CPOE DOA

I just had the opportunity to see what happens when you mix hospital administrators with computer geeks and accountants. You get computer order entry. This is basically where instead of writing orders in the chart, you have to find a computer and then enter them. This seemes like a great idea to the people above who have never been in the ED, OR or a hospital unit. It kind of goes like this. You go up to see your patient. Of course, to find out what has happened and their labs, you have to log into a computer. You then walk in to see the pateint, do your exam and then have to relog into the computer to enter what orders you want as well as to review what other orders others have written. Of course, you have to do this to every patient. Wait a minute, the nurse and the CNA as well as speech, nutrition and everyone else has to enter everything into the computer as well. What, their isnt enough computers? So now you have to wait to find a computer. Since it logs you out because of HIPPA, you just print everything out so at least you have some of the information. You then write your orders down on scrap paper until you can find a computer to enter them. This is what administrators,accountants and computer geeks call efficiency. Yet another great example paperwork (now computerwork) over pateint care.

Foxhole Faith

Several years ago I took care of a college professor. He had sent me a letter saying that he did not like my manner. Spefically, he did not like that I said God Bless You at the end of each encounter. He had written taht he did not believe in God and that may saying that was offensive to him and therefore wanted all his records and was finding a new physician who was in tune with his beliefs and was not forcing their faith upon him. Anyway, he showed up in the office this week with a stage 4 tumor and asked me to be his surgeon to remove it. I still said God Bless You, he replied, I need it.

Maimonideen Moment

We had a dinner to celebrate the retirement of a great doctor tonight. Like many doctors, he really wasnt retiring just scaling back to one day a week. Throughout his career, he never asked if people could pay, infact, many times he never charged. He never turned anyone away. As we spoke of our esteem for him, someone said something that just struck me. It summed up what we are and who we are. To paraphrase: " As physicians, we see all regardless of their race, income, predjudice, social class. Those we see entrust and share with us their souls in the form of their fears, aspirations and worries. We see all as equals in gods eyes and we never see a patient anything but a fellow creature in pain. We are entrusted with the souls of our patients, to provide comfort for their pain and to watch over them. This is our calling, a calling that exists forever and can not be recended, it can only be passed on with greater understanding of its dimentions."

Cooties Jump both ways

When I go to examine a patient, I always put on a pair of those purple gloves that I despise. Today, I went to see a patient and said hello and put on the gloves when the patient said that he did not want to be touched because Drs carry all kinds of germs and spread them from patient to patient. I paused and thought about it for a second. I had to see this gentleman because he had a huge abscess that he got from drug abuse. He was unkempt and had a rash all over that looked like a cross between meth skin and scabies. I dont think he had bathed in a while as the odor in the room reminded me of a gym bag that had been left in the trunk of a car in a hot day covered with all the old laundry that a football team could muster. Politely, I accommodated his wishes but I have to admit I was the one who was more worried of catching something.

Air Getting to Cancer

Three times today I had to explain the same thing. In each case, a patient had a lymph node that was suspicious and I was asked to remove it for a biopsy. In each case, the pateint at first refused because he/she had heard that once you get air to those, cancer goes everywhere. I try to explain that cancer does not behave that way and that in those cases that they heard that about the cancer was everywhere and the biospy just proved it. It is hard because I dont want them to think that the cancer is everywhere becuase we hope that it is just in the single lymph node but you can never tell. It always seems that no matter what, if the node is positive, the pateint will think that you spread the cancer because you got air to it.

EPA Job creation

I have a large group of patients that I take care of to the best of my ability who have lost their jobs and insurance. Most have had cancer, some chronic conditions. I had one come in today. He was both happy and sad because he now had a great paying job and good insurance but it was temporary. He is an Iron worker. He explained that suddenly he and his collegues have more work than they know what to do with. They are taking apart factories that had shut down hoping for the economy to improve. Apparently there is some new EPA regualtions that will make it very costly in the future to dismantle factories so any factory that thinks it may not be able to reopen in the future is in a rush to tear it down. In my patients case it has created jobs cutting up the steel and breaking up the boilers into scrap that is then shipped to China. Of course, all the jobs that the factory had were lost, and now the whole factory is lost and can not be re-opened, temporary jobs were created because the EPA regs, but once the factory is gone, so will the jobs.

JACHO/HIPPA free Zone

It was so refreshing. I saw over 400 patients and did not have to worry about JACHO or HIPPA. Of course it was on a medical mission trip to Guatemala. We saw and treated patients. We saw vitamin defieciency causing blindness, parasites killing children, simple infections devastating families and treated them all. Some we treated in mud huts, others on the floor of simple churches. The pateints were thankful. I wonder what JACHO would say about the hospital that was made of mud? Would we have to get HIPPA waivers for all those who formed a circle and prayed over our patients? I think JACHO needs to go on mission trips.