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Sunday, December 5, 2010

Problems and how to solve them

Teach a man good principles and let him govern himself. You can't solve problems by telling people what to do. This is why Intensity of Service, order sets, and setting criteria do not work to solve problems in healthcare.

It's a simple fact that people do not like to be told what to do. They like to be independent

A good example of this is that kids in America are getting too fat. So we have this problem, now how do we solve it.

A traditional approach, or the mom's and dad approach, is to teach their kids good principles, and hope they make the right decision. If they are educated, then perhaps they will make the right decision. Or at least be responsible for their actions if they choose to eat poorly.

This is the best way to solve problems. Let people solve their problems themselves. People are smart. This is especially true if we spend time educating them, and making sure they are knowledgeable of the latest facts (like Bronchodilators treat bronchospasm, or Xopenex is no better than Albuterol, or the hypoxic drive theory is a hoax).

Yet a new approach is the opposite. The latest method is to tell people what to do. Experts in Washington decide how every patient with a certain disease is to be treated, and all patients with that condition are expected to be treated that way, or the patient will not meet reimbursement criteria.

The result here is a bunch of therapies being ordered that are not indicated, instead of having the doctor at the bedside doing what he or she thinks is most needed.

A similar case explains why there are people who want to make laws limiting salt intake, or making sure there is pressure on restaurants like McDonalds to serve healthier (and less tasty) options that people don't want. These experts believe they know what's best for everyone, and believe they must force us to do what is right.

They don't consider the fact that every person is unique, or the fact that every person has a right to make their own choices, even if that is the wrong choice. We have a right to be wrong. We have a right to be stupid. Yet we aren't allowed to. We aren't allowed to make mistakes. We aren't allowed to learn from our mistakes, because we are prevented from making them.

They believe to keep kids safe we need to make laws banning swings because there are "too many swing related swing sets." It's not enough to say we and our grandparents survived with swing sets They've made policies banning chocolate milk because white milk is better for them. Yet all this does is cause some kids to get no milk, because they don't like white milk.

New York schools banned bake sales to reduce calories. Some schools even banned the dictionary because there are references to oral sex. That's not to consider the fact that kids are curious, and will find a way to discover new things on their own. Bans like this simply encourage furtive behavior.

All this does is create anger. People don't like to be told what to do, and when you tell them they have to do something, they purposely do what you don't want to spite you. I see this often with my kids. When I tell them not to do something, they do it when I'm not looking.

The same is true in hospitals, yet for fear of not getting reimbursed doctors are ordering therapies, such as breathing treatments, just to cover their bases. Here at Shoreline we have to order Smoking cessation on all patients with pneumonia, CHF or MI regardless whether they smoke. And we have to charge for it. Yes this is senseless, yet that's how it is in a world where we are not allowed choices.

The best way to solve problems is to teach good principles and let people govern themselves. We can help each other. We can turn to each other for help. We can be a team. Yet rules and laws stifle creativity, just as criticism stifles creativity.

We need to teach history. We need to teach facts. And then let the kids, the people, the moms and dads, the nurses, the doctors, the RTs decide from there. Given the freedom, people more often than not make the right decision. Yet it must be their decision.

On another level, there are generally three different ways people solve their problems.
  1. Get angry (a lot of apathy among RTs due to all the senseless orders); complaining
  2. Unplug: not pay attention; separate; just do the procedure and not care
  3. Find a happy place. Make the changes needed to make yourself happy given the situation. Teach principles and let people decide. Educate. Learn. Try to make things better. Stay calm. Teach facts. Talk to God. Pray. Do your part to improve the situation.
Obviously #1 and #2 are not going to help anyone solve the problem. Yet often often this is the course of action. People like me and you find our happy place. We want to make the best of the situation, and to try to do our part to make it better. I suppose that why this blog exists.
Know that people are smart and can solve their own problems, and don't become unwilling to tolerate another opinion.

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