Why Is Healthcare So Expensive?

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/13/AR2007021301149.html?referrer=emailarticle

Shame Lawsuits

I was reading on Paul Levy's blog about the shame MD's have when in a malpractice suit. The thing that struck me was when he said that doctors often practice "defensive medicine" (which is taking too many tests in order to avoid the chance of a lawsuit).

I can't think of the number of times I've seen that practice in place. A simple thing that is often unnecessarily done is taking daily labs on a patient while in the hospital, even if the pt. isn't that ill and we have a handle on things. I've even seen doctors run tests on patients that are asymptomatic because a family member is aggressive on getting the particular test done. It's sometimes easier to just do the test than fight with a family as to why it shouldn't be done. This is all done simply to cover themselves in a lawsuit as they did what the family wanted, or checked everything possible that was minimally invasive. If they didn't do what the family wanted and something was wrong, the family would have a lawsuit on their hands.

As a nurse I'm also taught to document defensively, to think about what I write and to make sure I've covered all bases in my note. And if I'm uneasy about something, the infamous "HO notified" will be written to cover me. I even used to work with another nurse who was so worried about the possibility of getting sued that she saved all of her notes! I'm not proud that every time I write a note I wonder how it would read in a courtroom.

I wonder how all these defensive practices are in protecting patients. In the old days doctors were revered and considered to be some of the most respected members in a community. Nobody dared to disagree with a doctor. Now, the patients are often armed with more information (whether correct or not) on their particular disease than some experts--thanks to the internet. I wonder if overall this is bringing more harm or good. The doctor patient relationship is all about trust and respect, as well as communicating effectively. Are these defensive practices building walls and preventing trusting relationships?

Daily Dog Video

My boyfriend and I have decided to do a little experiment. His new job is for an internet video company, and he is constantly amazed at how the #1 videos week after week on various sites are of animals.

With this information we decided to put together a site what will feature a new video of a dog every day! We even put a few ads on the page, we are basically curious to see what will happen and see if the site will pay for itself ($14/month). Anyway, check it out and let me know what you think!

Daily Dog Video

Nurse Uniform

I just learned this week that or Chief Nurse is looking at making a standard dress code or perhaps uniform for all the nurses.

Patients often complain of not knowing who their nurse is, I have more then once walked into a room and they thought that housekeeping was their nurse, or were confused as to how many they had at one time (they assume that anybody in scrubs and is female must be their nurse). Published articles have shown that it is something being challenged all over the country. I recently read an article in the American Journal of Nursing that discussed getting RN's to wear a patch with the letters "RN" in big bold letters as a solution. Have any hospitals tried this? I have not done research as to the success rate of this suggestion, if anybody has information I'd be very interested.

Other hospitals have the nursing staff wear scrubs, but they can only wear one color, and only nurses can wear that color. I think that is the solution I'm most leaning toward, as the days of white dresses, capes, and caps are long gone. Nurses need a uniform that is functional, comfortable, and easily washable. It also does need to distinguish the nursing profession from other hospital workers, as it is very confusing to patients. The care team consists of Dietitians, Physical Therapists, Occupational Therapists, Speech Therapists, Radiology, Nurses, and Doctors, it is difficult to keep straight when you are feeling well!

Nursing uniforms are needed, for the patients ability to feel more in control by simply knowing who is who. I look forward to see the change in the current practice and I can't wait to hear the response.

The Week in Review

I really can't believe how quickly time flew by this week. Our floor is loaded with sick patients, and overall the situations have been very urgent and very draining. I'm proud of the way the staff pulled together and helped one another out.

I'm also learning what it is like to be a teacher, I am precepting a nurse in her final semester before she graduates in May. This is a new experience for me, I used to teach in college but I've never had a student follow me, side by side, for weeks and weeks. It's forcing me to look at my own practice and I must say it is a good thing. I've been a nurse for two years now and I can't believe all I've learned and all I still have to look up. This is a good refresher for my practice and it is helping me understand what I do know well. I am astounded at how far I've come in two years!

Follow Up on Advocacy Patient

I just saw the post on Jan. 10th about how proud I was for fighting for a patient and making sure they get the care they deserve.

I've recently been taking care of the same patient, she's back from rehab and doing terribly. More complications have arisen after her surgery, and she is wiped out. I feel terrible for her as it was a surgery she never wanted to have. Now she's left fighting for her life and having more surgery, and will still need more surgery after that, currently in the ICU on a ventilator. When I went to visit she opened her eyes for me upon hearing my voice, but I don't know how much she registered. I don't know how to comfort her incredibly supportive family, as you can only say "I'm so sorry this has happened to you all" so many times.

What to do, what to say? Especially to those eyes that look through you and want out of their current nightmarish situation?



Hope.

Complications

I've just started reading a book titled "Complications" by Atul Gawande. I must say it will be an eye opening book for people who are not working in health care. This book does not sugarcoat a residency, instead it is brutally honest about what can occur when surgery begins, and when doctors make wrong choices.

This book also brings up all the questions of what to do when a good doctor goes bad. An example would be a physician who starts to take shortcuts and ignore problems that patients are having, leaving the patient with less than expected outcomes that greatly affect their well-being.

I never before thought about a doctor staying in the profession long after he should have retired. I always assumed (yes, I do remember what ass-u-me means) that doctors were smart enough to realize when they were jeopardizing their patients well-being by practicing.

Today a nurse I work with told me about an incident when she was a nursing student; a very well respected physician was performing an upper endoscopy and the consciously sedated patient started to unconsciously resist. Instead of pausing the procedure he reacted quickly and started slapping the patient on the head while telling her to behave. The rest of the team in the room caring for the patient were left with the burden of having to report their respected colleague of 30 years to the board, and even my friend had to leave a deposition of the incident.

I'm shocked that such an event could occur, and it is a prime example of when good doctors go bad.