Habitual offenders of the superfluous therapy

So you ever wonder how many hospital therapies are ordered simply out of a doctor's habit.

Aa 35 YO patient was admitted to the ER. His chief complaint was drowsiness, malaise and lightheadedness, especially when he tried to walk. He said he vomited blood and had a bloody stool. He was still nauseous.

Upon assessment his heart rate was 110 and his standing BP was 90/50. His labs showed a hemoglobin of 9.8. The doctor ordered a drug to help with the nausea and then ordered "foley cath, watch i's and o's."

The RN cringed at the order, but entered the room. "Your doctor ordered a foley cath." The patient was an RT, so she didn't have to explain what that was.

"Oh, okay," the patient said through beady eyes. The nausea med was kicking in and he was obviously in no state to make decisions with his mind numbed so. "I don't care."

"Hold on there," the patients wife said. She was an RN who worked upstairs in this same institution. "My husband and I have a pact. We call it a DNC pact."

"What's a DNC pact," the ER nurse said.

"It's a Do Not Cath pact. We do not want caths unless they are necessary. My husband here can just as easily get up and go to the bathroom or pee in a urinal. There's no reason he needs a cath."

"Okay," the nurse said. Ah, no argument. She didn't try to defend the order, which meant she knew it was another frivolous doctor order.

"Dr. Bart is a great surgeon I have no doubt," the wife said, "but I'm sure he's just ordering that just by habit. I know in OB where I work a doctor ordered a foley on a patient once, and I asked the doc, 'Why did you order a foley on this patient?' The doctor said, 'Oh, I guess I just ordered it by habit.'"

So, the moral of my little story here is: Make sure when you are admitted to the hospital that you utilize your right to refuse therapy. If it doesn't make sense to you, chances are it isn't needed.

Or, at the very least, ask questions like, "Is this really needed?"

"Um, Rick, do I really need this breathing treatment?"

Well, no. I know for a fact doctor Utilipticolicupolisolinos orders treatments on all his post operative patients out of habit. I confronted him once, and he has no clue what a breathing treatment even is.

I kid you not. Someone told him once treatments help make post op patients recover faster. Hmmm. Well, that's fine. Show me the study. Show me your proof. That's all I ask.

Or, are you simply ordering it out of habit. Does this patient really need an invasive ABG? Does this patient really need to risk a urinary infection and possible sepsis by having a catheter inserted into his yahoo?

Doctors are great. Doctors can do things I could only dream of (well, in a nightmare anyway). Still, doctors are very, very busy people who have lawyers salivating as they watch their every move waiting for a slip. It is this environment that encourages useless and uneeded procedures.

Well, plus you have to add in the habit factor.

It is the job of the rest of the profession to watch out for the patient and question such frivolous orders. And it is the job of the hospital bosses to support the RTs and RNs who do question orders (however, money often wins out over common sense. Hey, we make a ton of money off un-needed and useless procedures.)

So, since RTs and RNs are often quashed at their insistence that some "habitual" policies should be eliminated, the buck stops at the patient. If he refuses, the superfluous procedure is not done and the bill the customer never sees does not grow.

The buck stop with the patient and the patent's family. Still, too many people have too much faith in their doctors to make all the right decisions. They forget that doctors are human too and prone to get caught up in the system.

The 35 YO patient with the GI bleed had his problem resolved with hardly any medicines given. He went home two days later. And, believe it or not, he survived without the breathing treatment and without the foley.

So, we must ask this question: how many procedures do we do that are not indicated? How many procedures do we do just to avoid a lawsuit? How many procedures do we have to do just because of a habit?