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Friday, December 23, 2011

RT Idealists versus RT Realists

Some of my coworkers get annoyed that I'm always questioning need.  I'm always asking patients if they're really short of breath, and I'm always asking if they feel better after a bronchodilator.  And when a patient says he feels the same after a treatment and has never been short of breath, I chart as much.  I chart:  No difference with bronchodilator therapy.

When I have a patient with an SpO2 of 86 percent and the doctor orders for me to decrease that patients oxygen based on the hypoxic drive hoax, I ask why?  When I proposed a breathing treatment protocol to the staff and they cast it aside based on fear it would result in loss of work, I asked why they came up with that belief?  I asked if they have any proof protocols result in loss of work?  

One of my coworkers said a protocol would just result in more paperwork, and I asked why he thought that?  Another said doctors would never go for it anyway, and I asked why not?  Why do you think that?  

My coworkers seem to know everything?  They know what will pass and what will fail before we even propose it.  They should be our public leaders, because then the world would be perfect.  We would just do things because...  why?  Well they happen to know all the answers. 

The truth is they don't have all the answers.  The truth is they are idealists, and the reason they are annoyed with me is because I'm a realist.  Idealists do things based on feelings and emotion, and
realists ask questions and do things based on the truth and proven facts.  Idealists throw everything at every problem and hope something sticks -- order sets. Realists solve problems with protocols that encourage point of care critical thinking.

Idealist doctors solve problems by covering their bases by ordering everything -- cook book medicine.  Realists don't waste their time doing things that aren't proven to work for that patient, or that don't make sense; or at least they get annoyed when forced to do something they know isn't useful or scientifically proven to work.

Idealists are your political people who say things just to make people happy, and they do things that they know don't make sense just to keep a smile on a doctor's face -- and to boost that doctor's ego.

Realists questions doctors.  Realists question stupid orders.  Realists are hated because they are always asking questions instead of keeping their mouths shut and doing their job the way idealists

Idealists solve problems based on feelings and emotion which results in doing things that aren't proven and are often useless, such as creating order sets where every patient is given Albuterol.  Realists don't waste their time doing things that are needless because they take the time to think.

Instead of thinking, idealists call respiratory or order breathing treatments.  This results in useless procedures and causes the RT to run around ragged all day to get all this work done.  It results in burnout and apathy or RATS.  Since Idealists control the world right now because their ideas sound good on the surface, the healthcare system is in trouble.  

I would consider myself a realists.  It's why people get annoyed with me.  We grumble and gripe at new breathing treatment orders because we know Idealist in the healthcare system order things for no  other reason than ignorance.

Idealist:  See idealism.  A person who believes perfection is possible.  They believe a euphoric world is possible.  They are always making rules and policies in an attempt to create an ideal world, even if there is no proof their rules and policies will work -- even if there are facts that what they want to do won't work.  They believe if there is a problem something must be done, even if that means taking away personal rights and discouraging individual thought and choice.  They believe one or two experts can decide what's best for everyone, and it's these experts who create ordersets, policies and guidelines that everyone has to follow.  Even if they are wrong they won't admit it.  They may have screwed the heck out of the healthcare industry with their policies, but they won't admit it.  They are the ones who passed Obamacare in an attempt to create equality in healthcare.  They are the ones who created DRGs that resulted in the boom in the diagnosis of asthma and pneumonia. They are the 
ones who decided to give away free healthcare to the poor and have caused ERs to become flooded with people who don't need to use the ER.  Their policies have improved patient care and reduced the cost of Medicare and Medicaide, yet it's increased hospital costs and caused apathy and burnout among the masses.  They are the reason for increasing healthcare costs and the nonexistent healthcare crisis.  Idealists don't like it when you come up to them and are truthful (yes, the truth hurts). If you go to them with the truth they will get angry and toss vitriol at you and make you out to be the enemy.  They say that when you question their realist ideals you are cconfrontational. You are causing confrontation. Yet if you're afraid of confrontation you're an enabler.  The idealist at the bedside sees a patient who's short of breath with an audible wheeze and thinks bronchodilator before even assessing the cause.  Their goal is euphoria in the healthcare industry; an ideal system by their definition of ideal.  A scientist will not take this route.   Perfection.

Realist:  See realism.  Judgemental.  Basing decisions on proven fact and science.  They ask questions like:  Does this make sense?  Is this science we're dealing with?  Does this patient really need a bronchodilator?  Is the U.S. healthcare system really as bad as they say it is?   If the answer is no, then we don't do it or don't mess with it or don't waste our time.  If it's moronic and doesn't make sense, we try to find a better solution such as protocols.  They are the ones at the bedside doing the clinical assessments and critical thinking to determine the cause the the best solutions.  They base their solutions on science and proven facts as opposed to feelings and "it sounds good."  They are often feared and hated because the truth hurts before it makes you better.  


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