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Posts Tagged ‘regulation’

As I was entering the surgical center where I do cataract surgery, I was greeted by a sign on the door to the locker room . . .

rules

If you follow my blog with any regularity–or my new sister blog, The Silence Dunwell Letters–you know that I am a bit of a cynic when it comes to arbitrary regulations–rules that seem to be in place only to justify someone’s job–proof that they are doing their job, even if it isn’t very well.

So apparently these rules are designed for VENDORS.  I’ve always known them as sales reps, but tomato, to-mah-to.  Vendors makes me think they’re selling hot dogs or drinks.

dr-pepper-vendor

SO CLOSE!  Red Cap, but not BOUFFANT!

Red Bouffant Cap.  I’ll come back to that.  You know that I will.

Badge clearly visible.  Good rule.  No problem with that.

Current with requirements.  I have to maintain my license.  I don’t have a problem with everyone else in the operating room maintaining their credentials.

Long sleeve warm-up jacket?  What about summer time?  Is it possible the coach may want to put you in the game, so you better keep your arm warm?  There may be a good reason to require this, but I have FAILED to come up with any remotely logical reason to make this a requirement.  Leave me a comment if you think of something.

NO UNDERSHIRTS.  Seriously?  How will you know if they are wearing one under the already mandated LONG SLEEVE WARM-UP JACKET?  Are you [bleeping] kidding me?  Who’s going to inspect for this?  Do they have to undergo strip searches for illegal under garments?  Can anyone show me a medical study that even remotely suggests that the undershirts of non-operating personnel worn underneath an official warm-up jacket have been shown to increase the surgical infection rate?  Anyone?  McFly?  We are just a few sieg heils away from regulating the type of socks and underwear we use.  Oh wait, I think they do regulate the type and color of socks and shoes of the nursing personnel.

UPMC stands for U People Must Comply.  We will wear only their scrubs and have no other scrubs before thee.  We are the Stepford Doctors.

Shoe covers?  Not a problem for me.  As long as I can wear whatever shoes I want underneath.

And no problem with requiring that visits be scheduled.  We don’t want the operating room to resemble a flea market or bazaar.

But . . .

redcap

What in the wide, wide, world of medicine prompted this fashion faux pas?  I searched high and low but couldn’t find the big red noses or the clown shoes to go with them.  What are they vending?  Happy Meals?

I will assume–always an unwise thing to do, but this is my blog dammit–that they want these “people” to be readily visible.  Mission accomplished.  You could pick them out from a satellite image.  I guess the ID badges are simply not enough.

Seriously, is this necessary?  For the record, we never had RED CAPS before, so now we are spending health care dollars on this fabulous headwear.  (Hashtag #whyamericanmedicineisgoingtohellinahandbasket)

In all my years as a surgeon, I have never had an instance where there was someone in my operating room that I did not know, or was not introduced to (such as a nursing student, inspector, repairman, etc.)  And if there was someone in my room and I do not know why they are there— I ASK WHO THEY ARE AND WHY THEY ARE THERE.

I don’t depend on the color and coordination of their outfit to satisfy my curiosity.

Because any idiot can put on a red cap.  I did.  I wore that thing all day!  I’m operating and I’m vending!  Oh, I’m vending, Jerry.  I’m vending!  And I hear that UPMC allowed a VENDOR to perform surgery!  (Psst.  It was just me.  In the red hat.  Don’t tell.)

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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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Apparently there is a regulation that healthcare workers wear an ID tag.  It is not clear whether this is to ensure the safety of the public, remind absent-minded workers who they are, or protect the innocent.

For 23 years, I have performed eye surgery at a number of hospitals and locations.  I have NEVER worn an ID badge at any point while operating.

For one thing, we wear sterile hospital gowns over our scrubs, which would cover any name badge.

For another thing, I do not operate on patients I don’t know or have never met.  I certainly wouldn’t want someone I have never met to operate on me.  All my patients have seen me at least once in my office before any surgery is scheduled.  They KNOW me.  Badge or no badge.

The staff I work with knows me.  I have operated there since 2003.  Sure, there are new people hired now and then.  They get to know me.  No badge required for that little exchange of information.  Some may regret meeting me, but that’s another story altogether.

So while this well-meaning regulation may have some use in certain situations–I fully understand that a patient or family member in a hospital setting might be interested to know who is coming into their room and for what reason–is this person a nurse, a nurse practitioner, a physician’s assistant, a respiratory therapist, or a janitor, or is it someone who just stayed at a Holiday Inn Express last night?  I still think simply asking if you are curious would be sufficient, but no one asked me.

But there is no legitimate reason on God’s good earth, why I should wear an ID badge while operating at an institution that knows me, with people who know me, on patients who know me.  And for crying out loud, they have cataracts!  They couldn’t read the name tag anyway!

slapstupid

But today, the Board of Health (Bom, bom bommm!) came to our tagless institution for the supposed purpose of evaluating and certifying the place.  Basically this means they want to make sure that we are following their rules, even if those rules interfere with basic patient care.  None of this regulatory crap has anything to do with “patient care” anymore than Obamacare has anything to do with patient care (whereas it has everything to do with the government controlling your healthcare for better or worse, but again, that is a story for another day.)

But as I prepared to give patients the gift of sight today, I was accosted by a supervisor at our surgery center who insisted that I wear an ID tag–because the Board of Health (Bom, bom bommm!) is coming.

“Did we check the lights in the old north church?”

One if by land, and two if by sea.

The Board of Health is coming!  The Board of Health is coming!  (Bom, bom bommm!)

IDtag

Seriously?  Are you freaking kidding me?

And this serves what purpose in the treatment of my patients today????

The healthcare system in this country is sinking, and apparently the Board of Health is rearranging deck chairs on the Titanic.

I was not the only doctor wearing these make shift labels today–we all were.  Misery stupidity loves company.  None of us routinely wear ID badges. WE DON’T NEED THEM.  Doesn’t improve patient care.  And what’s to keep some criminal on the street from stealing a pair of scrubs and using a Sharpie pen to make his/her own name tag?

BTW–the Penn State badge is there because I am not allowed to wear my PSU scrubs anymore–only hospital issue uniforms.  Another brilliant regulation dreamed up by someone who doesn’t have a real job, doesn’t do my job, but knows they can do my job better, and has to justify their existence on this planet by enforcing said regulation.  The PSU badge does improve patient care–it makes me a happy doctor to wear it, and happy surgeons are BETTER surgeons.  Trust me on that one.  (Really, would you want someone unhappy to be putting sharp objects in your EYE!)

At least after I was done pounding my head against a wall in frustration, I could look down and remember who I was!

 

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