Monday, April 29, 2019

The Board

I trained as a medial student and intern in 3 different labour suites, caserooms whatever you
The unifying feature of caserooms was the The Board.

While The Board slightly varied between sites, there were constants.  The patient’s name, attending physician, Gravida and Parity, gestation and dilatation.  There was usually room for other info such as pre-eclampsia or VBAC.  It was such a valuable source of information for seeing what was going on and predicting workload.  The Board when I was junior was a blackboard with chalk.  Lately it is a whiteboard.  Such a low tech but effective way of communications.

At Vancouver General Hospital which did OB in the early 1980s, the medical students had to keep The Board up to date, which meant constantly having to bother the nurses about what the dilatation was (they didn’t tell you when they did vag exams, because you might want to do it yourself, which after all was one of the reasons you did an OB rotation) lest you get yelled at by  the crabby soon-to-be-former OB resident.  

When I came to my current medium size Catholic hospital 13 years ago the board had become more streamlined than what I remembered.  Dilatation and gestation were not charted, but it at least had the patients name, attending physician, gravida and para.  They also wrote a big E next to the patient if there was an epidural.  Very useful for anaesthesia when you came in on call.  

Something as effective and elegantly simple as the board was bound to come to an end of course.

Several years ago, I was called for an epidural and looking on the board saw that her last name was 3 letters long.  I went into the room but noticed she had a different name more than 3 letters long.  Back to the desk I went.  No I was told the 3 letters are the first three letters of her name which for privacy purposes we are now only allowed to use.  I rolled my eyes and did the epidural.  Of course as I commented many people nowadays have 2-3 letter last names, plus it is highly likely that you will have 2 people in labour at the same time who share the first three letters of their last name (McDonald/McDowell. Chan/Chang).  Other people whose opinion counted more than mine must have weighed in because they started putting on the full name again.  

About two years ago I got called for an epidural.  At our site they never tell us the patient’s name only the room #.  “Room 5 wants an epidural” they tell me.  I walked past The Board and noticed that the patient had the same last name as one of the obstetricians.  Of course when I walked into the room the patient had another name.  It turns out that for privacy now they were now only posting the name of the doctor on The Board.  Twice as it turns out under patient and under physician.  

The day before yesterday I walked onto the ward and The Board had shrunk to about 1/3 of its size.  “Why is The Board smaller?”, I asked.  “Its an accreditation standard, “ I was told.  I am not sure why it should matter at all to the accreditors but apparently it does.  The Board is now literally tiny.   Whereas you used to be able to stand back of the nursing station and read it, you now have to go right up to it.

This presumably is in the name of privacy.  My mother always told me if you had nothing to hide, you didn’t need any privacy.  I wonder how many patients really cared about their names being flashed up on The Board.  People after all pay to put birth announcements in the newspaper.  Labours are live-Tweeted, Facebooked and Instagrammed.  Plus I am sure in the past if people wanted the anonymity, they were accommodated with a pseudonym.  And if you’ve figured out that your husband’s mistress is in labour at this hospital you can probably find out which room she is labouring in.

At the same time, we actually have made labour a group activity.  It is not unusual to have multiple family members in the room, or hanging around the hallways (usually talking outside the call room) while the mother is in labour.   I frequently have to ask for all but one of them to leave when I do the epidural.  (As department head, I had to deal with a complaint about one of my colleagues doing just that).  My father on the other, even if he had wanted to, was not allowed to see any of the births of his 4 children, which may explain why I grew up so messed up.  

And there is the issue of depersonalization.  I seem to remember during my OB rotations that I actually knew the patient’s name.  Now most patients are referred to by their room number.  I even find myself writing the room number on the patient label I collect for billing so I can tell them apart.

Of course in the 21st century we could have replaced The Board with something electronic that might even be an improvement but I’m not holding my breath on that

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