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Thursday, September 26, 2013

Stupid doctor orders

I have mentioned stupid doctor orders on this blog, yet I have nary defined them.  So, for the sake of discussion, what, then, are stupid doctor orders as compared to good doctor orders.

1. Stupid doctor orders: 1)Orders from a physician that lack common sense and have no purpose, and therefore have no benefit to the patient.  2) Orders that benefit the hospital by assuring the patient meets reimbursement criteria, although with no otherwise scientifically proven benefit to the patient. 3)  Orders written based on habit and with no scientifically proven value 4) Orders that are based on antediluvian theories.

2.  Normal doctor orders:  1) Doctor Orders written based on scientific evidence, or at least best practice medicine; 2) Orders that benefit the patient

3. Antediluvian theories: Theories that are old and outdated yet are still worshipped by doctors.  A good example is the hypoxic drive theory.

4.  Regular theories:  Based on a rational guess

5.  Scientific fact:  Proven by science, as opposed to proven by "oh, it sounds like a good idea."

Here are some examples of stupid doctor orders:
  • Q4 Albuterol (how do you know the patient will be short of breath every four hours?)
  • Q6 Albuterol (how do you know the patient will be short of breath every six hours?)
  • QID Albuterol (how do you know the patient will be short of breath four times a day?)
  • IPPB: (still some physicians who wish to continue the quest to overinflate god alveoli)
  • Wean patient at a PS of 10 (like, that's the same as a ventilator breath that decreases WOB)
  • Set Fio2 order (40%, 50%, 60%, etc.)(why not just write order to maintain normal spo2?)
  • EKG because (let's have a real reason for ordering these, as opposed to just because...)
  • Serial ABGs (so what's the point of having patient on EtCO2 and SpO2 monitors if you're going to continue torturing the patient every day anyway?)
  • Ventilator tidal volume 1000 on a 500 pound man (Like, let's blow up the patient)
  • Ventilator tidal volume 100 on a 100 pound lady (like, let's ventilate the patient)
  • Breathing treatment on not breathing post operative patient (like, let's try bagging,  reintubation, or let's have the patient bring in his home CPAP because he's got sleep apneao, not bronchospasm)
  • Albuterol stat post operative for stridor (that's not stridor you idiot, the patient is snoring)
  • Albutetol stat for dyspnea (the patient has an f'd up heart, you idiot.  Ventolin is a bronchodilator, and will not help with dyapnea with exertion)
These are just some real life examples. 


CajunGal said...

I unfortunately (or maybe fortunately, come to think of it) landed in the urgent care yesterday because of a suspected upper respiratory infection. The doctor listened to my lungs but said she didn't hear wheezing and there was probably no need for a neb treatment at the clinic.

I like to think I've become more educated by reading your blog and as a result I almost fell in love with the doc right there on the spot! I finally found one who believed that I didn't need a Q4 neb just because I was an asthmatic that was having problems.
And she was down to earth to top it all off. I guess good docs do exist after all!

Think she'd find it odd to get a thank you card from me? ;-)
I kid!

Rick Frea said...

Thank you so much for the comment.

shadowkate said...

I got my first truely dumb doctors order that other day (I just started working an an RT).

The doc wanted an oxygen walk on a patient who couldn't walk five feet to the commode. The patient was already on oxygen and had the same amount of oxygen at his house already prescribed. Needless to say, I went to the patient, asked if he felt he could walk, he said no, and I charted 'inappropriate order'