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Friday, January 18, 2008

Relearning what we learned and learning more

After I had worked in the hospital for about five years I realized I had forgotten many of the basic things I was taught in school. The old saying that if you don't use it you lose it rang true with me.

One day we had a new RT hired here right out of RT school and he was still studying for his exams. He asked me if I knew what the alveolar air equation was. Of course I knew what it was, but I couldn't think of the formula nor how to apply it for the life of me.

Then one day I was called to talk to the hospital's lawyer because a man who was diagnosed with pneumonia died of something else "coincidentally" and the hospital's lawyer wanted me to be a witness to testify that the patient had obvious signs of pneumonia.

The lawyer said, "How often do you take care of pneumonia patients?"

I said, "I would say that probably about half of all our patients have pneumonia. So we take care of pneumonia patient's quite a bit."

"So you should be an expert in identifying pneumonia."

"Yeah, I guess."

"Okay, to make the jury impressed with your knowledge, I want you to rattle off the signs of pneumonia as fast as you can, like they are second nature to you."

"Okay," I said.

"So rattle them off."

"Ummm, pain with deep inspiration, brown sputum, isolated crackles, ummm..." My mind went blank. I could think of no more, however I knew there were more.

"No problem," he said, "When I talked with your co-worker he rattled off a list. I want you to memorize them in case we go to court."

I looked at the list; studied it. I added a few more signs that my co-worker missed, and the lawyer wrote them down.

I went home, looked up signs of pneumonia in one of my RT books, and discovered that we had both missed a couple more signs.

That was the day I decided I was going to re-learn what I had forgotten that I learned in school. I think you lose it not just because you don't use it, but because you get so used to just doing whatever the doctor tells you to do.

Not only that, but when you're a new RT, you are focused so much on just doing your job and doing it right, you tend to forget the most basic of RT knowledge.

When I was in school I took all the best notes. In some classes I wrote nearly word per word what the teacher said, and then went home and re-wrote all my notes into the computer and printed them off for studying.

But once I passed my registration test I put the boxes of RT class notes in the trash. Man that was dumb. So, instead of reviewing my great notes, I had to start from scratch. Thank God for the Internet.

Fast forward: I relearned what I learned once before and then I learned some more.

It's cool when a nurse calls you to assess the patient, and you know what is wrong right off the bat by your assessment. It's cool when you see signs not of bronchospasm, but of a pulmonary embolism. Or you see a reason to worry that this patient is at high risk for PE, or ARDS, or DIC.

Or, you look at the chart, and at the labs, and learn that the patient is probably a CHF patient as opposed to pneumonia based on the BNP of 30,000. And that the patient is in renal failure, confirmed by the high BUN and creatinin, and GFR of only 18.

Or you assess the patient and observe a high respiratory rate, high heart rate, normal BP, and learn the patient is on an antibiotic and you are the first to think sepsis. You talk with the nurse to see if she agrees with you, and when she does she calls the doctor, and a crisis is nipped in the bud.

In an ideal world you'd think anybody would be able to spot a sign of an illness and know right away what is wrong with the patient, but we all know it doesn't work that way in the real world. That's why we work as a team.

For that reason we at the RT Cave continue to do research on the Internet, to read the opinions of other RTs on the Internet, to listen intently when a doctor or nurse is patient enough to explain something we had no clue about that might come of some use at a later date. Who knows, we might be able to impress someone some day.

Being a small hospital, our bosses can't afford to send us to many RT seminars, or so they claim. But when we get the chance we go. When there is a free in service, and I'm not working, I'll be there with my pen and pencil -- especially if there's a free lunch.

While I'd like to think that this is the way all RNs and RTs think, I have had people tell me, "Why? You are an RT, so why do you need to know about sepsis? Why do you need to know about lab values other than ABGs? Why do you need to know about hemodynamics?

And sometimes I hear things like, "Well, I'm not getting paid anything extra, so I'm not going to learn anything new."

That's fine. I don't have a problem with people thinking that way. That's their choice.

That type of thinking isn't good enough for me though. I want to be more than just a body passing nebs, or doing some odd procedure.

4 comments:

Djanvk said...

I do think that was one of your best posts yea. Very Inspiring, well done.

asthmagirl said...

Awesome post. I'm glad you're seeking additional education. Frankly, I'd rather be treated by someone that knows a little bit more than by someone that knows just enough!

Glenna said...

Yes!!! I've been thinking along these lines too. I got out my notebooks from school and am starting to go back over them too. It is that you lose it but it's also that it becomes so ingrained that you forget how to verbalize some it, like the pneumonia signs, and some of it you never use again in that context, like the alveolar equation.

Totally agree.

Breathingthroughschool said...

It's kinda funny you posted about this because in school we are constantly told you are not going to be a button pusher, you may meet some button pushers, but you are going to look at the whole picture.