I got to see first hand the other night the revelations that occur to lead a doctor to deciding a patient needs a breathing treatment, as Dr. Mann set down next to me as I was charting on one of the many terminals on 2 Early, the med surge floor. It was real early in the morning, and he started small talk with me. He seemed really cool.
"Hey, hand me that chart would you," he said.
I grabbed the chart he motioned to, and continued on with my charting.
"Hey, you know what?" he said. "This patent's got pneumonia. Wow, I can't believe he's not getting breathing treatments. Well, I'm going to change that."
Wait a minute, I think. That patient has been here for two weeks, and he's breathing fine. I wanted to say that, but I was on such good terms with the doc. I didn't want to spoil a good thing.
I wonder if this is the reason why so many un-needed breathing treatments are ordered, because good RTs like me refuse to face up to a doctor for political reasons. Here I knew for a fact this patient didn't need treatments, but the doctor thought otherwise.
So, why is it that he wanted treatments for this patient. Why? Because the patient had pneumonia. And, somewhere, some time ago, he must have read an article that said that Ventolin goes down deep into the alveoli and washes the pneumonia out.
So, I went in to do the treatment. The patient said, "What the hell do I need that for."
"Are you having trouble breathing?"
"Nope. Never."
"Do you smoke?"
"Nope. Never."
"Hmm," I said, "Let me listen to you." I pulled out my handy-dandy stethoscope and listened to his backside. Perfectly clear.
"So, you agree I don't need that? Or, why do I need it, do you think?"
In this situation, I used to try to make the doctor look good, and lie: "Well," I would say, "It's supposed to help you get rid of your pneumonia, or cough it up at least." I've decided I'm not doing that anymore. I said, "Your doctor ordered it. You have a right to refuse if you want."
"Well, if he ordered it, then I suppose I do need it. What do you think?"
Burned out, I decided to be honest with the patient, "Sometimes doctors order things just out of habit. He may have read some article somewhere..."
"Yep, I know that. That's why it's good to go to the doctor educated."
"Exactly. And don't be afraid to refuse a therapy. Just because a doctor orders something doesn't mean you really need it. Doctors are human beings after all."
"I totally agree," he said. Yet, despite that we both knew the treatment wasn't indicated, I gave the treatment and he took it. And of course we bantered while it was going.
When the treatment was finished, he said, "Well, I'm going to corner that doctor in the morning about this. I don't' fell a bit different after this."
"So, you ever been short-of-breath before"
"Nope. I never even smoked. I really don't think I need that thing anymore."
"Well, be prepared for him to try to talk you into it. He's going to give you a line you know. He'll try to talk you into it."
"I bet he will."
So, we now have a new 'olin. All patients that have been in the hospital for 3-4 days with no difficulty breathing, and all of a sudden Dr. has an epiphany and says, “Hey, this patient’s got pneumonia. I’m ordering Washolin.”
The medicine, according to our fake doctor's creed, is a specially formulated version of Scrubbin-Bubblin designed specifically for pneumonia patients who show no signs of respiratory distress and are not short of breath. This medicine forms a sud-like material, shrinks from 5 microns to 1 micron (exact methodology unknown) finds its way to the alveoli and washes the pneumonia right out.
It works similar to a bronchial wash, only you don't need to bronch the patient. It's an alveolar Wash performed with the magically enhanced formula of Scrubbin-Bubbles version of Ventolin. How about that for a new breath-taking scientific revolution?
Yes, we know RT will bicker, but the patient will say something like, “What the hell do I need that for, I’m not having trouble breathing, and never have in my life.” This is a normal side effect. Don't let that deter you from ordering this highly indicated medicine. If the patient wants to refuse, that's his loss.
By the way, if Dr. accidentally forgets to order Washolin, the patient will still get better and eventually go home.
The list of 'olins on the bottom of this blog has been updated.
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