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Sunday, February 28, 2010

How to deal with arrogant, all knowing physicians, and why progress is slow in respiratory departments

The following is a comment and my humble response regarding this post, where I wrote that breathing treatments do not work for CHF. I don't do this often, yet I felt this was worthy of its own post.

Your Comment: I look forward to your post about pneumonia and bronchodilators. I've had this discussion with several doctors and nurses. In fact, one nurse wrote me up when I told him that there was no indication to use Albuterol in pneumonia.

My humble response: I've had the same discussion with doctors and nurses. There's really nothing you can do when so many people choose to deny the facts.

Always know that the #1 sign of arrogance, elitism, ignorance and denial is to belittle the messengers of the truth. I can think of many examples, but you can find your own just by studying Hitler, Stalin and Castro. Anyone who disagrees with those folks was killed or imprisoned.

I agree with the Founding Fathers that it is only on the battlefield of ideas that the best ones can be recognized and ultimately prevail. Only those afraid of the truth seek to silence debate, and intimidate those with whom they disagree. This explains why RTs are criticized when they go verbal with the facts about breathing treatments.

On the contrary, Those who know they are right have no reason to stifle debate because they realize that all opposing arguments will ultimately be overcome by fact.

Yet those who champion breathing treatments for all that wheezes, for all that is short of breath, do not seem to understand that. If science is on their side, then why should they care who's against them? "The debate is over!" is a line that's used only by those who realize they would never win a debate.

In the end, it's not the debate itself, but those preventing it that are the truly ignorant. Honest listening and, more important, honest questioning is the foundation of the American experiment. We must listen to each other with renewed ears and speak out with passion, while also recognizing the difference between anger and truth.

That's why some doctors and nurses talk about RTs who state the facts as "lazy" and "trying to get out of work." Most doctors aren't this way, but the fact that some are scares us all into submission. It's kind of a do-you-want-to-take-the-chance kind of a situation.

I believe, however, that the fear of write-ups, of rocking the boat, and the desire to be politically correct and to "keep the peace" is exactly why we are in this mess in the first place. Too many times we RTs do the treatment not because it's needed, but because that's easier than confronting the ignorant. I know that sounds harsh, but it's the truth.

And I'm the same way. You'll rarely hear me saying to a doctor, "That's not a wheeze, it's stridor," or, "What good is a treatment going to do for inflammation of the alveoli, which is what pneumonia is." Because when I did use those words to question a doctor's order, the doctor and nurse got angry.

It's easier to just do the treatment and go back to the RT Cave. It's easier to just do the job they want you to do, go home and collect that pay check. It's easier to just go along. Your life will be so much easier if you just go along.

There's no controversy in agreeing with everyone, and not confronting ignorance and complacency. Because you're non-confrontational, You will have more friends as doctors and nurses will pretend to like you. It's easier, but is it really the right thing? Well, in a hire at will fire at will society, it is I guess.

This explains why RT bosses and admins tell us they understand during our monthly department meetings, and on occasion they accept one of our protocol ideas and vow to run it by the physicians, and when the pressure from "busy-don't-want-to be -bothered", "don't-want-to-give-up-autonomy", "don't-want-to-give-up-power" doctors rises, they back down and the protocol goes down with the rocked ship.

Yet, so long as you are polite and professional in your approach to educating doctors, you shouldn't need to worry about a write-up. Sometimes they can be good. Sometimes that's how the powers that be become aware of problems, and the seeds to solving the problem are planted.

Any RT who stands up and professionally approaches ignorance should be heralded. Many people resist change, even change that is based on facts and scientific data and common sense. They hate it. They would rather hold on to old fallacies. These people need to be confronted. They are resisting progress, and need to be held accountable.

So continue to be yourself, be careful as to know who you are confronting, and know when it's a good idea to back off and shut your mouth. It's also a good idea to know if you can trust your boss to back you up. That's the nice thing about my boss, so long as I'm not "complaining," he will always back me up, and my fellow RTs too.

However, unless you work for an elite teaching hospital where there are student physicians and Interns standing next to you while you're assessing a patient for an un-indicated breathing treatment, progress will be slow. So be patient, and keep up the good, peaceful fight.


TOTWTYTR said...

Thanks for the post. Fortunately, I work in a system where there is a long history of the medical directors backing the medics when we are right.

Sadly, Albuterol falls into the "Chicken Soup" school of medicine. That is too many people take the "Can't hurt, might help" approach.

If only everyone is medicine was interested in doing what is best for the patient and stayed current on the science.

Well, I can dream, can't I?

Rick Frea said...

I love the chicken soup analogy. That hits the nail right on the head. Yeah, it's pretty much the same thing where I work.