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Wednesday, April 10, 2013

Stand your ground

I'm fine with you guys disagreeing with me.  However, I'm going to say things on this blog that are considered by some to be "controversial."  I could just keep my ideas to myself, but what fun would that be.  And if Rene Laennec kept his ideas to himself, we wouldn't have the stethoscope.

Did you know that?  Rene Laennec was probably not the first person to use a tube to listen to lung sounds.  I mean, history says he was, but I think more accurately it was probably done before just the person (or persons) who did it were afraid to face a stubborn and proud medical community.

I don't mean to say that in a negative way, but it is true.  Most historians agree with me on this one.  In the 1920s the medical community was introduced to the stethoscope, and the basic response was, "You want to carry what? I'm a doctor, I don't carry stuff with me?"

The same rejection came when John Floyer invented the pulse watch.  Physicians said, "You want me to carry what?  I'm a doctor, I don't carry stuff with me?  Man, I could make a long list of things that were initially rejected by the medical community.  You'd probably be surprised.

I can make an extemporaneous list right here.  Things initially rejected by the medical community (unofficial list):
  1. Stethoscope
  2. Pulse Watch
  3. Germ Theory
  4. Bronchospasm theory of asthma
  5. The Hypoxic drive theory is a hoax
Okay, I added in the last one to prove my point.  I truly do not believe in the hypoxic drive theory, and now there are physicians (not because of me, I don't want you to think this has anything to do with me) who support that the hypoxic drive theory is a hoax, and I interviewed one of them when I wrote my post: Hypoxic Drive: A history of the myth.  

I'm also a proponent with Albuterol being available over the counter, and I'm fine with you guys rejecting that idea.  I'm fine with doctors getting so mad at me they refuse to speak to me for months, as one of our physicians did.  I just mentioned it in jest, and we had a fun discussion (no sweat, no tears), and he walked off all mad.  

I can't help myself.  It's kind of the same as about ten years back I drew a blood gas on a homeless man that no doctor wanted to take care of because the man didn't take care of himself.  He came in with maggots in his leg wounds and stunk so bad we had to dunk him in the tub, took 10 of us to do it, to get the maggots off and the smell out.  

So three weeks later this patient is still admitted, and he's supposed to be going home.  So I do a blood gas because he doesn't look right to me.  I called his doctor who didn't want to do anything.  So I get the nurse to back me up, and we called the critical care nurse and supervisor.  We did this only on a gut feeling, and we decided together we had to do something even if the doctor didn't want to  

The nursing supervisor said, "Why did you call me?"  I said, "Because this guy doesn't look right to me and I decided we ought to do something.  Just because he's a poor homeless guy doesn't mean we can blow him off.  Look at him!"  I took the fall for the nurse, who was afraid of getting in trouble.  

I already had my blood gas kit, and I put the needle into the arm of the non-responsive patient. Blood oozed from the site and dripped down the arm and onto the sheets even as the needle was in.  This never happens, folks.  This guy, I could tell right then, was in DIC and he was in Sepsis and he was probably also in ARDS.  

The ABG showed a pH of 6.01.  Yes, that confirmed my suspicion.  By now the ER doctor shows up, and I give him the ABG results.  He says, "Oh, this must be a venous poke.  Do it again!"

"No, I said, "It's not venous.  And even if it is, that pH is still bad."

"Draw it again."  

So I do, and the result is the same.  The man was moved to the critical care with the diagnosis of DIC, Sepsis, and ARDS.  He died two days later on a ventilator.  

Later I talked to the medical director, and he said, "You did the right thing.  A person doesn't just go into spontaneous ARDS.  That person must have been showing signs long before you called, and what you did was heroic."  

Now I'm not trying to toot my own horn here, I'm just trying to make a point:  Stand your ground. If you have a gut feeling about something, if you have an idea, don't be afraid to go with it.  The automatic reaction of many people is to reject anything new.  The medical profession is a proud profession, and it is definitely no exception.  

And I mean no disrespect to the medical community either, because in the end it generally does the right thing.  The medical profession is no different than a peaceful phlegmatic person who gets comfortable and is resistant to change.  

I also believe that many of the procedures we do that aren't really medically indicated occur because we let it happen.  It happens because most RTs don't stand their ground because they are afraid.  They are afraid of the unknown.  

I wrote a post a while ago that I believe Albuterol has no effect on pnuemonia.  One doctor got so mad at me he wrote me to tell me he will never again recommend a patient to my blog.  I was actually honored, because I never expected a doctor would ever recommend my blog in the first place, let alone come here.

Yet it goes to show the dogmatic profession in full swing.  All I did was propose a theory based on empiric evidence.  I opposed their theory, that is based on skimpy evidence, if any evidence at all. Lord knows, the hypoxic drive theory was postulated based on a study of only four patients, and disproved 3534 times since then. So this is proof that while the medical profession pretends to push order sets based on "best practice medicine," they don't means "based on best scientifically proven to work medicine."

So keep this in mind the next time you come across an idea.  And keep this in mind the next time your humble RT comes up with an idea and shares it on his blog.  In no way am I trying to anger people: it's all about education.


Anonymous said...

I enjoy reading your blog very much, and I wish more people would comment. However, it sounds as though you take a lot of heat. Be glad about this, because if they are mad it means they are also paying attention and we really do need more of that in the world today.

Rick Frea said...

I like to think the reason I get few comments is because most people agree with me. You also have to consider that due to HIPPA, many people are afraid to comment out of fear -- one of the bad side effects of a bad law. Thanks for the kind words.