slideshow widget

Sunday, August 1, 2010

The dilemma of bronchodilator reform

For many doctors, treating all patients that are short of breath as though they have asthma and ordering breathing treatments is a culture and a dogma, just like conservatism and liberalism are.

Individual bronchodilator ordering doctors may think they've reached their conclusions through careful deliberation -- and no doubt many have -- but there is no escaping the undertow of history and culture. Ideas and ideology are transmitted in more ways than we can count, and ignorance about where our ideas come from doesn't mean they don't come from somewhere.

Now, of course, this doesn't mean that the past has an iron grip on the present. For example, I am a strong supporter of states' rights, but that doesn't mean I would have agreed with the Jim Crow rulings of old. Sure states' rights were used to justify this racist ruling, yet it's not something I would have supported.

The bronchodilators-treat-all-lung-ailments-and-all-annoying-lung-noise doctors are confident they've always been on the right side of history, just like George Clooney was confident he was on the right side of history when he said, "Yes, I'm a liberal, and I'm sick of it being a bad word. I don't know at what time in history liberals have stood on the wrong side of social issues."

Well, no human being believes in his own mind he's on the wrong side. That's one of the interesting things about life, is that we all think we are right. It's also the most challenging, because we know we aren't all right.

These doctors -- perhaps among the best in the business -- believe they are doing the right thing. They believe research and history supports their dogma. This is one of the main reasons I write about bronchodilator reform on my blog: to puncture the smug self-confidence that simply by virtue of being a bronchodilator loving doctor one is also virtuous, and in the right.

That simply ordering a breathing treatment so the family thinks you're doing something, you're in the right. That simply by covering your bases by ordering an $80 a pop treatment every four hours you're in the right.

Today's doctors aren't the authors of past generations' mistakes any more than George Bush is for the callousness of some conservatives who champion states' rights for the wrong reasons well before he was born.

No, the problems with these doctors (few they may be) today reside in the fallacies that were born with the advent of respiratory therapy. A perfect example is the hypoxic drive theory, which was born because a few RTs wanted to create work for themselves. Another example is breathing treatments today, where at a small hospital we need procedures to continue working, so we enable doctors to order frivolous, un-indicated breathing treatments.

Then there are those amongst us who champion for protocols, and many of us have protocols. Yet due to some of us being lazy, some doctors may be hesitant to give away a large chunk of responsibility and autonomy to the RT.

Yes, we RTs brought some of this unto ourselves.

The relevance to the past is that unlike the conservative who has wrestled with history to make sure he does not repeat it, bronchodilator doctors see no need to change their opinions of medicine. What they were taught in medical school is and will always be true until someone forces them to change.

Like we RTs here at Shoreline did when we put the mist tents in the basement and told the pediatricians we weren't allowed to use them anymore. Or until the pediatricians at the children's hospital we send our bad neonates to told our doctors they could no longer over-oxygenate children (although many still do due to dogmatic views).

And so, armed with complete confidence in their own good intentions, they happily go marching past boundaries we should stay well clear of. They reinvent ideological constructs we've seen before in earlier times, unaware of their pitfalls, blithely confident that the good guys could never say or do anything, or order any therapy, that was pointless because good intentions is by definition anything desirable or might have potential benefits that outweigh the risks.

Of course bronchodilators mostly come without risks, and therefore that makes ordering them for everything easy. It takes the "if" out of the equation for them anyway. Of course bronchodilator ordering abuse is nothing if not the organized pursuit of the desirable, just like liberalism is the desire for the ideal.
Word of the Day:Corrigible: That which may be reformed or corrected; punishable

Bronchodilator abuse will some day be a corrigible offense.

No comments: