I have thought for a long time about publishing this account.
If you read my blog, you will probably get the impression, that I don't suffer fools gladly, and that I occasionally and often unintentionally stir up shit.
Now in case I go into politics, I would like to state that anybody who uses their authority including their sexual gender to bully or disadvantage somebody is a complete slime bucket. I am sure most people share this revulsion. It is however this revulsion that makes accusations of sexual harassment so potent.
I am male and a doctor. Most nurses are female ( a significant number of ICU nurses are male though). Doctors who are mostly male are higher on the hospital food chain than nurses (although as a student and resident I fequently questioned this). In the hospital the relationship between doctors and nurses is often one of tension. Part of this is a good thing. If either side automatically deferred to the other, it would be to the detriment of the patient.
Now, when I first started working at the Centre of Excellence, it was pretty obvious that there was some real bad blood between anaesthesia and the ICU nurses. Everywhere I worked there has been some sort of tension; I think ICU nurses resent anaesthetists who aren't intimidated by all the machines and lines in the ICU. The first time I dropped a patient off in the ICU, one of the nurses asked, "Who is the idiot who sutured in this central line?". I told her I was the idiot and waited for the apology which never came. Anyway it seemed for the first few years all we talked about at staff meetings was the steady stream of complaints: ETT not taped in correctly, line tangled, O2 cylinder empty, patient brought into ICU at inconvenient time for them, and, incredibly, an accusation of billing fraud by anaesthesia. After a while it seemed like things got better but I suspect it was just that things that used to piss me off didn't matter any more and I just learned to do things that wouldn't piss them off. Sort of like a bad marriage.
Sorry that this is taking so long to get to the point but I have to give the background.
About a month before the event in question I took a patient back to the ICU after a major head and neck case. We called these face-offs and they usually last at least 16 hours. This one however had been done once before and only took 8 hours so we took the patient back to the ICU around 1600 hours. When you take a freshed trached, ventillated patient back to the ICU, it is a lot more complicated for anaesthesia than just taking a patient back to the RR. While the CofE does at least 3 of these cases a week, it seems like every time I take a patient back to the ICU it is like they have never done it before. I have to ask for a transport monitor, ambu bag and oxygen cylinder. I'm not sure whether my colleagues just take their patients back to the ICU apneic and unmonitorred. I have to usually connect the monitors, zero the art line, make sure the lines aren't tangled or pulled out during the move. I also have to make sure the patient doesn't wake up on the way to the ICU. In short phoning the ICU to tell them we are on the way, is low on my priority list and something I figure someone else can do. Besides at the CofE when a patient goes to the ICU, an orderly actually goes over there to get the bed so that the patient doesn't have to transferred twice. Sort of a warning that we're coming pretty soon.
Now I don't know whether somebody from the OR phoned the ICU that day. It was apparent when we arrived that they weren't ready for us. For example there wasn't a ventillator.
The second clue that they weren't expecting us was the arrival of the charge nurse into the room where I was ventillating the patient by hand while waiting for the RT and ventillator to arrive. She unleashed a string of invective at me which lasted at least 5 minutes. The jist was that I alone of all the people involved in the case should have phoned the unit.
Now I am married and went to medical school, internship and residency in the 1980s so I have had my share of public tongue lashings and maybe I should have just said sorry and slunk out but on this particular day, I felt that a line had been crossed.
After the ventillator arrived. I walked out in the corridor approached the charge nurse, took her to an out of the way part of the ward and told her that her behaviour was entirely innappropriate and that I expected an apology. She refused.
So, I wrote a letter.
About a week later, the unit supervisor phoned me to tell me that she had a investigated the incident, that what I said happened had actually happened, that it was not appropriate, and that the nurse in question would be writing me a letter of apology which I received in due course.
To be continued......
Monday, December 1, 2008
Monday, November 17, 2008
Akela
I recently posted about my old scout master who probably was a pedophile and why we might not have seen the warning signs. The fact is there was somebody in our scouting community who was even weirder.
I talk about Akela. If you are unfamiliar with cubs; leaders in cubs are given names from Kipling's Jungle Book series. The head honcho is Akela, then it goes down the chain Baloo, Baghera, etc.
Our scout group at the tail end of the baby boom had enough cubs to make up two packs. These were known as A pack and B pack. Today there would be a stigma about being in B pack which is the pack my brothers and I went through. There wasn't then although A pack was clearly superior in every way. It was all attributable to their Akela. (Our pack had an Akela too , actually we had 2 different ones during the time I was a cub).
Akela was a 50ish gentleman, unmarried who lived with his mother. (Sound familiar?). She helped out with his cub pack and was given the title of Raksha. I'm not sure where in the hierarchy comes Raksha. She died sometime while I was still in cubs. Akela was born in England and had been an instructor at the military college but had retired early. I suspect there was some money in his family.
Our area of Victoria was by no means the slums, in fact it was probably the most affluent area of Victoria, however there were clear class differences. "A" pack were definitely a higher class of cub. Many of them had hyphenated names, quite a few of them went to private school, some had faux English accents. My mother when it was time for me to go into cubs for some reason tried to get me into "A" pack. She phoned Akela, who was quite positive until he asked her what school I went to. She told him and he made some lame excuse about why I couldn't be in his pack and I went into "B" pack. Apparently I came from the less right side of the tracks.
One of the ordeals of my cub career was the twice yearly soccer game against "A" pack. For the most part this meant getting thoroughly annihilated. One game we only had 10 players so "A" pack lent us their worst player who scored our only goal. Once we tied them which was a huge moral victory. After I left cubs, our Akela (Bkela?) got sick of being beaten and brought in ringers, kids who could actually play soccer and the beatings ended. They also beat us in softball and in floor hockey.
Overall even when at the time, it appeared that "A" pack was better organized and had a lot more fun than we did in "B" pack. Partially this was because Akela was retired and had time to do stuff, unlike our Akela who was just a parent of one of the cubs and had other commitments like a job. For example during the 3 summers I was in cubs we only had one summer camp because our Akela couldn't get the time off from work.
Which of course brings me to camp. Akela owned a large property about 30 minutes away. We camped there in Scouts and it was a fantastic location. It was wooded and a small river ran through it which was wide enough and deep enough to swim and dive it. Akela had built some tent platforms and a small building and his cub pack went out there a couple of times a year for a camp.
Once a year, "A" pack had a little party and slide show on a Saturday. One year my mother was asked to bake some squares and help out at the party (apparently A pack mothers didn't bake). She asked me if I wanted to come along, so I did, mostly so I could have some of her squares. Therefore I got to watch the slide show.
Aside from the slides documenting their humiliations of "B" pack on the soccer field, there were a number of slides of the camps out at Akela's property. Most of these slides were of the cubs swimming and it was quite apparent that nobody was wearing bathing suits. No they weren't swimming fully clothed, they were naked. Watching this slide show, were all the cubs parents, sisters, and who know how else.
And nobody thought this was unusual.
Now none of these pictures were graphic although you could see lots of pre-adolescent genitalia.
When I went to Scouts I got to know many of these cubs and it was something most people just laughed about. Apparently Akela and his mother strongly believed that swimming naked was in some way character building. Nobody ever said they had been touched inappropriately although it isn't something you bring up. Some people admitted to being embarrassed because girls in their class at school attended the slide show.
A few years later, one of the parents attended the slide show; complained and the skinny dipping stopped.
A few years later, Akela started up another cub pack labelled "C" pack who were children from a disadvantaged area of town. Every afternoon after school he would pick them up in the panel van our group had bought and drive them to and from the scout hall. He was trying to give them the same experience as his upper crust kids were getting. After a year or so, he went and asked the "group committee" would administered our group and raised funds for $10.00 for a party for his "C" pack. They turned him down and he resigned as Akela of "A" pack. I believe he continued on with "C" pack for a while after.
I was actually there the day he resigned. I was in Venturers and somebody had asked me if I could help out with his cub pack so I agreed. I suspected he was a bit of a pervert even then but I had talked to him a few times over the years and had sort of come to like and respect him. I helped out for about 2 months and had a lot of fun. He really liked his kids and he may have been a little tactile but never in the danger zones.
After he resigned, his pack went thru several leaders and probably folded. Things weren't the same.
He later donated his land to the local Scouts.
Again single man, lives with his mother, takes pictures of naked boys. Eccentric, that's all we thought in the 1960s.
I talk about Akela. If you are unfamiliar with cubs; leaders in cubs are given names from Kipling's Jungle Book series. The head honcho is Akela, then it goes down the chain Baloo, Baghera, etc.
Our scout group at the tail end of the baby boom had enough cubs to make up two packs. These were known as A pack and B pack. Today there would be a stigma about being in B pack which is the pack my brothers and I went through. There wasn't then although A pack was clearly superior in every way. It was all attributable to their Akela. (Our pack had an Akela too , actually we had 2 different ones during the time I was a cub).
Akela was a 50ish gentleman, unmarried who lived with his mother. (Sound familiar?). She helped out with his cub pack and was given the title of Raksha. I'm not sure where in the hierarchy comes Raksha. She died sometime while I was still in cubs. Akela was born in England and had been an instructor at the military college but had retired early. I suspect there was some money in his family.
Our area of Victoria was by no means the slums, in fact it was probably the most affluent area of Victoria, however there were clear class differences. "A" pack were definitely a higher class of cub. Many of them had hyphenated names, quite a few of them went to private school, some had faux English accents. My mother when it was time for me to go into cubs for some reason tried to get me into "A" pack. She phoned Akela, who was quite positive until he asked her what school I went to. She told him and he made some lame excuse about why I couldn't be in his pack and I went into "B" pack. Apparently I came from the less right side of the tracks.
One of the ordeals of my cub career was the twice yearly soccer game against "A" pack. For the most part this meant getting thoroughly annihilated. One game we only had 10 players so "A" pack lent us their worst player who scored our only goal. Once we tied them which was a huge moral victory. After I left cubs, our Akela (Bkela?) got sick of being beaten and brought in ringers, kids who could actually play soccer and the beatings ended. They also beat us in softball and in floor hockey.
Overall even when at the time, it appeared that "A" pack was better organized and had a lot more fun than we did in "B" pack. Partially this was because Akela was retired and had time to do stuff, unlike our Akela who was just a parent of one of the cubs and had other commitments like a job. For example during the 3 summers I was in cubs we only had one summer camp because our Akela couldn't get the time off from work.
Which of course brings me to camp. Akela owned a large property about 30 minutes away. We camped there in Scouts and it was a fantastic location. It was wooded and a small river ran through it which was wide enough and deep enough to swim and dive it. Akela had built some tent platforms and a small building and his cub pack went out there a couple of times a year for a camp.
Once a year, "A" pack had a little party and slide show on a Saturday. One year my mother was asked to bake some squares and help out at the party (apparently A pack mothers didn't bake). She asked me if I wanted to come along, so I did, mostly so I could have some of her squares. Therefore I got to watch the slide show.
Aside from the slides documenting their humiliations of "B" pack on the soccer field, there were a number of slides of the camps out at Akela's property. Most of these slides were of the cubs swimming and it was quite apparent that nobody was wearing bathing suits. No they weren't swimming fully clothed, they were naked. Watching this slide show, were all the cubs parents, sisters, and who know how else.
And nobody thought this was unusual.
Now none of these pictures were graphic although you could see lots of pre-adolescent genitalia.
When I went to Scouts I got to know many of these cubs and it was something most people just laughed about. Apparently Akela and his mother strongly believed that swimming naked was in some way character building. Nobody ever said they had been touched inappropriately although it isn't something you bring up. Some people admitted to being embarrassed because girls in their class at school attended the slide show.
A few years later, one of the parents attended the slide show; complained and the skinny dipping stopped.
A few years later, Akela started up another cub pack labelled "C" pack who were children from a disadvantaged area of town. Every afternoon after school he would pick them up in the panel van our group had bought and drive them to and from the scout hall. He was trying to give them the same experience as his upper crust kids were getting. After a year or so, he went and asked the "group committee" would administered our group and raised funds for $10.00 for a party for his "C" pack. They turned him down and he resigned as Akela of "A" pack. I believe he continued on with "C" pack for a while after.
I was actually there the day he resigned. I was in Venturers and somebody had asked me if I could help out with his cub pack so I agreed. I suspected he was a bit of a pervert even then but I had talked to him a few times over the years and had sort of come to like and respect him. I helped out for about 2 months and had a lot of fun. He really liked his kids and he may have been a little tactile but never in the danger zones.
After he resigned, his pack went thru several leaders and probably folded. Things weren't the same.
He later donated his land to the local Scouts.
Again single man, lives with his mother, takes pictures of naked boys. Eccentric, that's all we thought in the 1960s.
Role Models
One of the questions I ask prospective residents when I interview them is, "who are your non-medical role models?" Just to get them talking, nothing at all to do with their potential as an anaesthesiologist.
I have recently asked myself, who were my role models?
I can think of a few, my parents, a few teachers and....
My old scout master.
Scouting was a huge part of my childhood and adolescence. I was in Cubs, Scouts and Venturers from the time I was 8 until I graduated from high school. The most formative years were however from 11-14 when I was in scouts.
Our scout master liked to be called by his first name. In the 1960s having an adult who let non-adults call him anything other than Mr. was unusual. His first name was Dave and I will call him that for the rest of this blog.
Dave was born in England and had moved to Canada with his parents as a young adult. He was still not married and lived with his parents. Dave ran the scout troop. Other adults and few older teenagers helped out from time to time but it was Dave's show.
We had our meetings every Thursday evening. These were incredibly well organized evenings chock full of several interesting activities all planned by Dave. Every Saturday morning he came to the scout hall for those of us who wanted to pass tests or earn badges. Every couple of months we had a hike on a Saturday or Sunday. We also had weekend camps about three times a year and in the summer we had a 9 day camp in the mountains.
Dave was a real hiking and camping enthusiast. He was big into light weight camping where you packed in all your gear. The idea was to be as comfortable as possible while still carrying in almost everything. We often had over 30 people per camp so every camp was a major military operation supervised by Dave.
Periodically we had "wide games" which were huge operations based on variations of "capture the flag" or a treasure hunt. These were also elaborately organized and some of them must have taken days to set up.
Dave's effect on the troop was such that our troop had over 40 scouts at a time when Scout troops all over the area were folding.
Dave also helped out perioidically with the Venturers, was involved in the local hiking club and was involved as a Big Brother.
Dave was soft spoken, when not in scout uniform (which he wore with short pants and knee socks) he was always well dressed. There was a story that he broke up with a rare girlfriend because she wore jeans to his parents house. He drove a Rover. He was an enthusiastic landscape photographer and had an SLR camera which weren't very common in the 1960s (and was the first thing I purchased when I finally had money). If you had a problem, he was always willing to talk things out and could be very philosophical.
As I said he was a huge influence on my life. I wish I could say that this was the start of a life-long commitment to camping, hiking and mountaineering; sadly while I enjoy looking at mountains, I don't really like climbing and I enjoy my bed too much.
I went up to Venturers at 15 (I stayed an extra year in Scouts, I liked it so much). About a year later, Dave who worked for the government was transferred to another town. He got right into the local Scouting movement and the next summer his new troop had a joint summer camp with his old troop.
I last saw him when I was 20. I was coming home for a break from my summer work and was on the ferry home. He was also visiting his parents. We sat together and talked for the whole trip. It was like two old friends talking together. I have never seen him since.
I went to medical school, kicked around in various places in Canada and I was living in Eastern Canada when I heard that he had been charged and pleaded guilty to sexually abusing one of his scouts. He spent some time in prison. I was out of the province so I missed any media coverage and I have lost contact with just about all of my scouting buddies. I have talked it over with my older brothers who preceded my in Scouts. One says there is no way he was guilty; the other says, of course he was guilty. My father believes he pleaded guilty in order to prevent the child who accused him from having to testify and be cross-examined. I have a hard time believing anybody would willingly go to jail as pedophile.
Now looking back, maybe it should have been obvious. We have a quiet soft spoken man who lives with his parents, is heavily involved in Scouting and Big Brothers, doesn't have a girlfriend, and likes to take pictures. Perfect profile of a pedophile? This was the 1960s; there were lots of men like him and they were largely respected in the community. When I was writing this blog, I googled him and all I could find a was an award for distinguished service to scouting in 1969.
All I can say is he never touched me (maybe I was lucky) and I never ever heard anything untoward about him from any of my friends although being diddled by your scoutmaster isn't something teenagers brag about. One time in Venturers we were hiking up in the mountains and we came across him camping with his Little Brother. In 1973 we didn't think that was unusual.
About 5 years ago our scout troop had a reunion. It was on a weekend and while I wasn't working, it would have meant flying there so I didn't go. I just thought it would be a whole lot of people I had nothing in common with anymore trying to make conversation. The whole uneasiness about Dave played a role. One of my brothers attended and said it was a lot of fun and that Dave was there.
About a month later, I got a letter from Dave. He said that he was now retired and living with his wife(!) on one of the Gulf Islands. I meant to write hime back to tell him what a good role model he had been for me but the letter disappeared into a black hole on my desk and I never did write the letter. I lost his address too.
I attended a workshop on hypnosis last spring and we talked about forgiveness. The speaker said it is possible to forgive somebody without condoning what they did. I cannot condone anybody who uses a position of authority to hurt somebody, especially a child. I can forgive him however for what he did to that child and for the doubts he has raised about my whole Scouting experience.
I have recently asked myself, who were my role models?
I can think of a few, my parents, a few teachers and....
My old scout master.
Scouting was a huge part of my childhood and adolescence. I was in Cubs, Scouts and Venturers from the time I was 8 until I graduated from high school. The most formative years were however from 11-14 when I was in scouts.
Our scout master liked to be called by his first name. In the 1960s having an adult who let non-adults call him anything other than Mr. was unusual. His first name was Dave and I will call him that for the rest of this blog.
Dave was born in England and had moved to Canada with his parents as a young adult. He was still not married and lived with his parents. Dave ran the scout troop. Other adults and few older teenagers helped out from time to time but it was Dave's show.
We had our meetings every Thursday evening. These were incredibly well organized evenings chock full of several interesting activities all planned by Dave. Every Saturday morning he came to the scout hall for those of us who wanted to pass tests or earn badges. Every couple of months we had a hike on a Saturday or Sunday. We also had weekend camps about three times a year and in the summer we had a 9 day camp in the mountains.
Dave was a real hiking and camping enthusiast. He was big into light weight camping where you packed in all your gear. The idea was to be as comfortable as possible while still carrying in almost everything. We often had over 30 people per camp so every camp was a major military operation supervised by Dave.
Periodically we had "wide games" which were huge operations based on variations of "capture the flag" or a treasure hunt. These were also elaborately organized and some of them must have taken days to set up.
Dave's effect on the troop was such that our troop had over 40 scouts at a time when Scout troops all over the area were folding.
Dave also helped out perioidically with the Venturers, was involved in the local hiking club and was involved as a Big Brother.
Dave was soft spoken, when not in scout uniform (which he wore with short pants and knee socks) he was always well dressed. There was a story that he broke up with a rare girlfriend because she wore jeans to his parents house. He drove a Rover. He was an enthusiastic landscape photographer and had an SLR camera which weren't very common in the 1960s (and was the first thing I purchased when I finally had money). If you had a problem, he was always willing to talk things out and could be very philosophical.
As I said he was a huge influence on my life. I wish I could say that this was the start of a life-long commitment to camping, hiking and mountaineering; sadly while I enjoy looking at mountains, I don't really like climbing and I enjoy my bed too much.
I went up to Venturers at 15 (I stayed an extra year in Scouts, I liked it so much). About a year later, Dave who worked for the government was transferred to another town. He got right into the local Scouting movement and the next summer his new troop had a joint summer camp with his old troop.
I last saw him when I was 20. I was coming home for a break from my summer work and was on the ferry home. He was also visiting his parents. We sat together and talked for the whole trip. It was like two old friends talking together. I have never seen him since.
I went to medical school, kicked around in various places in Canada and I was living in Eastern Canada when I heard that he had been charged and pleaded guilty to sexually abusing one of his scouts. He spent some time in prison. I was out of the province so I missed any media coverage and I have lost contact with just about all of my scouting buddies. I have talked it over with my older brothers who preceded my in Scouts. One says there is no way he was guilty; the other says, of course he was guilty. My father believes he pleaded guilty in order to prevent the child who accused him from having to testify and be cross-examined. I have a hard time believing anybody would willingly go to jail as pedophile.
Now looking back, maybe it should have been obvious. We have a quiet soft spoken man who lives with his parents, is heavily involved in Scouting and Big Brothers, doesn't have a girlfriend, and likes to take pictures. Perfect profile of a pedophile? This was the 1960s; there were lots of men like him and they were largely respected in the community. When I was writing this blog, I googled him and all I could find a was an award for distinguished service to scouting in 1969.
All I can say is he never touched me (maybe I was lucky) and I never ever heard anything untoward about him from any of my friends although being diddled by your scoutmaster isn't something teenagers brag about. One time in Venturers we were hiking up in the mountains and we came across him camping with his Little Brother. In 1973 we didn't think that was unusual.
About 5 years ago our scout troop had a reunion. It was on a weekend and while I wasn't working, it would have meant flying there so I didn't go. I just thought it would be a whole lot of people I had nothing in common with anymore trying to make conversation. The whole uneasiness about Dave played a role. One of my brothers attended and said it was a lot of fun and that Dave was there.
About a month later, I got a letter from Dave. He said that he was now retired and living with his wife(!) on one of the Gulf Islands. I meant to write hime back to tell him what a good role model he had been for me but the letter disappeared into a black hole on my desk and I never did write the letter. I lost his address too.
I attended a workshop on hypnosis last spring and we talked about forgiveness. The speaker said it is possible to forgive somebody without condoning what they did. I cannot condone anybody who uses a position of authority to hurt somebody, especially a child. I can forgive him however for what he did to that child and for the doubts he has raised about my whole Scouting experience.
Sunday, November 16, 2008
I Was a Medical Criminal Part III
Just a note that after venting on my blog, I did what someone described as the closest thing an Englishman will do to rebelling, I wrote a letter. I wrote a letter to the chief of staff for the region.
A few days later, his executive assistant phoned me and wasn't really helpful BUT a month later I actually got a signed letter from the Chief of Staff himself, appologizing for the whole incident.
So I am no longer an medical records criminal.
A few days later, his executive assistant phoned me and wasn't really helpful BUT a month later I actually got a signed letter from the Chief of Staff himself, appologizing for the whole incident.
So I am no longer an medical records criminal.
Saturday, November 15, 2008
Am I a Luddite
Technology was supposed to make life simpler for us. In some ways it has. I would never want to go back to submitting my billing on paper; paying my dues on-line is easier and of course if I wasn't writing this stupid blog, I would actually feel obliged to do some work.
A couple of new technological hurdles are making me wonder however.
At a recent staff meeting, a member raised a concern about our new anaesthetic machines. Apparently in our case room we have the newest generation Drager machine. It is in the case room because for some reason Ob-Gyn "paid" for it. The problem with this machine is that if it is turned off, it takes literally 30 minutes for the software to boot up.
So don't turn it off you say.
Unfortunately for infection control reasons all operating rooms are terminally cleaned once a day which means moving all the equipment into the hall. This means unplugging the anaesthetic machine which unlike my laptop, doesn't have a back-up battery. (My laptop also plays music and surfs the internet unlike my anaesthetic machine.) Therefore unless somebody turns it back on, when you show up at 0300 for the prolapsed cord, the machine will not work. Now there is a process where you can "hot boot", the machine however the manufacturer warns that after 10 hot boots, the software will be damaged.
Our department has exclusively Drager machines in the main OR which also have a boot up process after being unplugged but it is possible be randomly pushing at buttons to bypass this.
Does all this software make anaesthesia safer. No.
Gather round children while Grandpa tells you about anaesthesia in the olden days.
We had machines that were essentially copper pipes with valves. They were driven by the compressed gas from the central supply or from the O2 cylinder. And they were safe. If the compressed O2 failed, the N20 which was held open by the gas pressure also shut off, and a loud whistle sounded. There was a mechanical link which automatically reduced the N2O when the O2 flow was reduced and in addition it was impossible (on most machines) to completely turn the O2 off. You didn't need to plug them in to an electrical socket which meant you could if you were stupid enough or where forced to, move them with the patient to another room using the O2 cylinders. Oh yeah the O2 also drove the ventillator.
Now the greatest advance in patient safety in my lifetime was the invention and adoption of pulse oximetry. Not newer more elaborate machines that need to the plugged in to the wall socket and have finicky software. Not to mention those annoying alarms. Talk about crying wolf.
A year or so ago I went down to Ecuador. While there I went over to another hospital to do a case. In the room we were given I encountered an old Ohio machine. Some people would have fled the room in horror but I had actually used a similar machine, I was able to inspect it quickly, ascertain that it was in working order (and I am not very good with machines) and I knew that with a pulse oximeter, I would be able to give a very safe anaesthetic. Later that evening I recounted my adventure to a slightly younger anaesthetist who recoiled in horror at using a machine that in his words should be in a museum.
The second issue was the new Smart Pumps our hospital now has.
These are computerized infusion pumps designed to prevent medication errors. During the early fall nurses had to attend inservices lasting several hours to learn to use these machines. As anaesthesiologists we alone amongst physicians have to adjust these pumps we tried to get an inservice. I spent a great deal of time with the company explaining why we needed a full inservice (instead of just looking at them between cases which was what they offered). As it turned out I had to miss the inservice so I still in the dark about how to adjust these pumps. Again do these expensive and time consuming pumps improve patient safety.
No.
Will still there be medication errors?
Yes.
This reminds me that my wife who recently recertified as a nurse actually had to learn how to calculate flow rates by counting drips. She asked my about this. I told her it showed just how long it had been since most academic nurses had actually been in a hospital because nobody does that anymore.
A couple of new technological hurdles are making me wonder however.
At a recent staff meeting, a member raised a concern about our new anaesthetic machines. Apparently in our case room we have the newest generation Drager machine. It is in the case room because for some reason Ob-Gyn "paid" for it. The problem with this machine is that if it is turned off, it takes literally 30 minutes for the software to boot up.
So don't turn it off you say.
Unfortunately for infection control reasons all operating rooms are terminally cleaned once a day which means moving all the equipment into the hall. This means unplugging the anaesthetic machine which unlike my laptop, doesn't have a back-up battery. (My laptop also plays music and surfs the internet unlike my anaesthetic machine.) Therefore unless somebody turns it back on, when you show up at 0300 for the prolapsed cord, the machine will not work. Now there is a process where you can "hot boot", the machine however the manufacturer warns that after 10 hot boots, the software will be damaged.
Our department has exclusively Drager machines in the main OR which also have a boot up process after being unplugged but it is possible be randomly pushing at buttons to bypass this.
Does all this software make anaesthesia safer. No.
Gather round children while Grandpa tells you about anaesthesia in the olden days.
We had machines that were essentially copper pipes with valves. They were driven by the compressed gas from the central supply or from the O2 cylinder. And they were safe. If the compressed O2 failed, the N20 which was held open by the gas pressure also shut off, and a loud whistle sounded. There was a mechanical link which automatically reduced the N2O when the O2 flow was reduced and in addition it was impossible (on most machines) to completely turn the O2 off. You didn't need to plug them in to an electrical socket which meant you could if you were stupid enough or where forced to, move them with the patient to another room using the O2 cylinders. Oh yeah the O2 also drove the ventillator.
Now the greatest advance in patient safety in my lifetime was the invention and adoption of pulse oximetry. Not newer more elaborate machines that need to the plugged in to the wall socket and have finicky software. Not to mention those annoying alarms. Talk about crying wolf.
A year or so ago I went down to Ecuador. While there I went over to another hospital to do a case. In the room we were given I encountered an old Ohio machine. Some people would have fled the room in horror but I had actually used a similar machine, I was able to inspect it quickly, ascertain that it was in working order (and I am not very good with machines) and I knew that with a pulse oximeter, I would be able to give a very safe anaesthetic. Later that evening I recounted my adventure to a slightly younger anaesthetist who recoiled in horror at using a machine that in his words should be in a museum.
The second issue was the new Smart Pumps our hospital now has.
These are computerized infusion pumps designed to prevent medication errors. During the early fall nurses had to attend inservices lasting several hours to learn to use these machines. As anaesthesiologists we alone amongst physicians have to adjust these pumps we tried to get an inservice. I spent a great deal of time with the company explaining why we needed a full inservice (instead of just looking at them between cases which was what they offered). As it turned out I had to miss the inservice so I still in the dark about how to adjust these pumps. Again do these expensive and time consuming pumps improve patient safety.
No.
Will still there be medication errors?
Yes.
This reminds me that my wife who recently recertified as a nurse actually had to learn how to calculate flow rates by counting drips. She asked my about this. I told her it showed just how long it had been since most academic nurses had actually been in a hospital because nobody does that anymore.
Transferring your stress
I attended a meeting last weekend. It was a pain meeting but one of the talks was on "stress management in the pain provider". It was a talk I looked forward to when I looked at the program first thing in the morning. The presenter is a physician who works for the medical association's physician help program and in addition writes articles that I have always enjoyed reading.
I was disappointed.
Right from the start, this doctor (who is younger than me) stated that his practice was currently restricted to weekend locum coverage and surgical assists. During the talk he casually mentioned his interesting travels, his winter "retreat" in the New Mexico desert and the fact that he never works on his wife's birthday.
So.......
The solution to stress for all of us is:
Work part-time but also only chose work that you really like when you feel like it.
Take lots of vacation.
Now I work more or less full-time both as an anaesthesiologist and also as a chronic pain doctor. This is by choice, anaesthesia is one of the specialties where part-time work is a viable option. I also take between 6-10 weeks of vacation depending on how things shake out. Sometimes my work is stressful, I can't say for sure whether it is more or less stressful than 25 years ago.
But imagine now if all the doctors decided they were going to work part-time and only do work that suited them. Aside from needing 2-3 times more doctors, what about the patients and work that doesn't suit anybody. Who sees these patients.
Our expert in stress is not alone however. There are becoming more and more doctors who are working part-time, refusing to take patients with chronic diseases, refusing to work evenings or weekends (in fairness our expert apparently only works weekends which are a pain but you do get paid more). This is causing more stress on those of us who are old school and believed that you take the good cases with the bad and that real doctors still work evenings and weekends.
Anyway I hope our expert in stress is able to put his honorarium to good use and maybe he can do fewer weekends or maybe take off his neighbour's birthdays. I hope he is thankful to the taxpayers who subsidized his education so that he can work part-time,to mention the individual who didn't get into medical school so that he could, and the physicians in his community who have picked up his slack.
And I am no further along in managing my stress
I was disappointed.
Right from the start, this doctor (who is younger than me) stated that his practice was currently restricted to weekend locum coverage and surgical assists. During the talk he casually mentioned his interesting travels, his winter "retreat" in the New Mexico desert and the fact that he never works on his wife's birthday.
So.......
The solution to stress for all of us is:
Work part-time but also only chose work that you really like when you feel like it.
Take lots of vacation.
Now I work more or less full-time both as an anaesthesiologist and also as a chronic pain doctor. This is by choice, anaesthesia is one of the specialties where part-time work is a viable option. I also take between 6-10 weeks of vacation depending on how things shake out. Sometimes my work is stressful, I can't say for sure whether it is more or less stressful than 25 years ago.
But imagine now if all the doctors decided they were going to work part-time and only do work that suited them. Aside from needing 2-3 times more doctors, what about the patients and work that doesn't suit anybody. Who sees these patients.
Our expert in stress is not alone however. There are becoming more and more doctors who are working part-time, refusing to take patients with chronic diseases, refusing to work evenings or weekends (in fairness our expert apparently only works weekends which are a pain but you do get paid more). This is causing more stress on those of us who are old school and believed that you take the good cases with the bad and that real doctors still work evenings and weekends.
Anyway I hope our expert in stress is able to put his honorarium to good use and maybe he can do fewer weekends or maybe take off his neighbour's birthdays. I hope he is thankful to the taxpayers who subsidized his education so that he can work part-time,to mention the individual who didn't get into medical school so that he could, and the physicians in his community who have picked up his slack.
And I am no further along in managing my stress
Monday, October 6, 2008
I Was a Medical Records Criminal II
When I wrote the previous post, it brought to mind some other brushes I have had with medical records.
When I first finished my internship I went to do locums at a medium sized city in Atlantic Canada. I worked there for 10 months. Even then I was pretty compulsive about medical records and dictated all my histories and discharge summaries promptly or so I thought.
When I left I phoned up medical records, told them I was leaving town and could they get all my charts together because I wanted to finish them before I left. Like I said I was pretty conscientious then.
I worked in another community for about six months and then left the province for greener pastures. A few months after arriving in greener pastures I got a letter from the medical director stating that I was deficient in completing multiple charts and that they would be reporting me to the Medical Board unless I forthwith reported to their medical records department. I wrote a polite letter back stating that I was now on the other side of the continent, that I had actually tried to complete everything before I left, that they could have tried to contact me while I actually lived only an hour away and that despite everything if they sent me the charts I would be happy to try to complete them.
In time I received a large bundle of charts. Many of these were charts belonging to people who I had done locums for who figured it must have been me who looked after the patient in question (in most cases it wasn't). I also found out that many specialists had a little trick of transferring patients back to their family doc on the day of discharge, thus making the family doc responsible for the discharge summary. I was stung pretty badly there, worse because in most cases I never even knew the patient was in hospital and had usually never met them. I also learned for the first time that the hospital had a policy that when you assisted on a hysterectomy (which I did quite a bit) you had to write a consult agreeing that the procedure was necessary. (Imagine me as a very young GP telling the Gynecologist, "you leave that uterus in!")
Anyway I completed them as best I could and sent them back and I never heard back from the hospital again.
The first hospital I worked for as an anaesthesiologist had a very activist medical record department. We anaes don't do a lot of dictating but we do as it turns out give a lot of verbal orders which eventually have to signed. The hospital had a two week cut-off after which you were off staff and you were supposed to keep up on it which meant visiting medical records to see if you had any charts.
Now at this hospital there was a computer screen at the doctor's entrance and you were supposed to log-in every time you came in the hospital so that switchboard would know you were in the hospital. This was of minor importance when you were on call because you couldn't here overhead pages in the OR or caseroom and if switchboard didn't know you were in the hospital they wouldn't try to look for you. This on one occasion resulted in an orthopod yelling at my wife on the phone because she didn't know where I was and I had forgotten to log in. Anyway after that I always tried to log in.
One evening I was coming in to do some type of "emergency" and tried to log-in only to be told I couldn't log-in because I had been kicked off staff for not signing my verbal orders. For a second I thought, this is great, I'm going home and someone else can do this emergency. But I didn't, I worked on illegally. Actually a couple of days later, I mentioned this to the Chief of Staff who told me, "actually it didn't mean you were really off staff", which of course made me wonder what exactly it did mean and why did they even bother.
Another story someone told me around that time is kind of funny. This doctor was driving thru a rural community and was listening to the local radio station when, leading off the local news was the announcement that a doctor he knew had been suspended from staff at the local hospita. He of course contacted his colleague to find out what had happened and was told, "Oh, I just got behind on my charts, I'm not really off staff".
When I first finished my internship I went to do locums at a medium sized city in Atlantic Canada. I worked there for 10 months. Even then I was pretty compulsive about medical records and dictated all my histories and discharge summaries promptly or so I thought.
When I left I phoned up medical records, told them I was leaving town and could they get all my charts together because I wanted to finish them before I left. Like I said I was pretty conscientious then.
I worked in another community for about six months and then left the province for greener pastures. A few months after arriving in greener pastures I got a letter from the medical director stating that I was deficient in completing multiple charts and that they would be reporting me to the Medical Board unless I forthwith reported to their medical records department. I wrote a polite letter back stating that I was now on the other side of the continent, that I had actually tried to complete everything before I left, that they could have tried to contact me while I actually lived only an hour away and that despite everything if they sent me the charts I would be happy to try to complete them.
In time I received a large bundle of charts. Many of these were charts belonging to people who I had done locums for who figured it must have been me who looked after the patient in question (in most cases it wasn't). I also found out that many specialists had a little trick of transferring patients back to their family doc on the day of discharge, thus making the family doc responsible for the discharge summary. I was stung pretty badly there, worse because in most cases I never even knew the patient was in hospital and had usually never met them. I also learned for the first time that the hospital had a policy that when you assisted on a hysterectomy (which I did quite a bit) you had to write a consult agreeing that the procedure was necessary. (Imagine me as a very young GP telling the Gynecologist, "you leave that uterus in!")
Anyway I completed them as best I could and sent them back and I never heard back from the hospital again.
The first hospital I worked for as an anaesthesiologist had a very activist medical record department. We anaes don't do a lot of dictating but we do as it turns out give a lot of verbal orders which eventually have to signed. The hospital had a two week cut-off after which you were off staff and you were supposed to keep up on it which meant visiting medical records to see if you had any charts.
Now at this hospital there was a computer screen at the doctor's entrance and you were supposed to log-in every time you came in the hospital so that switchboard would know you were in the hospital. This was of minor importance when you were on call because you couldn't here overhead pages in the OR or caseroom and if switchboard didn't know you were in the hospital they wouldn't try to look for you. This on one occasion resulted in an orthopod yelling at my wife on the phone because she didn't know where I was and I had forgotten to log in. Anyway after that I always tried to log in.
One evening I was coming in to do some type of "emergency" and tried to log-in only to be told I couldn't log-in because I had been kicked off staff for not signing my verbal orders. For a second I thought, this is great, I'm going home and someone else can do this emergency. But I didn't, I worked on illegally. Actually a couple of days later, I mentioned this to the Chief of Staff who told me, "actually it didn't mean you were really off staff", which of course made me wonder what exactly it did mean and why did they even bother.
Another story someone told me around that time is kind of funny. This doctor was driving thru a rural community and was listening to the local radio station when, leading off the local news was the announcement that a doctor he knew had been suspended from staff at the local hospita. He of course contacted his colleague to find out what had happened and was told, "Oh, I just got behind on my charts, I'm not really off staff".
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