slideshow widget

Friday, March 7, 2008

A letter to end bronchodilator abuse

We here at the RT cave are hoping you will join us in our quest to bronchodilator reform. Like you, we will not be satisfied until no more unnecessary and useless breathing treatments are ordered.

What follows is a sample letter we, in an ideal world (or in our dreams), would send out to the greatest culprits of bronchodilator abuse here at Shoreline.

If you are near retirement, or are recently retired and have pitty on us RTs still forced to do useless not indicated bronchodilator therapy, please feel free to use the following sample, tweak it a bit to fit your desires and angers, and sent it out.

You will be doing a great service for your fellow RTs, who are on a mission to end bronchodilator abuse and too chicken to do anything about it.

March 7, 2008

Dear Dr. (fill in name):

We are burned out right now because of your insistence on ordering breathing treatments that we here at the RT Cave have determined there is absolutely and definitely no indication for.

Would you please stop ordering breathing treatments just because a patient is: lying in bed, snoring, grunting, has a fever, has rickets, has the flu, a cold, pneumonia, is cold, is hot, is coughing, is not coughing, has gas, has a hangnail, is out to lunch, had a stroke, smoked once, had asthma 30 years ago, has a a rescue inhaler at home, has a headache, is on a vent, Bipap, sleep apnea, priapism, abcess, stomach ache, snot, ear infection, sneezing, MS, MRSA, pulmonary edema, CHF, swollen ankles, death rattle, AIDS, maggots, diarrhea, nausea, pulmonary fibrosis, lung cancer, pnueumothorax, pleural effusions, annoying lung sounds, loquacious, cirrhosis, poor circulation, butt rash, gangrene, smells, is annoying, is phychotic, is seeing things that are not there, is combative, or in any other way annoying to you.

We also would like you to stop ordering breathing treatments just because you are tired of the RN calling you, want to prevent unecessary calls, the RT annoys you, or because the family wanted you to do something and you didn't know what else to so so you ordered breathing treatments just to soothe the family.

The typical scenario regarding the above indications for treatments is we RTs walk into the room, the patient is sleeping comfortably and is annoyed that we had to wake them up because "What? Why the hell do I need this?"

"Um.....because the doctor ordered it." That's the only honest answer I can find, after digging deep into my mind for something I can say that isn't a lie.

Fortunately for us some of these patients refuse, and usually only after we hint to them that they do have a right to refuse, however, some of these patients want these treatments "because if the doctor ordered it, I must need it." This is a fallacy that seems to run rampant these days. It seems that many patients view doctors more as gods, and not so much as ordinary people.

The other unfortunate scenario, and this seemed to be the situation of the 15 patients on treatments this past weekend, is the patient is out to lunch, obtunded, sedate, lethargic, aphasic, unable to move, or simply bored, or in another way unable to decline.

We cannot in good faith simply write refused on these treatments when we all know these patients are unable to determine whether or not they really need them. However, when we RTs walk into the room and see the patient lying there just fine, we can hardly think of what the heck happened that the doctor might have ordered this.

We understand you are privy to top secret information of which we have obtain portions of and have posted on our blog, our quest now is to educate you doctors on the real indications for breathing treatments, which we think are simple and easy to understand.

By understanding the real indications for breathing treatments, you might have to stop and actually assess the patient, and actually think for a bit, but you would be benefiting the patient by not pumping into their system un-needed medications, benefiting the RTs by eliminating their urge to cringe and cuss and, on occasion, annoy RNs as a result, and you would also cut down on the un-needed expense of paying for the treatments which can run as much as $400 a day, when $0 for no treatments would be more appropriate therapy.

We understand that the last 350 times we've sent you this letter you more than likely disregarded it as a joke, or crinkled it up and whipped it across the room in anger while snickering to yourselves, "stupid RTs."

Or, as is the case with some of your co-workers here at shoreline, you pinned it up to your dart board next to the pictures of the RTs who complain the most about stupid doctor orders, and the RNs who call you way, way, way too much.

However, our mission here is not to annoy you, but to make you better doctors all around. Not only would you be expanding your knowledge base by sending for our indications for bronchodilator list, you would be doing a great service not only to your patients, as described above, but to your friends -- us RTs.

It is our mission to end abuse of bronchodilator therapy.


Rick Frea
Bronchodilator Reform Inc.


sometimesibreathe said...

Great letter. Our children's gives out albuterol like candy. Too bad kids can't refuse treatments.

Amy said...

Haha....I know the situation can't possibly be as bad as that list (or can it?) in the first couple of paragraphs, but then again---I've certainly been on the receiving end of "Just give your daughter a nebulizer treatment" plenty of times in the ped's office when some other treatment/med was warranted.

Until I started reading your blog, I never considered how frustrating it would be for medial folks, too.