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Wednesday, April 20, 2011

The Five Stages of RT Grief

I'm sure you guys have heard at some point in your lives or careers about the Five Stages of Grief. Usually they are used to explain how someone deals with the fact they have a life threatening disease, although they do explain many other aspects of our lives too.

For instance, the Seven Stages of Grief also explain how we medical care practitioners (RNs and RTs) deal with the medical field, and perhaps other people too.

For starters, here are the Seven Stages the Grief:

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Consider the following flow of events. You are in high school or some point in your life and you decide to become an RT or an RN. You make this decision becaue you want to make a difference. You want to help people. You, in essence, think you are walking into the ideal situation. After all, the U.S. Healthcare System is the best in the world.

Now I do think and always have that the U.S. Healthcare System is the best in the world. I'm not arguing that. Yet I do think a problem lies in that the Healthcare System is not so much focused on improving patient care, it's more focused on money.

I have never in my 15 year career as an RT ever sat in front of my boss getting lectured because I didn't give good care. I have never had a patient complain about me. However, I have been lectured because I didn't chart a treatment or because I made some minor mistake here or there that might effect -- you guessed it -- reimbursement criteria for that patient.

Thus, it all comes down to money. Money is all that matters. They will tell you they are trying to improve patient care when they create order sets, yet that's not the complete truth. The complete truth is they want to make sure all these procedures are ordered for a given diagnosis (DRG) so that the hospital is reimbursed. That, in essense, is the true purpose of the Keystone Commission. That's the ultimate goal of CMS (Medicare and Medicaid) and Insurance programs.

In essence, the entire medical field is screwed up. Now, here is the sequence of Grief as it pertains to Respiratory Therapy:

1. Denial: We leave RT School thinking every thing is hunky dory. We really believe every breathing treatment we give will be useful. Yet soon we realize most of what we do is either a waste of time or delays time. So we simply deny it. We go on as though we were still living in the ideal world we learn about in RT School.

2. Anger: We realize now that it is screwed up. That we were not simply making up in our heads that 80% of what we do is useless. We become apathetic. You hear there is a lot of apathy in the medical field, and when you see an apathetic RT he is in the Anger stage of Grief.

3. Bargaining: This is where you try to make it better. When I was in this stage I really felt I could make a difference. I created my cheat sheets and wrote protocols for just about everything. One of us might join the Keystone Committee thinking w'd get to know doctors better and would be able to convince them to work with me in creating protocols. This would all make it better. You look in to other RT jobs thinking the grass might be greener on the other side of the fence.

4. Depression: Yet soon you realize no one wanted to make it better, or at least few wanted to make waves. Most decide all that matters is getting a paycheck In fact, with all the new order sets this problem got worse. Instead of doing fewer useless therepies we now do more. While we complained about doing outpatient Holter Monitors in the ER, instead of getting rid of STAT ER Holter monitors our boss ordered 76 new Holters. The Keystone Committee has created order sets for each DRG which make sure every patient with said diagnosis gets an EKG or a breathing treatment whether they need it or not. You are now depressed. You feel hopeless. There is nothing you can do. The protocols you wrote are ignored. You realize the grass is not greener on the other side of the fence, and you are thus bummed. You feel trapped.

5. Acceptance: This is where I am at right now. I have passed the above steps and I've now come to terms with the fact the medical field the way it stands right now is the best in the world, yet it still sucks. Doctors are afraid of lawsuits, and politicians don't care. In fact, politicians just passed Obamacare, which has made everything worse by its unintended (or intended depending on how you look at it) consequences.

I'm not saying I'm never going to do anything to make it better, yet I've resigned myself to the fact that most of my attempts will be rejected and ignored.

Don't get me wrong. The field of RT is still a good and rewarding career. I would still recommend it to anyone. Yet like any other career, it is not perfect. It is a young and flawed profession. The medical field in itself is also young and flawed. And those who purport to make it better somehow just make it worse. Which is why many of us RTs decided long ago to work so we can go home.

And, as with the rest of the medical field, you will have to accept that much of what you do is not to the benefit of the patient. In fact, much of what you do will have no impact on the health of the patient whatsoever.

Yet everything you do will impact whether or not the hospital gets reimbursed for that patient. Yet, once agian, the bottom line is money. Only the future, and perhaps who we vote into political office, will change this bottom line. Yet I wouldn't bet my life on a quick solution.

The people who have the ability to help the patient have their hands tied behind their literal backs. Only you can make it better by reaching the acceptance stage as fast as you can. It took me 15 years.



1 comment:

Anonymous said...

I feel like I go through all of these stages over and over again when I work. Some days are better than others, but what keeps me going is the personal satisfaction I get out of seeing somebody feel better because of what we do. A while back I was burned out while working with a particular kid that was in the last stage of graft vs host disease after her bone marrow transplant. After much frustration, some creativity, a lot of time, and a little praying I got this girl some comfort on her BIPAP. I was as about as burned out as one could be at this point and she tells me before I place her new BIPAP mask on "Thank you for helping me breath". I almost cried right there.

Sometimes palbuterol does help as much as using all your clinical skills to wean somebody who is hard to get off and keep off a vent. Sometimes it's as simple as adding a bubble humidifier to a little oxygen to give some added comfort to a dyeing patient. (sorry about the spelling) This was the case with my grandfather ten years ago. I can still hear him ask me if I knew someone at the hospital where he was admitted because of that simple request. I guess my point is that most of the time what we do goes unnoticed or is not openly acknowledged, but you might be surprised how much is regardless of the cost.