Anton's Syndrome

In true wisdom the administration decided on a computer order entry system and then mandated that the whole center go live with it last Saturday. They turned their blind eyes towards all the problems that were pointed out in the system and did not bother to discuss it with the physicians. It lasted 71 hours. Even with all their manadated training and PR the system crashed the whole medical center and increased medical errors 10 fold. There had to be an emergency halt placed on using the system and an immediate reversal to go back to the old charts. Still allowing their Anton's Syndrome to override all logic, the administration now states that it will be back on line once the small bigs are fixed. The biggest medical errors were of course, people paying attention to the computer instead of the patient!

"I love the smell of Play Doh in the morning!"

We had a JACHO inspection of the Childrens Hospital last week so all the things that really matter to the kids were hidden. Of course with JACHO you cant have toys for the kids to play with because they might have germs or be racially/socially incorrect. Crayons are right out becuase they are a choking hazzard. Now that JACHO is gone, we can bring out the one thing that helps every child in pre-op as well as their parents. Play Doh! Sure it is against JACHO, but you can hand it to any child and they immediately start playing. For patents, the mere smell brings them back to their own good childhood memories. It is a sorry state of affairs when we have to smuggle Play Doh into the hospital!

Digital Neglect

I'm having a bit more time to write as I wait for meds to come up from the pharmacy. Before we could call down and they would tube them up. Took about 5 minutes. Now it has to be entered into the computer where it vanishes and you wait and wait and wait. You then call down to the pharmacy where they reply that they have to log in to see if it has made to them. If it has, they have to do all kinds of other stuff on the computer before they can go get it, mix it and finally send it up. Takes about an hour. Isnt efficiency great! Anyway, as you can tell one of my pet peeves is taking care of the paperwork instead of the comouter. I have been collecting incidents where this has happened but some of my favorites are when the family memebers take matters in their own hands becasue the person who is supposed to be taking care of their loved one is too busy on the computer to come and do their job. the latest is when a patient had accidentally disconnected his feeding pump from his NG feeding tube. I happened to come in and saw the wife put it back on, reset the pump and sit back down. I was impressed. She saw my look and said, that she knew how to change the IV bags, reset the IV pump and zero the lumbar drain. I asked if she was a nurse. She said no, she had to learn becuase the nurse was too busy to come in and fix these things. She added, "God help those pateints who dont have anyone with them!"

Scavenger Hunt

We do our best to share the pain of who takes call during the holidays. This year it is my turn to take call during the great medical center wide scavenger hunt called the first week in July. This is when all the new interns start. They are doing their best to find their way around while learning to take care of patients. Of course, the new "patient centered focus" means that instead of actually learing to take care of patients they are learning how to navigate their way through the hospitals new Computerized Order Entery system that was also started this first week of July. (note to self, dont get sick the first week of July). Where we used to have interns lost trying to find interventional radiology and the microlab, they are now lost in cyberspace trying to figure out why insulin is listed in the computer under "adult" instead of "insulin"! Before, interns and residents all had Washington Manuals in their pockets so they had a quick reference on what to do when the patient s/p xlap for dead bowel went into vtach. Now their pockets are full of notes on how do you log in and make your way through all the HIPPA screens to find out if the patient already had been given his K. I was called in to consult on a gentleman and when I sat down and talked with him, he said "I hope that d*** computer is doing better because I sure aint!"

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."