents with NPs. In one of the most ironic episodes, I was in the lounge last night waiting for the patient to have an artline discussing this very thing with another doc waiting for his post op film when I got a stat consult. The patient had come in through the ED where they were seen by an ARNP who consulted pulmonology. It was another ANRP from pulmonology who came and saw the patient and then arranged for admission who then called for the stat consult. The consult was for acute shortness of breath, decreased breath sounds on left! When I got to the room, the patient was pulling a chair over to see if he could stand on it to adjust the picture on the TV. He had a slight wheeze. I asked if he was short of breathe, he answered," Oh, yeah". I asked how long had he been short of breathe, to which he answered, "ever since they removed my left lung". I thought either I am being set up or this is candid camera. I asked what brought him to the hospital this evening to which he replied that he was having some abdominal pain from his old ventral hernia. Being paranoid, I checked him over and then went to the chart. There in all the best EMR was a six page history and physical of computer generated mumbo/jumbo. No where could I find anything that mentioned his hernia or the fact that he was missing a lung. I went to call the resident who had approved the admission but he had already left and signed out to another. This resident stated that the patient was having severe SOB and pneumothorax and that surgery had been called to place a chest tube! I then tried to call the pulmonology ANRP, but they had also finished their shift and left!

Welcome to the world of "not accountable" "Shift" "Dumbed Down" medicine.


rnraquel said...

So, they thought he had a pneumo because they couldn't hear breath sounds on the side where he had no lung? Aren't they supposed to do a chest xray?
Throckmorton, I love your practical logical ways. I wish you worked at my hospital.

SeaSpray said...

"Being paranoid, I checked him over and then went to the chart."

I imagine this kind of thing will increase your paranoia over time.

Throckmorton - My understanding is that they reduced the residence hours because they were so sleep deprived, mistakes were occurring.

But what you and your colleagues are concerned about seems to be quite a serious concern as well. And I think I recall you wrote a post in which you said that when they go into private practice ..they won't have the stamina to work clinic hrs, surgery and be on call.

Which is the greater risk? Sleep deprivation or lack of hours in for experience?

It would seem to be training/experience. Because I also remember you writing about how a patient should go to the surgeons who have the most experience.

And then to think people without medical degrees are making such important decisions regarding treatment for patients. *sigh* And that will happen more and more.

I liked it better when I thought all doctors were perfect ..2nd only to God, didn't make any mistakes and knew everything. And hospitals were the cleanest safest places to be if you were sick.

I really used to believe that.

Last week I heard a radio discussion in which they were discussing infection rates in hospitals. the guest stated the reason they got Gabby out of the hospital so quickly was to reduce the risk of her acquiring an infection. They said that 25% of the people admitted into the hospital die ..not because of the reason they went in for,but because they die of a hospital acquired infection. I think they said either 20 - 25% or 25 - 30% die of infections they picked up in hospital. That is so HIGH! Really high!

I'm beginning to feel like being a surgical patient with a hospital stay is like playing Russian Roulette.

I can only imagine how frustrated you feel with all the things you have to consider for yourself and your patients. Your blog header and profile description are truly the way it is. I appreciate it more now, then when I first came in here. It's like the patients and docs have to not only be defense ..but also offense.

SeaSpray said...

"I think they said either 20 - 25% or 25 - 30% die of infections they picked up in hospital."

I meant to say: I think they said either 20 - 25% or 25 - 30% die *every year* of infections they picked up in hospital."

And that housekeeping is not adequate enough. I noticed that when I worked in the hospital.

I remember one of the ED docs commented that our hospital was so clean as compared to city hospitals and I wondered just how bad the city hospitals were.

This guest went on to say that people should have a pack of those clorox sanitizers and wipe down the phone, bed rails, remote, etc themselves. As a patient, I wondered about this stuff myself, but thought maybe I was being a germaphobe, It's both a relief and a concern that I was right to be concerned.

I think there needs to be better education in this area regarding hospital stays.

I'm sorry I went off track with the infection info.