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Wednesday, September 9, 2015

Breathing Treatments: The ideal way verses the real way

When I have a respiratory student I can't help but think of the two different worlds we live in side by side, at the same time, and these are the ideal world and the real world.  We as therapists try to live as though we are in the ideal world, although ultimately find shortcuts, we need shortcuts, to help us adjust to real life situations, and so we end up working in the real world.

For the purposes of discussion, allow me, once again, to define the two worlds we live in.

The ideal world:  The ideal world is the one concocted in a lab, it's the fake, world. It's euphoria. It's the place where everything is supposed to work as designed. It's where everything is perfect. In this world you walk into the room, identify the patient, and then leave the room to go to the pyxis to get the medicine. Then you go get the computer, log in, find the patient in the computer, click on the patient, and log into the emar. Then you grab the scanner and scan the patient. Then you scan the medicine. Then you assess the patient, and chart your assessment. Only now do you open up the medicine and start the treatment.  Then you ignore the patient (because in the ideal world the patient doesn't need you) and you chart. Then you look at the patient, maybe talk to him or her while you wait for the treatment to be done. And of course all this time no one else needs you, because in the ideal world you can pay 100% of your attention to just one patient at a time. Then the treatment is done.  You stop the treatment. You take the nebulizer to the bathroom where you take it apart and rinse it out in sterile water. Then you assess the patient again. Then you do your post treatment charting. Only now do you leave the room and move on to your next procedure. In the ideal world everything goes according to plan, and every solution is manufactured, as if in a factory.

The real world:  This is how things really work.  This is reality.  This is where things do not work as planned, because in the real world you never know what to expect.  In the real world there are outside forces placing pressure on you to take shortcuts so you can get done with this faster so you can move on to another task.  In the real world the patient wants to talk to you, or the patient may need you for some other reason, like walking to the bathroom or setting up a tray.  In the real world the patient matters.  In the real world you might need to talk to a nurse during the treatment.  In the real world all sorts of stuff happens that you cannot plan for in a factory, things that might pull you away from the patient and the computer.  It is the real world all the solutions manufactured in a factory (or in the case of medicine, in leather chairs in Washington D.C.) do not work.  In the real world you walk into the room, identify the patient , and start the treatment. Then you assess the patient. Then you log into the computer and scan the patient and the medicine. Then you chart the pre and post assessment and log out of the computer real fast.  Then you sit and pay attention to the needs of the patient.  You might have a discussion about how much the healthhcare profession is messed up.  Then you do you post treatment assessment and then stop the treatment, coil it up in a bag and set it on the windowsill.  Then you move on to your next procedure.  You jot down a few notes, maybe, and later (when you have time, if you get time) you log back into the computer and chart your post treatment assessment.  This shortcut, real world, way of doing a treatment is the only way that works in the real world, otherwise you would be so far behind you'd never get all your word done.

Of course, if they ask, you did it the ideal way.  You are, in this way, a trained politician; a trained liar.

You see, this is a perfect example of how everything in this world, including medicine, is politicized.  It's not based on science, it's based on politics. You have these people sitting in leather chairs, the so called experts, who think they can fix all the problems of healthcare with their pens and their papers, and then what they do is they create this ideal, fiction, euphoric world where everything fails to work as planned and chaos ensues. Their attempt is to increase safety and reduce costs, and what ends up happening is they make things less safe and more costly. This, my friends, is socialism at its best.  What we have in 2015 is a healthcare system based on socialism.  That is why it is failing. That is why nurses and doctors are so frustrated with it.

So, anyway, that is the difference between the ideal world of doling out breathing treatments and the real world way of doing it.  Surely, you want to do it the ideal way.  But in the real world, nothing ever works out as planned.  In the real world you play it by ear and use common sense, because nothing else works. If you sit and try to be ideal, you will fail to be a good respiratory therapist.  The trick is to find a way of being real and safe at the same time.  It is hard, and it takes effort.  And it can be done.  It would probably drive prices down too.  In fact, I know it would.  Because the only thing that has never been tried in healthcare is capitalism.

Further reading:

2 comments:

Mary Ransom said...

Agree it is politics but see it as profit driven corporate politics and not socialism.

john bottrell said...

I would agree with you if the rules were made by hospitals, and they're not: they are made by the government (i.e. CMS, Obamacare). In America, it's not possible for the government to control an industry, so this is as close as it gets. It's sort of what some people refer to as putting a happy face on socialism so it will pas in a country where the rule of law applies.