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Tuesday, January 30, 2007

Faux Hospital Lexicon

The following are some made up terms to describe some of the things the administrators at hospitals may focus on. 
  1. Faux core measures:  These are measures based on fallacy based scientific research believed (not proven) to benefit a patient with a given diagnosis (DRG).  These are often referred to as core measures, yet we know they actually aren't.  The following are some examples of faux core measures:  Giving Albuterol every 6 hours to all pneumonia patients, giving oxygen to all post op patients.
  2. Core measures  Ideally, these are measures based on evidence based scientific research proven to benefit a patient with a given diagnosis (DRG).  The following are some examples of core measures:  Giving antibiotic to pneumonia patients within one hour of admission, Giving pneumonia vaccine prior to pneumonia patients being discharged, removing foley catheters 24 hours post operative to prevent infection, and Giving Albuterol to all asthma and COPD patients.  At present there are 27 core measures.
  3. Palliative care: the application of care strategies to alleviate the patient's suffering.  Many times, palliative care is confused with hospice care.  
  4. Hospice care: is the shift in care goals from curative to comfort only.  Patients qualify for hospice care when their life expectancies fall to six months.
  5. Curative care:  Efforts are made to cure symptoms and treat the disease.  This is generally done until 
  6. Core Measure Set:  These are sets of core measures (and faux core measures) to help provide administrators and staff a focus on approaching goals of improved patient care, reduce costs, and assure the patient meets reimbursement criteria (although the later is generally not admitted to, it's often the main intention).  At present, the Keystone Collaborative has a list of 4 core measures, which include heart attack, heart failure, pneumonia and surgical care.
  7.  Centers for Medicare and Medicaide Services (CMS):   This is a government service that uses core measures as a basis of measuring performance of individual hospitals, and provides a means of comparing hospitals on a basis of that performance. These allow CMS to reimburse hospitals based on performance. CMS also reviews data from hospitals and submits a quality review report card on a quarterly basis.  Currently, most hospitals report their data once per year
  8. The Joint Commission:  1)   It's a nonprofit organization responsible for accrediting and certifying health care organizations.  Their goal is to set standards (core measures) to improve the quality of health care by implementing a national, standardized performance measurement system. This commission creates core measures based on indicators derived by CMS.  2)  A government commission with the set mission of creating a universal healthcare system one small step at a time.
  9. Accreditation:  A process of determining if an institution is credible to be performing a certain service.
  10. Quality report card:  This is a quarterly report card based on data from hospitals regarding core measures,  and this data is submitted to the public.  This information is made transparent to the public.  The stated goal here is to create an incentive for hospitals to enhance performance and show the public whether goals are being met.
  11. Comparing performance: Hospitals across the country are measured and compared by The Joint Commission against all other accredited institutions on their performance in Core Measures.  The main method used is the Internet and the Quality Report Card.
  12. Best practice care: 1)  These are practices that are scientifically proven to work for a given medical condition.  Example:  giving Albuterol for exacerbations of asthma is proven to work.  2)  More recently, this word has become a buzzword meaning anything -- even that which is assumed and not scientific -- to benefit a patient.  Example: Giving Albuterol to all asthma, pneumonia, CHF, COPD, CF, Rickets, dyspneic, wheezing and annoying patients makes doctors and nurses feel like they are doing something beneficial for the patient.
  13. Evidence Based Scientific Research:  Studies and science have proven that performing a certain procedure (such as a breathing treatment) will work for a certain condition (exacerbation of asthma, bronchospasm).  These are often used as the basis for meeting core measures and creating order sets.
  14. Fallacy Based Scientific Research:  Studies and science have not proven that performing a certain procedure (such as a breathing treatment) will do anything for a particular condition (such as CHF, pneumonia) but the powers that be falsely believe it will do something.  A good example here is bronchodilator abuse and the hypoxic drive theory (hoax).
  15. Order sets:  See Cookbook medicine, automaton.  A sheet of paper that lists all the procedures that need to be completed for a given diagnosis (DRG) to make sure core measures are met and to assure the patient meets CMS set reimbursement criteria.  It's treating all patients the same.  These work well to have all departments reaching for the same goal to obtain optimal patient care, shorter inpatient stays, and reduced cost.  Be careful, because absent appropriate protocols, these can increase workload and result in burnout and apathy.  These are often referred to as protocols to make them sound better (see faux protocol).
  16. Faux Order Sets:  See Cookbook medicine, automaton, healthcare socialism. An order set based on the best practice medicine where everything that might be required to meet reimbursement criteria is automatically ordered.  These are often called protocols because the word protocol is better accepted. They usually result in  more procedures and tests being ordered than are truly needed, lead to increased cost for hospitals, decreased cost for the government, and increased worker burnout and apathy but administrators don't care because they also assure reimbursement criteria is met.
  17. Healthcare socialism:  See covering your bases.  It's equality of patient care.  It's making sure every patient gets access to equal medical care and costs.  It's treating every patient with a given DRG the same, with the same medicine, the same tests, and the same prices.
  18. Cookbook medicine:  See order set.  Treating all patients the same.  Covering your bases.
  19. Protocols:  See capitalism, individualism.  A capitalist approach to medical care.   These are written instructions that allow the medical care provider at the bedside to use education and experience to make the best decision for the patient at that moment. It encourages individualism.  It's a common sense approach to providing best care to the patient, reduced costs to the hospital, and improved morale of those providing the care. It also eliminates annoying calls to the doctor.
  20. Healthcare individualism:  It's encouraging point of care decision making to benefit the patient.  It's doing what's best for the patient at that time.  See protocol.
  21. Diagnosis Related Group DRG): A method for the government to have an excuse not to pay the same price for healthcare related services as the general public, or a reason not to pay market value for services. 
  22. Reimbursement Criteria:  See intensity of service
  23. Intensity of Service:  This means that patient was sick enough to need to be admitted to the hospital. It's based on reimbursement criteria set by CMS.  The goal is give CMS a reason NOT to reimburse the patients.  These standards are based on some scientific based evidence yet mostly faux evidence based medicine. For a hospital to be reimbursed this criteria must be met.  Since it's illegal for CMS or hospitals to use such a list, independent companies list this criteria in books and threaten to sue you if you list them on your website.  An example:  A patient is admitted with pneumonia will require IV fluids or antibiotics, or Q2 hour mental checks, or regularly scheduled breathing treatments.  If all these are done (whether needed or not) then the patient will usually be considered as having met requirements in this regard.  If any of these are not done, then CMS will have an excuse to refuse to reimburse the hospital for that patient.  As a result of this, most core measures are used as a means of assuring the hospital gets reimbursed as opposed to actually being of any benefit to the patient.
  24. Covering your bases:   It's the idea that you do everything you can think of for that patient with the hopes that something will help.  Or, it's the idea of throwing everything you can think of for that patient with the hopes that you do everything you can to meet Intensity of Service so the hospital gets reimbursed for that patient.  An example is Albuterol isn't needed but the doctor orders it on the 0.1% chance it might do something, or just to make sure reimbursement criteria is met.
  25. Reminders: These are laminated pages in the doctor's order section of the chart that remind anyone thumbing through the chart (DR, RN, RT) to focus on core measures.
  26. Utilization Review:  1)  This is a hospital department with the task of making sure government set reimbursement criteria is met so the hospital gets reimbursed for a patient visit.  It's a department formed in 1985 when DRGs were created by the government.  2)  After a patient is discharged, a nurse on the hospital staff goes back through the patient's chart to make sure the patient was an eligible Core Measure patient, if the appropriate care was delivered (reimbursement criteria met), and if the documentation was in accordance with the mandated abstraction process. The results of this review are then submitted on a quarterly basis to CMS, who publicly reports the data to aid in hospital improvement efforts and transparency with the public.
  27. Hospital Reimbursement: Generally, CMS offers reimbursement based on a hospitals performance on core measures. Actually, this strategy is often referred to as "pay for performance."
  28. Acute Mycardial Infarction Core Measures set:  It's treating every patient having a suspected heart attack the same based on what's proven to work. It's a set of core measures for the diagnosis (DRG) of chest pain or heart attack.  An example of such a set would include:  Aspirin at arrival, Aspirin prescribed at dischargeSmoking cessation (whether they smoke or not), Beta blocker prescribed at discharge, angioplasty within a few hours.
  29. Heart Failure Core Measures set: It's treating every patient with heart failure the same based on what's proven to work: An example of such a set may include the following core measures: Aspirin at arrival, Aspirin prescribed at discharge, Smoking cessation, Beta blocker prescribed at discharge, angioplasty, decreased mortality
  30. Pneumonia Core Measures set:  It's treating every patient with heart failure the same based on what's proven to work.  An example of such a set may include the following core measures:  Oxygen assessment, pneumonia and flu vaccine, blood cultures prior to antibiotic, smoking cessation, antibiotic within an hour of hitting the door.
  31. Surgical Care Improvement Project set:  It's treating every post op patient the same based on what's proven to work.  An example of such a set may include the following core measures:  prophylactic antibiotic immediately after surgery,  discontinuing prophylactic antibiotics 24 hours post op, controlling post op glucose, clipping pre op hair rather than cutting, maintaining normathermia.
  32. Keystone collaborative:  The Michigan Health and Hospital Association (MHA) Keystone Center for Patient Safety and Quality was created in March 2003 as a 501)(c)(3) division of the MHA Health Foundation. MHA Keystone brings together hospitals, national experts and best practice evidence to improve patient safety by addressing the quality of health care delivery at the bedside. Keystone is a voluntary collaborative to improve quality and save lives. The collaborative claims that since its inception, participating hospitals have observed significant and measurable patient safety improvements that have improved quality and have saved lives.
  33. Measurable patient safety improvements:  Use of statistics to show that a hospital is improving or not improving in regards to core measures.
  34. Faux measurable patient safety improvements:  Using previously non existent data and comparing this with current data, and then claiming the hospital has improved in this regard and giving Keystone credit for any improvements.  For example, ventilator acquired pneumonia (VAP) statistics were not measured prior to 2000, and since then it has been measured.  In 2010 VAP statistics were counted showing a VAP rate of zero.  So the Keystone collaborative claims it's mission has reduced VAP rates to zero.
  35. Keystone Committee: This is a committee at an individual hospital that gathers together on a monthly basis to review core measures and to assure best practices are being used and met. This consists of individuals from various departments, including doctors, nurses, administrators, quality assessors, respiratory therapists, pharmacists, lab techs, x-ray techs, and others. The most up to date evidence based scientific research is reviewed to to create and update order sets, protocols and other clinical pathways to making sure core measures are met.
  36. Rapid Response Team: A team of medical professionals (RNs and RTs) who are called to any patient not in the critical care unit who is showing early signs of distress. The purpose is to catch and treat these patients before their condition worsens to prevent them from needing the services of the critical care unit. The idea here is a patient will show signs of failure long before it happens, and if we can observe these signs, and treat the patient appropriately, we can prevent progression of illness.
  37. Approval for reimbursement: Whether or not a hospital gets reimbursed for services rendered is a function performed by the HCFA regional office based on state agency certification recommendations.  Approval is based on whether or not reimbursement criteria are met.
  38. Healthcare Finance Administration (HCFA):  Part of the U.S. Department of Health and Human Services (HHS) responsible for administering Medicare and Medaid.
  39. Medicare:  Healthcare provided by the U.S. government for any American citizen over the age of 65.  It's paid to anyone regardless of health or income.
  40. Medicaid:  Healthcare provided by the U.S. government for Americans unable to work.  The problem with this system is it works as a disincentive to work, and too many people become dependent on it who could otherwise get a job and buy their own health insurance.
  41. The American Society for Healthcare Risk Management (ASHRM): This is the society for healthcare risk management. This professional organization strives to advance risk management in the healthcare field through professional development, membership services, enhanced communications, risk management innovation, and effective governance. 
  42. Board Certified: Physicians who have completed residency requirements and have passed board examination in their specialty. Board certification is not required by law and is not the same as licensure, which is granted by the state
  43.  Case Management Society of America (CMSA):  An organization that helps case managers at similar institutions (such as hospitals) learn from the successes and failures of similar institutions.  They assess, plan, facilitate options and services to improve health services, reduce costs, and improve the means of accomplishing these goals.  They educate and create networks
  44. Case Management:  A group of hospitals planning, facilitating and advocating together to determine the best options and services necessary to reduce costs and improve outcomes.  It's a method of trying to get the most bang for your buck.  Usually an independent agency (such as CMSA) acts as an independent agency to help a group of hospitals achieve their goals by coordinating their efforts and expand the range of services offered.
  45. Obamacare:  Government mandate to assure that all patients are treated the same, and this has resulted in an increased need for QA analyzers and order sets in lieu of more nurses and respiratory therapists.  It's also resulted in more work, order sets, increased costs, confusion, end of life counseling and rationing of healthcare.
  46. End of life counseling:  Talking to people about how they want to end their life. It's not mandatory, yet if you don't do it you don't get reimbursed for that patient by CMS.  So, in other words, healthcare professionals and hospitals are blackmailed into doing it.
  47. Rationing of healthcare: 1)  Creating reimbursement criteria so that it's so hard to get reimbursed for some procedures that no one will choose them.  It's telling people they have a choice yet knowing people will not be able to choose the free market option due to high costs.  It forces people to choose the government option.  In this way, progressive experts in Washington get to set all the policies for healthcare, determine who gets what and at what costs.  2)   Government set criteria for determining who will get home oxygen, BiPAP, glucose monitors, etc.  For example, if your CO2 is not 52 on discharge you cannot qualify for home BiPAP, and if your PO2 doesn't drop to 88% while walking you do not qualify for home O2.  It does not matter if a patient needs something, if criteria is not met the patient will have to go without.  It does not matter if the patient dies, it's about saving money.
  48. Active surveillance:  Having the medical staff gown, glove and wear a mask when you admit a patient suspected of having a contagious disease such as MRSA.  The patient stays in such an isolation until the disease is ruled out.  The goal is to prevent the spread of disease.
  49. Popular Dilemma:  Many RTs and RNs are overworked and under paid.  This may ultimately lead to low sense of self worth, mercy, apathy, Nurse Apathy Syndrome, Respiratory Therapy Apathy Syndrome (see below)
  50. Good staffing:  Having an appropriate number of workers on duty to complete expected assignments.  Ideally, if workloads are high, staffing should be increased as appropriate.  If workloads are low, staffing should be reduced as appropriate.
  51. Compensation:  Workers should be appropriately and fairly paid for the work they perform.  Workers should be paid extra for doing the work of more than one worker, and also paid extra if they are at home and are called in.
  52. Poor Compensation:  Paying workers as little as possible.  So long as staffing is at appropriate levels wages and salaries should not be increased.  Workers are then told that their compensation is on average with the surrounding market.  This often results in low morale, yet that's fine so long as staffing is at a good level and the hospital continues to make a profit.  This is often coupled with poor public relations (see below).
  53. Fair Compensation:  Making an "honest" effort to pay fair market wages for the tasks completed, and providing fair benefits and raises based on inflation and performance.
  54. Taking advantage of workers:  Some bosses know workers will come into work when they are called in just because they know what it's like when workloads are high.  They want to help out their coworkers.  I usually come when I'm called in because if I were working I'd want someone to be willing to come in and help me.  So bosses often "take advantage" of this and so long as we continue to come in when called, they will not fairly compensate us for our generosity.
  55. Overworked:  One person doing the work of two or three or four people
  56. Underpaid:  When a person is paid less than the fair market wage for the work completed; unfair compensation
  57. Good Public Relations: An attempt by administration to keep workers happy with fair compensation.
  58. Poor Public Relations:  An attempt by the administration to keep workers happy.  When they can't accomplish this goal with fair compensation, they do it by having midnight meals, holiday parties, and buying donuts every once in a while.
  59. Worker satisfaction:  The level or degree of happiness with workload, compensation, and morale of the institution.  Usually if workloads are high, worker satisfaction decreases, yet this can be made up for with increased compensation. We can look at this from two angles.
    • From the employee:  Administration is often unable to justify additional staffing.  Like the grocery business, budgets are often set based on the previous years workload.  It's not possible to predict busy and slow times.  So during slow times some workers may have to go home early to save money, and during busy times workers may be expected to be overworked and underpaid for the work they do.  They do not want to pay extra for extra work because workers should be willing to help out their coworkers and be part of the team.
    • From the employer:  When it's busy extra workers should be available.  One person should not be expected to do the work of more than one person.  Burnout, apathy, low sense of well being are often the result of being overworked.  When the workload is low, the employee will send workers home because the workload doesn't justify extra workers, yet when the workload is busy workers are expected to work harder and longer hours.  This is unfair.  If we are called in to work extra hours, we should be justly compensated.
  60. Nurse Apathy Syndrome:  Nurses become apathetic and burned out from responding to too many unnecessary alarms. 
  61. Respiratory Therapy Apathy Syndrome: Respiratory therapists become burned out and apathetic due to too many stupid doctor orders.
  62. Hospital lawsuit:  When the hospital or individual workers are sued for neglect.
  63. Law of Respondeat Superior:   Vicarious liability.  The hospital is accountable for the negligent acts of its employees. In most cases the plaintiff sues the hospital because the hospital is more likely to have assets than the employee, and the hospital's policy provides coverage to the corporation for the negligent acts of its employee. But if the patient sued only the employee and did not sue the hospital, the hospital's insurer would provide no coverage to the employee. While this is rare, it can and does happen, particularly where the patient has a personal grudge or doesn't use a lawyer
  64. Vicarious liability:  See Law of Respondeat Superior.
  65. Indemnity:   This is what happens when the hospital is sued for neglect.  It provides that where a master pays for the wrongs of his servant under respondeat superior the servant must indemnify (or repay) the master. Most hospital insurance policies provide for the insurer to seek indemnity from any liable employee. Thus, if the hospital pays $300,000 to settle a claim arising from the negligence of a therapist, the insurance company can sue the therapist for indemnity to recover what it paid. Again, while this is rare, it does occur."
  66. Contribution:  When the physician and not the hospital is sued for negligence. Suppose the physician settles a claim for $300,000 and alleges that had the therapist communicated the blood gas values to him, the harm would not have ensued. He can sue the therapist for contribution and force him to pay all or part of the amount he paid in settlement
  67. Hospital lawyer:  He represents the hospital and not you.  If the plaintiff sues the hospital the hospital liability insurance will cover you.  Yet if the plaintiff sues you, he will not represent you.  He represents the hospital and not individual care providers.
  68. Hospital Malpractice Insurance:  It covers the hospital and not individual care providers.  However, if the hospital is sued and you can help, you will be called to participate in the lawsuit.  He may represent you if you are sued and the hospital is sued, yet his ultimate goal is to represent the hospital and not the individual.
  69. Individual Malpractice Insurance:  Your own insurance to protect you against malpractice lawsuits.  You may need it if you work in an area of high risk.  The only time you would need it would be if you were sued and not the hospital.  However, a majority of times the hospital is sued because people know the hospital will be able to pay while individuals may be strapped for cash.
  70. Positive Outcome Based Medicine:   this is where you do what works, and don't do what doesn't work. You do what's needed, and you don't do what's not needed. This truly would result improved outcomes and reduced costs. This would improve care and reduce costs and improve worker apathy.  The problem with this approach is it cannot be directed from Washington; decisions must be made at point of care.  Protocols are a good way of accomplishing this.
  71. Preventative Medicine:  This is where you encourage people to exercise and eat right and quit drinking and smoking, and in this way you prevent people from getting sick. You encourage them to visit their doctor for annual check-ups, and to get annual testing done.  This was tried during the 1980s and it didn't work.  The problem with this theory is that people who are completely healthy, who eat all the right foods, who don't drink, who never smoked, and exercise daily come into the hospital and get diagnosed with cancer, and patients who eat unhealthy, smoke, are obese and drink daily live to the age of 90.  So you can see, how you live your life does not prevent you from getting sick. It might help, yet all the cost of preventative procedures you'll be getting every year will more than offset any savings from the people who live longer from living well.  A more recent attempt at this is the Keystone Collaborative and the creation of order sets and cookbook medicine.  
  72. STAT:  This is a term that means immediate attention is needed to save a patient's life.  More recently it has become an abused buzzword to speed up care for the convenience of the physician more so than the patient.  Due to abuse and overuse, many medical professionals have become de-conditioned to the term.
  73. Optimal patient care:  Giving the best care with the least tests and procedures.  Giving the least care by spending the least money.
  74. Pay for performance:  You are being good little socialists.
  75. Brainwashing:  Telling hospitals they have a choice to follow core measures but punishing them with less reimbursement when they don't.  In other words, a hospital is brainwashed to do it the way the government wants for the greater good.  A good example is smoking cessation.  Many hospitals chart and bill for smoking cessation on every patient even when it's not given just to get better reimbursement.
  76. Pyxis:  A device to lock medicine up because RNs and RTs can't be trusted.  A device pent on making our jobs harder.
  77. Automaton: The ultimate goal of the great society is to force all medical care providers to provide to various situations the same way.  They have to follow the set presentation, respond the same way to similar situations, and not sway from the master plan set forth by a non-medical professional sitting in a leather chair in Washington.  For example, RTs must say the following when giving an initial treatment:  "Hi, I am _____ from respiratory therapy.  This is a breathing treatment.  It will help you breathe better.  Do you have any questions."  You are not allowed to think or ask inappropriate questions such as "Are you short of breath?"
  78. Performance based reimbursement:  A politically correct way of saying that we only reimburse if you do everything one government expert sitting in a cozy leather chair in Washington has decided you need to do for each DRG.
  79. Protocol/ order set combinations:  The best common sense approach to incorporating best practice medicine.
  80. Euphoric hospital setting:  All patients with a given DRG treated the same regardless of actual need or individual ideas of the doctor.  Physicians worship the state instead of the individual patient.  Less pay by the government = happiness.  Saving lives is not part of the equation.
  81. Ancillary staff: These are workers who are told what to do, and do them as instructed without asking questions.  Examples include x-ray and laboratory techs.
  82. Professional staff: These are professionals who are involved in the care of the patient and are a part of the team that "thinks" of solutions to acute and/or chronic problems the patient is confronted with. Examples include nursing and respiratory therapy.
  83. Chronic Bed Syndrome: Here you have your typical chronically sick patients who are unable to get out of the bed. They usually present with some grumpiness and fear not bossing you around without saying thank you. They expect you to cater to their every need; to actually know what they need before they ask. They tend to fit into any or all of the following adjectives: grumpy, demanding, purposeful apathy, melancholy, bossy, condescension.
  84. Whoa is me Syndrome: Some diseases might be MS, ALSMSA, trauma, rehabilitation, chronically ill, or any such disease where the patient slowly develops atrophy of muscles and possible paralysis. She needs constant assistance moving and perhaps even drinking. They constantly yearn empathy and can at times fall into the Chronic bed syndrome. Ultimately, they want you to feel sorry for them. Something you might hear from this patient is, "Oh, why did this happen to me."
  85. Slippage: When you say what you would normally keep to yourself. Lack of politics. The act of not being politically correct. According to "failure to maintain an expected level, fulfill a goal, meet a deadline, etc.; loss, decline, or delay; a falling off." Normally we RTs maintain a certain level of respect, however occasionally we slip and tell doctors, or RT bosses our true feelings about bronchodilator reform. Synonym: 2 a.m. syndrome (see below). I also wrote about
  86. 2 a.m. syndrome: see slippage. Just prior to getting a second wind, the RT crew has a tendency to get loose lipped and say things that don't necessarily make sense. Likewise, they may say things that they otherwise would not talk about, like personal things, sex, life in general. They also may have a tendency to laugh hysterically at simple things.
  87. Patient Complainers: You know they complain about every little thing. They get a headache and they'll be in the ambulance faster than you can say, "You're fine."The thing about complainers is you must take them seriously every time, because the moment you don't is the time they'll be having a true emergency.
  88. Poor planning: Often a problem of hospital administrators. They must remember that poor planning on their part does not constitute an emergency on the part of the staff.
  89. Chevy Chase Vacation Syndrome: when you finally get a vacation from work, yet when you try to do things you think are fun with your kids, they fight you tooth and nail. The kids are only thinking about their needs and wants, and fail to have empathy for the parent.
  90. Hospital Style Vacation: It's Christmas, and it's your day off to spend with your family, come on in to work and join the fun.
  91. Frugality: Wise nurses and respiratory therapists and anybody else who does not have to start spending more wisely because we're in a recession because they are always spending their money wisely.
  92. Ignorance: There are a lot of ignorant people in the world, because it is a lot easier to do nothing than it is to spend quality time learning. This explains whey bronchodilators are ordered for patients not having bronchospasm, and why some physicians refuse to use the skills of the expert staff at the bedside. It also explains why some nurses insist the RT come and do a breathing treatment just because the patient exibits a low sat or respiratory distress, as opposed to calling the RT to assess, make recommendations, and treat.
  93. Patient enablers: Patients who seldom questions doctors and pretty much do everything they are told. This sounds like a good idea, although it assumes doctors are all knowing and powerful, when in fact they are human prone to error. By never questioning physicians these patients are enabling doctors to do whatavever they want, and enabling unaccountable totalitarian ego centrism.
  94. Goofus Parents: Also known as dumb ass parents. They are the parents whose kids come to the hospital regularly due to poor parenting. These kids smell like sweaty socks, are dirty, are inappropriately dressed for the season, are not on asthma preventative medicines, have no doctor, are hyperactive, poorly disciplined, have cool Aide in bottles up to the age of five, may have teeth missing or discolored, and are filthy dirty.
  95. White Coat Fever: Also known as doctor anxiety. A collection of symptoms predominantly prevalent among people of all ages ages, races, creeds and sexes, which occurs when one is exposed to the presence of medical professionals or the anticipation thereof. Symptoms include: Rapid heartbeat, Biting of fingernails, Sweaty palms, Unusually quiet, Tapping on the chair, bed or table, Higher than normal blood pressure, Feel warm inside or even hot, Shivering, and Saying stupid things
  96. The Forgotten Man: Man A is planning to buy a new suit coat. He has the $100. The public has empathy for Man B, so they encourage their Senators to sign a bill raising man As taxes by $100 so they can help out Man B. Since man A has to pay $100 in taxes, he can no longer afford to buy a new suit coat. While the unemployed man is being helped with that $100 and we are all happy about that, Man C is actually the forgotten man here. He will lose business, because during a recession people find better ways to spend money than buying things like suit coats and entertainment and other such things. I imagine many medical care workers are forgotten men and women. Yes it's true many are still working, yet we are not getting raises to keep up with inflation, and we are not getting all our hours. So we cannot spend money on things like, say, suit coats. So man C suffers even more. He cannot pay for his hernia repair.
  97. The Forgotten Patient: The patient who is a good tax paying citizen who is forgotten by society. He is the one with medical a chronic medical condition, is barely able to make ends meet regardless whether or not he has medical insurance and regardless that he has a job. They are the patients who have to pay full price for medical services because they have no insurance, while insurance companies and the government pay discounted prices. While much of societies concern is for the impoverished, these patients are often overlooked.
  98. Nursing Home Syndrome:  Patients who are so used to getting waited on hand and foot that they begin to expect it and get angry and demanding when you aren't prompt at resolving their needs.
  99. Patient Complainers:  The thing about complainers is you must take them seriously every time, because the moment you don't is the time they'll be having a true emergency.
  100. Off Label:  a term used to describe use of a medicine for uses not approved by the Food and Drug Administration (FDA) and not recommended by the pharmaceutical company. It refers to any of the following:  Using unapproved dosing,  using a medicine for an unapproved conditions, and prescribing a medicine for an unapproved age group.  Despite contrary belief, prescribing medications off label is perfectly legal in the United States.  This is a good thing because it allows doctors a right to use a medicine to its full potential and this greatly benefits patients.
  101. No fun diet:  A diet that devoids the patient of anything fun.  It's usually ordered by doctors who order everything they can think of to cover their asses.  You can only eat essential foods and usually in liquid form.  You cannot have caffeine or pop.
  102. HIPPA (Health Insurance Portability and Responsibility Act):  An act that makes it illegal to share information about a patient without that patient's permission.  However, it's often misunderstood to mean that no information about a case can be shared.  This is not true.  Information may be shared about a patient for educational and quality improvement purposes.  Likewise, you are allowed to say the names of patients in the waiting room.  What you cannot say is what that person is in the waiting room for.  The act also makes the individual health care professional personally responsible for violations of this act along with the hospital. The Bill was signed by President Bill Clinton in 1996.
  103. Autonomy: Independence or freedom, as of the will or one's actions: the autonomy of the individual.(From
  104. PatientAutonomy:  The patient is allowed the freedom to make the best medical decision based on the best available information about all possible options.  The desire of caregivers to treat the patient as an individual person. Yet the truth is, there really is no such thing as patient autonomy.  The reality is the following:
  105. Real Patient Autonomy:  The patient is lead down a certain path, given one or two options, and lead to believe he made the best decision on his own.  Most people are naive about medical options and trust their physician to make the right choice for them.
Note: *It's important to note here that this report card should not be used to compare hospitals.  The reason I say this is because while the goal is to meet a score of 90% or better on each core measure, a score of 80 percent isn't necessarily bad.  A good example of this is comparing a small hospital with a large hospital.  Small hospital may only have 10 patients in a given month with pneumonia, and two patients not given the pneumonia vaccine will garnish a score on that core measure of 80 percent.  A large hospital may have 100 such patients, and if 10 pneumonia vaccines aren't given that hospital will still garnish an acceptable score of 90 percent.  So you can see the numbers can be skewered based on the patient load, and may not reflect actual hospital performance.  Thus, this data should be used by the hospital to assist improvement, and not act as a report card to grade hospitals.  The stated goal is hospital improvement and public transparency.

1 comment:

Loretta said...

This is a fun list. If I relive again I'd be a RT!