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Friday, September 12, 2008

The Creed: Length of therapy and ABGs

What follows is what will be added to the new addition to the Real Physician's Creed: How to take care of Pesky RTs. Again, this is TOP SECRET information for physician use only, and was never intended to be released among the RT community.

My source for this TOP SECRET information will be kept anonymous, because if his peers find out he is the leak, he will be banned from the medical community at best, or ridiculed at worse.



Page78

(Section B-3)
Physician's Real Creed: Length of therapy and ABGs:

There has been a new development in the line of bronchodilator therapy as taught at at medical schools around the nation. The following are new additions from the previous edition of this all important physician's creed.

30. If nothing else works, order Ventolin Q4 hours. The theory here is that eventually the Ventolin will break the disease process, and the patient will eventually be well enough to go home.


RTs will wine, something like this:

"I have a patient over on South who's been on breathing treatments for three weeks now. I have to hurry up and get up there, because this next one just might be the one that cures him."
While the RT is being facetious, we know it works. This is why you must follow DR. Rule #376: Once you order a breathing treatment, you must never discontinue it. Because we know, this next one JUST MIGHT BE THE ONE.

31. A low SpO2 is an indication for an ABG, even if the patient is in no respiratory distress.
32. An ABG should definitely be done during a CODE, even though we know what the results will be.

33. When you can't figure out what else could be wrong, an ABG should be ordered to rule out PE and sepsis. RT will cringe the ABG is not indicated, but we don't care. Probably 90% of all ABGs we order are to rule out PE, and of those about 97% are perfectly normal. Still, this is not a useless "unnecessary and useless poke" as RTs will say.

34. Serial a.m. ABGs should be ordered on any patient who was once in respiratory distress. RTs will whine that this is an invasive therapy, or that they have better things to do, or that the patient hasn't been in respiratory distress in three days. None of those complaints matter: we need to make sure the SpO2 is accurate.

35. No matter what RT says, a pH is not automatically normal just because the patient is in no respiratory distress. Just because the pt was "NARDN/ Denies SOB/ SpO2 99% on RA/ LS clear" as the RT charted on the ABG, does not mean the ABG was not indicated.

36. We know that in some hospitals the doctors have to draw their own ABGs. In these hospitals, the number of ABGs dropped by 75% because these doctors realized how un-indicated most of them were(see this Ventworld discussion). We do not want that to happen at your hospital, so DO NOT APPROVE ANY POLICY THAT MAKES YOU DOCTORS HAVE TO DRAW THE ABG. All this would do is give RTs one more reason not to gripe.

Besides, RTs love doing ABGs. And it gives them a reason to keep working. Therefore, they should be happy that we order them.
37. Thus, we doctors must not give into protocols that monitor EtCO2 and SpO2 at the expense of ABGs. If nothing else, we must not be bothered with learning all that stuff about ETCO2s and normal EtCO2 values. What is the normal range of EtCO2 anyway: 35-45, 20-50??? That's for future doctors to worry about. We need to stay in the 1980s as opposed to the 2000s.

3 comments:

Murphy said...

Yes, forcing the docs to do the ABGs does cut down the numbers ordered. Have you ever noticed how many ABGs are ordered on "ER"? I think that's why so many docs order ABGs. They want to be like the "real" docs on "ER."

Chris said...

I'm fascinated by how many basic spelling mistakes there are in this "Physicians creed." Is it possible this is a bull*** farce intended for nothing but stirring up discontent?

Rick Frea said...

The Creed is a document written sometime in the early 1900s in an attempt to keep old medical myths alive. I believe it's updated every 10 years or so to prevent nurses and RTs from usurping the autonomy of the physician clique.