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Posts Tagged ‘cataract’

As a routine precaution during cataract surgery, we normally tape the patient’s head to the operating bed.  Our patients are sedated (wouldn’t you want to be sedated if someone was working on your eye?) but sometimes they wake up at unpredictable times.  Everyone metabolizes drugs differently.  So to prevent them from suddenly sitting up like the Cowardly Lion and quipping, “Unusual weather we’re having, ain’t it?” we gently but firmly run tape across the forehead and under the head rest.

May be a bit low tech, but IT WORKS.

In the past, we had this big ass roll of tape to make a couple of passes around the head (or more if the patient seemed likely to be a problem child.)  A typical roll might last for eight cases.

1inchtape

More than enough tape to get the job done!

Enter UPMC (the acronym for “U People Must Comply.”)  Someone, somewhere, in the vast corporate mind of the beast decided or calculated that  “single use” rolls of tape were more economical.  Or maybe they ordered 10 million rolls of the wrong tape.  Whatever, the reason, this is what we have to work with now.

singleusetape

The picture can be deceiving.  One roll of this single-use roll just barely makes one circuit over the head, so on most cases, we are now using TWO rolls of single-use tape to protect our cataract patients from their own involuntary movements.

Never mind the insanity of making rules to govern every situation as if every situation is identical, but isn’t this terribly wasteful?  At two rolls per case, we’re using about 8 rolls for every one of the larger multi-use rolls.  Is that environmentally conscious?

Rather disgusted, I told the nurse to just order the old rolls for us to use.

I was informed that we can’t do that.  This is what we are required to use.  Silly me.  This isn’t the United States of America.  I can’t be allowed to do what I think is in the best interest of my patients.

I’m going to go off on a rant right now (and several run-on and poorly structured sentences) so you might want to grab a Snickers and an English teacher.  Okay.  Do not grab an English teacher.  Unless you are Donald Trump.  Or you are married to said English teacher.

I am getting rather tired of people telling me, the surgeon, how to do my job.  I am told that I have to mark the patient’s eye.  (That is a good idea.  We always did it before, but . . . )  I am told where I have to mark it (in the holding room instead of the operating room where my chart is and with the patient in the proper position for the surgery–I know that sounds weird but when I operate I sit behind the patient’s head so his right eye is my right and his left my left, but when I face them in the holding area, my right is his left and vice versa–for someone who had operated for years the other way, it took some getting used to and I tried carrying my charts around, but now I have two charts, the previous patient and the next patient and of course I wrote on the wrong chart shortly into this new experiment which quite frankly made a simple but important safety act more cumbersome and difficult with no definable benefit), and how I am supposed to mark it (on the cheek below the correct eye, marker that won’t rub off easily (patients have to scrub, often with alcohol, to remove my initials tattooed on their face), and I have to include THREE initials, because I might forget who the fuck I am after following all these god-damned insane regulations.)  I am basically told what medications we can use because if it’s not in the hospital formulary, it ain’t happening.  I am supposed to date and time my orders–this is an outpatient procedure that takes 10-20 minutes in most cases.  How is dating, and worse yet timing, my signature of any benefit to patient care???  Anything I sign in the chart has to be on that date and within a fairly definable time frame.  I’m not supposed to wear a watch in the OR, yet I am supposed to time everything.  What the hell did I go to medical school and residency for?  I could have saved EIGHT years of my life and just had the federal government (The Joint Commission) and UPMC tell me what to do.  Maybe Trump will wipe out the Joint Commission after he’s done erasing the EPA.  And I am done digressing.

But I heard this single use tape experiment has been so wildly successful at improving patient care and cost-efficiency that UPMC is going to roll out their next great idea:  single-use toilet paper rolls.

toiletpaper

Because you shouldn’t be pooping on company time anyway!!!!

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So after trying to pick the golf ball off my sweater this morning, I still go to work.

As I am giving pre-operative instructions to my patient who is scheduled next week for cataract surgery, I get to the point in the discussion where I inform them what medications they should or should not take the morning of surgery.

In the good old days, I could just glance down at the list on my paper chart and know exactly what medications a given patient was taking.  (Or at least the ones they remembered or told us, but patient’s memories don’t improve with computerization anyway.)  But good old Uncle Sam has shot to hell the good old days of practicing medicine, and I must now click on a different tab to bring up medications.  The computer does not always respond right away, so sometimes there is a delay before any useful information can be gleaned from among all the “meaningful use” crap clogging up the health record system.

And instead of waiting for the computer to unfreeze, I ask the patient what medications they are on.

Generally speaking, they should only take “essential” medications such as those for heart, breathing and blood pressure the morning of surgery with a little sip of water.  Not every patient knows what their medications are for, so I like to review the list with them.  And some medications should still be taken even if they don’t fall into those categories, such as anti-seizure medications.  Others, like Flomax, should be stopped a week before surgery.

I am still waiting for the list to pop-up and I couldn’t understand what the patient answered as to what medications he was taking.  Three sets of ear tubes as a child and multiple infections have left me with a modicum of hearing loss.

So I ask him again what medication he is taking.

He answers again, but I still can’t quite understand what he is saying, and what I think he said, isn’t a drug I am familiar with.

Still no answer from the Obama-care computer.

And then I make a fatal mistake.  I am embarrassed to have to ask the patient a third time to tell me the name of his medication.  I am also impatient because my computer is useless to me at this moment.  So I think that trying a different tactic might help facilitate me finishing this discussion and moving on to the next embarrassment patient.

If I don’t know what the name is, I can still make a decision based on what he is using it for.

So I calmly ask him what he takes this medication for.

Fortunately, he either didn’t hear me, thought I was a complete idiot, or wisely chose not to answer.  At this moment, the computer manages to find the list of medications and display to me that my patient is taking Viagra.

ViagraFalls

And I, his eye doctor, just asked him why he was taking this.

EPIC FAIL.

So what would you say in this instance?

I stammered, as my tech tried not to laugh out loud, “I guess you can skip taking that the morning of surgery.”

Stamping out blindness is never easy or for the faint of heart.

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Most cataract surgery patients are thrilled with their “new” vision after cataract surgery.  A few years ago, the husband of one of my patients pulled me aside and thanked me.  He said that I saved him having to get a new TV.  Before her surgery, his wife complained that something was wrong with their TV and no matter how much he argued, she couldn’t be convinced.  After her cataract surgery, though, she thought the TV looked fine.  True story.

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