I'm Sorry If I Offended You, But Blame It On My Neurons.

I am a nice guy. As my wife says, sometimes I say things in ways I shouldn't have.

But often times I am misunderstood in my intent.   I will often times call a cat a cat.  And not to offend the dogs out there,  I call a dog a dog.

There have been many a people that I have ticked off (unintentionally) since I started this blog.

Everything I write about are my observations about how I see things.

Here is a smattering of folks who have let me know of their feelings towards me.

Most recently from the respected physician #1 dinosaur when  I blogged about managing my own thyroid medication.

                                                                                                                                                                          I had a spat with the alpha one antitrypsin deficiency crowd when I blogged about becoming a medication pimp. That was a doozy.

I ticked off a few specialists in my blog by implying that procedures are about money in my red headed step child post  and here too.  I find it interesting, I didn't get any hate male from the read heads.

A chronic pain person lambasted me for my frequent flyer club post.

Some docs who abdicate their responsibilities as a physician by hiring PA's and NP to do their work for them to free up more time for procedures (where the money is)  were upset with me here in my entry pay for performance, procedure style

I had one lady insult me and then ended up calling herself a bitch (that was strange) in my post about what chronic illness looks like.

I got a lawyer pretty fired up in my lawsuit lotto entry.

I got ridiculed by a clinical nurse specialist  on her website for suggesting that hospital implemented documentation teams were not about anything other than more money for the hospital on my blog entry in a tongue in cheek look at the reasons for the nursing shortage

These are a few of the more notable examples of groups or individuals whom I have upset in one way or another in my 4 short months of blogging.

Let me tell everyone, categorically,  my intent with every entry is to call it like I see it.  I have said many times over and over again,  nothing should be taken personal.  I write, mostly,  about concepts and categories and how I see them in the setting of our health care delivery system. 

If I use a specific example about an experience of mine, it is not meant to single out any specific incident, but rather to represent, on a broader sense, the concepts which I blog about.

I had a long talk with my wife the other day about how being a physician has in some ways put me at a disadvantage in understanding how other people think.  I am convinced that my neurons have been changed.  

That I am certain of.  

I am sure many physicians feel the same way.

I could feel it happening during med school and residency.  The way I looked at everything and how others interacted with me changed. 

It was completely unexpected.  

My wife is a nurse, and as I have stated many times before, I have the utmost respect for nurses.  Underpaid and over worked.  They deal with the crap,  literally, on a daily basis of front line patient care.  They have to put up with the demanding families, the rude patients and rude doctors  who often times treat them more like waitresses than professionals.

Doctors?  5 minutes at the bed side and on to the next patient.

I often times marvel at the difference in understanding for what I think are simple concepts, which often times become a sort of patient emergency due to a lack of understanding, or a rigid hospital protocol that does not allow a common sense clause to be built in.

I described to my wife situations where I would receive phone calls for things that, while may seem silly to me,  simply aren't to the new nurse or nurse who must follow rigid protocols, or the nurse, who hasn't grasped a a certain aspect of patient care yet.

For physicians, we are always learning.  The education will never end.  It is the same for nurses. And I respect that. That they are always learning.  Just like me.

I should never fault a nurse for not understanding something,  just as I would not fault myself for not understanding something.

  

When I need help,  I look it up, or I call a specialist.  When a nurse needs help, they may ask their fellow nurses, or they may call me.   Sometimes the nurse has no choice but TO call me.  It is in their hospital protocols.  

Rigid protocols, to be applied equally across all people who are vastly different, but carry a unifying diagnosis.

Since you can't build a safety net based on separate patient characteristics,  it is built on rigid objective data as I describe below.

Several recent examples which I felt did not meet my muster for needing a phone interjection included:

1)  Being called for an INR of 1.0, the day after getting the first dose of coumadin.  I was asked if I wanted to adjust the coumadin dose.

2)  Getting called for a "low urine output"  on a 90 year old with a creatinine of 2.5

3)  Getting called for a bicarb level greater than 45 in a patient with chronic hypercapnea from sleep apnea and COPD

4)  Getting called for a hemoglobin of 8.5 in a patient with a chronic hemoglobin of 8.5.

I have learned to accept through deep aching soul searching that what may seem like common sense to me, and does not need an "actionable intervention (a phone call)",  may in fact be a combination of many factors on why I get these displaced phone calls.

After talking with my wife,  I have come to the conclusion , that this is simply the system we operate in.  For example:

1)  Nurses are required to call critical levels,  which have rigid definitions, even if a patient has a chronic, stable critical lab value  which by definition would make it not critical.  But I can't expect the lab or the nurse to take the fall, so to say.  The lawyers would chew them up and spit them out.    This is not the nurses fault.   It is my job is to write an order not to call this noncritical critical lab value.  

2)  Nurses often times look at each other when physicians do things they see as highly unorthodox or contradictory to their training.  "What the hell are they doing?"  I often times can agree with this train of thought when two docs such as myself or anther specialist are doing therapies which seem contradictory to each other.  Medicine is not an exact science.

3)  Nurses come from many different training backgrounds in terms of specialties, age, experience, levels of experience, 4 year degrees, 2 year degrees.  The range of nursing understanding and comfort is as broad for nursing as it is for physicians.  We are in the same boat,  just at different levels in the health care delivery chain.  I can very clearly relate with this.

4)  What may seem like common sense to me,  may be just that.  I can not expect every health care worker in every field to have the same level of understanding and training as I have.  When I need help,  I call a specialist.  When  a nurse needs help,  they call me ( or the specialist).

5)  It is up to me to clarify for the nurses what constitutes an emergency or a phone call.  Our group under took this effort several years ago.  We sent out guidelines on what to call to the night MD and what could wait until the morning crew arrived.  This cut down unneeded middle of the night pages by 70-80%, on some nights.  Oh,  and we changed the drawing of our labs from 3 am to 5 am.  I often times will now write an order not to call me low urine out put, or potassium levels less than 3.  It is up to me to define expectations.

6)  Know that we are all on the same team.

Thanks to everyone for their continued reading about what I think is going on and where we are heading.  Our entitled country is heading for an unmitigated financial disaster,  if in fact we are not already in one.  

When I say stuff that may seem offensive to you, please,  don't take it personal. 

You can blame it on my neurons. 

 I am.  

Hell,  everyone else can forgo responsibility for their actions.  

I think I'll let my neurons take the fall.

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