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Wednesday, February 1, 2012

Faux Respiratory Therapy Lexicon

Basic Definitions:

1. Amnesia: This is what occurs when a night shifter goes to days for a long enough period of time. He, or she, forgets what it was like to work nights. Synonym: Night Shift Suppression Syndrome.

2. Night Shift Suppression Syndrome: See Amnesia above.

3. RT Grumpiness: This is what happens to RTs who develop apathy due to too many stupid doctor orders and burnout.

4. RT Deja Vu: Catching yourself repeating yourself to a patient. Catching yourself repeating yourself to a patient. Habit of asking questions automatically at that point in the procedure. Other signs include but are not limited to: Selective hearing, Lack of attention, Burnout, Brain infarct, Exhaustion.

5. RT idealism: The belief that perfection is possible, and an ideal setting for RTs is likely in the near or distant future where there will never be unindicated procedures ordered by doctors.

6. RT Realism: The wisdom that perfection is not possible, and the ideal profession is not possible, and that we must work within the means of reality.

7. RT Procrastinate: Delay doing an ordered procedure with the hope that you won't have to do it, or the hope (see below) the patient will realize it's not needed and refuse, or the nurse will forget about it.

8. RT Hope:You delay, and then you do what the doctor ordered hoping the patient will realize he doesn't want it, it's inconvenient, and refuse the therapy. However, more often than not, RT hope merely comes down to RT frustration

9. RT Frustration: Irritation that a patient says something like, "Well, the doctor ordered it, so I must need it."

10. RT Feel Stupid: A really awkward feeling an RT gets when he has to do a breathing treatment on a young, physically fit person who can blow 4,000 liters on his incentive spirometer, has no prior medical history, never smoked, has no lung disease and has absolutely no need for a breathing treatment. 11

11Rhonchi-eeeeeeeeze: if you takeRhonchi, and you realize that it was a word that originated in ancient Greece, yet when it was translated to Latin during the Roman Inquisition the pronunciation of the i's became eeeeeeeeeeeeeeeeeeeee. Therefore, if you pronounce rhonchieeeeeeeeeeeeeeee correctly, the i sounds like eeeeeeeeeeeeeeeeeeeee which sounds like wheeeeeeeeeeze, and there fore a bronchodilator is indicated.

12. Bronchodilator fallacies: Ignoring scientific fact and believing bronchodilators treat all respiratory ailments and all that wheezes. Synonym: bronchodilator lies; bronchodilator ignorance (see below)

13. Bronchodilator lies: Telling people that bronchodilators will help them (or their mother or father or friend) when all bronchodilators do is treat bronchospasm. Giving a patient false hope by falling back on that inevitable breathing treatment.

14. Bronchodilator ignorance: When the most intelligent amonst us believe in the myth that a bronchodilator breathing treatment cures everything from rickets to a bad mood, from patient anxiety to a nurses arrogance.

15. Treatment Stacking: Giving breathing treatments to more than one patient in more than one patient room. You'll be leaving one patient unattended while treating another. Ideally one should not stack, yet sometimes we have no choice.

16. Bronchodilator Reform: An ongoing request by RTs to educate RNs and physicians that bronchodilators are bronchodilators and nothing more.

17. Anti-irritation meds: A new line of medicine that doesn't yet exist to treat RT apathy, cynicism and vexation caused by annoying requests and stupid doctor orders.

18. RT Professionalism: RTs who radiate professionalism through their speech, manner and dress are more likely to be given a high degree of autonomy on the job, something every RT covets. It's your privelidge which must be earned and maintained through professional accountability. You must also keep up to date on your RT wisdom, and go above and beyond without complaining, and with a friendly disposition.

19. RT Autonomy: Something you earn through professionalism.

20. RT enablers: We RTs and RNs tend to let doctors get away with anything because we fail to question their authority. We, thus, enable them to get away with whatever they want. We fear them for whatever reason. We fear the wrath of doctors, and the wrath of our bosses for rocking the boat. If we ever want doctors to be held accountable, we need to start questioning them, although we don't: we enable. This is why we have bronchodilator abuse, tylenol abuse, and patients on ventilators three weeks too long. We fear not just doctors, but our own bosses. Due to this attitude on our own part, we have become enablers.

21. RT Equanimity: RT Equanimity is an important tool, essential for things running smoothly in the hospital setting. When an RT is cool, calm and collected, it shows he's compitent and confident at his skills.

22. RT Walk: When someone else can tell how busy an RT is by how he or she walks. A moseyed walk means slow, and a rush means busy.

23. Bronchodilator honesty: This is where get tired of being politically correct and lying to patients and their family and honestly, and humbly, tell them in an appropriate fashion that Albuterol won't benefit any ailment that isn't bronchospasm.

24. Bronchodilator osmosis: Calming vibes sent from the Ventolin amps in your pocket that is absorbed by osmisis by other people in the room. So, just by RT being in the room, this has a calming effect on disgruntled patients.

25. Respiratory Fate: The realization you were born to be an RT, and that the grass isn't always greener on the other side. The realization you are better off creating challenges and enjoying these challenges as opposed to getting frustrated with the monotony and politics of the job.

26.  Faux  Pneumonia: A fictitious diagnosis of pneumonia simply because pneumonia is the most reimbursable diagnosis.

27.  Bronchodilator honesty:  You are honest to the patient and tell them when you thing a breathing treatment is not indicated; you tell them they have a right to refuse.

28.  Bronchodilator lies:  1)  You are politically correct and tell the patient a bronchodilator will help a patient breathe better when you know this is a bunch of bull.  2)  When a doctor or scientists explains that a bronchodilator will do something you know it can't, such as help a patient expectorate pneumonia.

29.  Treatment stacking:  Concurrent therapy.  This is doing more than one treatment at a time.  By professional organizations it's viewed as bad because the patient safety may be a concern.  However, considering most treatments are not needed and this results in treatment overload, it's often necessary, convenient, and harmless.

30.  Treatment overload:  When more bronchodilator breathing treatments are ordered than are indicated.  This leads to RT passivism and RT apathy

31.  RT passivism:  Not responding to a situation that should foster emotion.  Someone dies and you don't care. Someone can't breathe and you don't care.

32.  RT apathy:  Lacking emotion.

32.  Respiratory Therapy Apathy Syndrome:  When an RT gets tired of doing BS procedures he develops apathy toward his job and his patinets.  This may foster uncharacteristic mood swings and verbal outbursts even when asked to do something useful.  This is often the result of bronchodilator abuse

33.  Bronchodilator Abuse:  1)  When unnecessary breathing treatments are ordered due to doctor belief that bronchodilators cure all annoying lung sounds and all causes of dyspnea.  2)  When unecessary breathing treatments are ordered due to reimbursement criteria set by the government.

34.  Reimbursement criteria:  Government set criteria that blackmails hospitals into ordering procedures for a particular DRG (such as breathing treatments for pneumonia patients) that aren't needed so the government has an excuse to refuse reimbursement when said procedures are not ordered

35.  Dyspnea:  1)  Short of breath  2) feeling of air hunger 3)  Feeling you can't catch your breath  4)  Many doctors and nurses mistake dyspnea for bronchospasm.

36.  Paradoxical bronchospasm:  2)  The belief that long term use of Albuterol (s-isomer) in some patients causes underlying bronchospasm.  It's been proven in studies but has never been evidenced in real life.  2) An excuse to market Xopenex as a stronger and safer medicine than Albuterol

37.  Bronchodilator stupidity:  If it proves their own theories it's believed.  Example:  Studies that show Albuterol enhances sputum production are believed wholeheartedly, yet studies that show Albuterol causes inert bronchospasm are conveniently ignored.

38.  Enhanced Sputum Production Hoax:  The belief that Albuterol will cause patients to cough up a loogy.

39.  Cough suppressant Hoax:  The belief that Albuterol will cause a patient to stop coughing.

40.  Wheeze:  Any annoying lung sound.  Requires bronchodilator.

41.  Bronchodilator Faux Thinking:  The process of calling an RT instead of racking your brain.

42.  Bronchodilator Faux Science:  Instead of using science doctors and nurses order Albuterol.

43.  Bronchodilator Osmosis:  A spirit of equinimity that eminates even from unopened amps of Albuterol.  Hence, just the presence of an RT can relax an unruly or anxious patient.

44.  RT enablers:  When an RT tells a doctor or RT boss what he expects that doctor or boss wants to hear instead of the truth.  The goal here is to keep your job by lying and being politically correct.

45.  Keystone Committee:  1)  A committee with a set goal of making sure clinical pathways (i.e. order sets) are created so that government set reimbursement criteria is met so the hospital can make as much money as possible.    2)  The process of creating clinical pathways (i.e. order sets) so every procedure imaginable is given to every patient with every DRG with the hopes of covering all our bases.  The idea here is that if we do everything the patient is bound to get better eventually.  3)  If you order everything for every patient you're bound to hit with something.  It often results in a disregard for the risk of RT and RN burnout and apathy.

46.  RT Equanimity:  When an RT is cool, calm and collected, it shows he's competent and confident at his skills.  It's the most important RT trait.  It allows the nurse and doctor to concentrate on their jobs instead of yours.  It also helps every one else stay calm

47.  RT Preparedness:  An RT who keeps up on his RT wisdom so he stays ahead of the game and is ready for any situation at all times.  Thus, a well prepared RT is the calmest person in the room.  See RT equanimity.

48.  Faux Confidence:  The bronchodilators-treat-all-lung-ailments-and-all-annoying-lung-noise doctors who still believe they're on the right side of history when they believe in faux and outdated ideas such as the hypoxic drive hoax and hoaxonex.

49.  Hoaxanex:  The belief that Xopenex is somehow stronger and better than Albuterol

50.  Hypoxic Drive Hoax:  A theory postulated back in the 1930s when RTs were desperate to prove to doctors they were a useful profession.  Now that the theory has been debunked  we can't get doctors to quit believing in it.  It's the belief you need to decrease oxygen when the PO2 is 86% or above.  It's an excuse to make doctors not liable for keeping patients in a hypoxic environment.  See Faux Confidence.

51.  Hypoxic Drive Theory:  A theory which states COPD retainers use oxygen as their drive to breathe and not CO2.  It's debunked on a daily basis but most doctors don't care.  See hypoxic drive hoax.

52.  Covering your bases:  1)  The silly idea that simply ordering a breathing treatment so the family thinks you're doing something, you're in the right. That ordering an $80 a pop treatment every four hours you're in the right.  2)  Obviously if you throw everything at every patient you're going to hit on something and the patient will eventually get better.

53.  Order sets:  The idea that if you do everything for every patient you'll hit on something and the patient will eventually go home.  It's a way to guarantee patient reimbursement.  It's socialism at it's best.

54.  Protocols:  Capitalism.  Individualism.  It's a policy that allows for common sense decisions to be made at the point of care by qualified medical professionals.  It reduces hospital costs, improves patient outcomes, and improves RT apathy.

55.  Hospital costs:  1)  The price the hospital has to swallow for doing procedures.  2)  It's the flat fee the government (CMS) pays minus the price the hospital incurs in taking care of the patient.

56.  Overhead:  The fewer the procedures needed to care for a patient the more money will be left over as profit once the government (CMS) reimburses the hospital for that patient.  Protocols result in fewer needless procedures and more overhead (profit) for that patient, and order sets and covering your bases reduce overhead and profit for that patient.

57. RT Confrontational: An RT who's willing to question  stupid doctor orders

58.  RT Enabler: 1)  An RT who's afraid to confront a doctor who orders something in opposition to proven facts and science. They are afraid to cause controversy. Antonym:  RT Confrontational.  2) They allow doctors and nurses to get away with their false theories like the hypocic drive theory, or that Albuterol cures all annoying lung sounds. 

59.  Idealist RT: Idealists will tell you bronchodilators work for all that wheezes, or for all annoying lung sounds, or for all lung diseases.  They keep their mouths shut like good little boys and girls and don't question any doctor orders.

60.  Realist RT:   The realist at the bedside giving the treatment sees the truth, that the treatment did nothing.  They will also tell you if it did something.  They get annoyed when senseless and unindicated breathing treatments are ordered.

61. Annoying Lung Sounds:  Sounds doctors and nurses don't like.  Sounds that cause fear and make nurses and doctors worry about the patient.  Any lung noise audible or silent that causes the doctor to require thought.

62.  Thought:  Call RT

63.  RT ignorance:  When an RT thinks he knows everything.  He knows how to do the nurse's job and doctor's job.

64.  RT Burnout:  Physical exhaustion from working too hard.

65.  RT Apathy:  The loss of empathy for patients because of all the BS therapies that are ordered. 

66.  Respiratory Therapy Apathy Syndrome (RATS):  It's when RT apathy becomes chronic.  It should not be mistaken for RT burnout.  The RT starts to suffer from uncharacteristic and unexpected mod swings and verbal outbursts when they are asked to do menial tasks.  They develop a feeling that much of what they do is a waste of time.  They develop a feeling that nothing they do matters, and they have little energy even for doing useful tasks.  They often become humble when they should be aggressive because they've given up hope that anything will change.  They become obedient and unresisting, and accepting.  They give up and let doctors win because such RTs have come to terms that they cannot beat the doctor clique.  At some point, this respiratory therapist feels he is simply an observer, a peon whose job is to do what he is told to do rather than what he thinks is right.  He feels he is well educated and trained, but is unable to use his skills. He feels he's not allowed to think.  He becomes an observer, a neb jockey, because he begins to think he thinks doesn't matter. 

67.  RT Politics:  Not making waves.  Defending stupid doctor orders and not questioning ignorance and stupidity just to keep the peace.

68.  Priming the pump:  It's when you waste 1-4 puffs of the medicine so that when you take it for real you are getting the maximum medicine available.  It's ideal to recommend it, but most patients don't want to waste valueable medicine they paid for.

69. Neb jockies:  A respiratory therapist who is limited to administeringnebs without regrd to the respiratory cre professional's opinion or whether it has any therapeutic benefit to the patient and without regard to the other knowledge and skills that an RT possesses.

70.  Pulmonary Toilet:  Do every thing you can to flush all the junk out of a patient's lungs.  Do it even if the patient is already full.  Do it even if the patient has nothing in there.  Examples include mucomyst, chest physiotherapy (CPT), etc. 

71.  Faux Pneumonia:  The patient displays no evidence of pneumonia (labs normal, xray normal, assessment normal, etc.) yet the diagnosis made by the physician is pneumonia.  One common explanation is this is the most reimbursable diagnosis.

72.  Plamonia:  (n) A faux diagnosis of pneumonia for a patient admitted to the hospital awaiting placement to a nursing home; pneumonia for pacement

73.  Faux diagnosis:  (n)  A fictitious diagnosis to assure patient meets criteria for reimbursement (see faux pneumonia)

74.  Positional crackles:  crackles that move with position; while lying on right side crackles will be on right side, when sitting the crackles will be in bases (they move, like water, to the area of least resistance).

75.  Ventilitize:  The process of loading up a patient with so much ventolin there will be no further need to ever need hospitalization again. 

 76:  Germ spreaders: Every person admitted to the ER with sniffles, sneezes, body aches and pains, is ordered to get a beta adrenergic aerosol so we can spread their germs by means of aerosol.

77.  Respiratory intensivists:  An RT who exists just to do breathing treatments required so the insurance company is happy enough to flip the bill.

78.  Desensitize:  1)  To make less sensitive; Make someone less likely to feel shock or distress at scenes of cruelty, at other people's pain or suffering, or at death, due to overexposure

79.  Desensitization:  The process of becoming less sensitive to stuff you are overexposed to

80.  Respiratory Therapy Desensitization:  The process of a respiratory therapist doing so many breathing treatments on people who don't need them that he grumbles and gripes even when a person does need them.

81.  Automaton:  An indivudual who acts in a mechanical/ robotic fashion; he just does things by order of habit; he does a he is told

82.  RT Automaton:  An RT who treats all patients in a mechanical/ robotic fashion; they do not go off the beaten path because they are trained to do as they are told and that is that. For example, when a patient says, "Why am I getting this treatment; I'm breathing fine?" the RT is trained to say, "Because the doctor ordered it.  Our doctors are the smartest in the world."

83.  Automatize:  Automatic response to same event every time

84.  Respiratory Therapy Automazation:  The process of becoming an automaton, and , thus, treating all patients the same; speaking to all patients the same, speaking in a robotic cadence; speaking too loud even to those who can hear; responding with a grunt, curse and shudder every time your pager goes off

85.  Bronchodilator Defenders:  These are clinicians who defend any bronchodilator order.  They are often found saying things like "the doctor ordered it" or "it certainly can't hurt."

86.  Imaginary Wheezes:  An indication for bronchodilators. Used in a quote:  "Hey, can you fetch me an inhaler for this man's imaginary wheezes.

87.  Imaginary Bronchospasm:  An indication for bronchodilators.  Used in a quote:  "Hey, can you fetch me an inhaler for this man's imaginary bronchospasm."

Types of Respiratory Therapists:

1. Ancillary staff: These are workers who are told what to do, and do them as instructed without asking questions.

2. 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.

3. Button Pushers: Respiratory Therapists who take care of ventilators and do nothing more than follow doctor's orders and push the bottons on the vent. They are ancillary staff. They may assess and have ideas, but do not communicate with physicians, and make little effort to participate as a team member to the benefit of the patient.

4. Respiratory Therapy Nurses: A term that might give the RT profession the respect we have earned and well deserve, as the term "nurses' in itself should bring about the respect of a profession that is often treated as an ancillary service.

5. Dragons: These are the RT Bosses. They guard the RT Cave during the day and have their watchful eyes peering upon everything you do, yearning for you to make the tiniest little mistake. When they catch you they pounce even before you get a chance to dot the i or cross the t. Usually, they are home sleeping at night, resulting in a more relaxed work atmosphere.

6. Queen Bees: These are all the supervisors. They take the heat from the worker bees so the dragons don't have to deal with piddly little things; like things that don't involve money. One of their biggest responsibilities is doing the schedule, and they often get pounded by unhappy bees if the schedule is not to the respective bee's liking. While they get paid just a smidge more than worker bees, they get paid way less than the dragons. Yet, while these are usually aspiring dragons, they do not complain. Now, it also must be noted that Queen Mother Bees are often in a money mindset just like dragons. For example, you are not allowed to have overtime, because the farther under budget the Queens keeps the department, the bigger the dragon's bonus at the end of the year. This is probably the most stressful job in the hospital and the least respected, as while the worker bees come at her with their problems, the Queen is also getting constant "heat" from the dragons to keep the department under budget. This is actually a lose lose job. But someone has to do it. You have to remember that queens are great people like you and me with a job to do and a family to support. And, besides, you might be one some day.

7. RT Bosses: (See Queen Bees and Dragons) These are the bosses or hospital administrators. If you want to learn more about these unique individuals click hereclick here and then click here. These individuals all where suit coats, and will usually present with smile and, of course, they will want a hug or a hand shake. They love money. Everything is all about money. They want every i to be dotted and every t crossed so as to make as much money for the hospital as possible. They want to keep the worker bees just Happy enough so they want to keep working, they also want to make sure money keeps flowing in.

8. Worker Bees: These are all the Peon RNs, RTs, environmental experts, computer whizzes, x-ray techs, lab staffers, and all the other individuals who swarm around the hospital making the place look good so the dragons can make their annual bonuses.

9.   RT Automatons: RTs who are trained to do and say the same thing every time a certain procedure is done on a patient, while disregarding uniqueness of the patient and the clinician.

10. The stepping stones: These are the RTs who use the career of RT as a stepping stone to a more illustrious medical profession. In my humble opinion, this is the way to go. What better way to learn about medicine than through the eyes of an RT. I'm serious here.

11. The quitters: These are the RTs who don't like to work. Some "Quitters" take a job of RT because they think it will be an easy job and they won't have to do anything. As soon as they learn what RTs really do, they either quit or are forced out the door.

12. The contents: They are the happy-go-lucky RTs who never complain. They are the RTs you love to give report to because they are always happy. They rarely make any effort at learning new information other than what is required. They usually prefer not to work with critical patients, and when they do they never question doctors and they prefer to be button pushers. Usually, you will see these RTs happily knocking off treatments on the floors.

13. The complainers: This composes probably about 60% of all RTs. These are usually very intelligent people who love the career of respiratory therapy in theory, but hate the reality of it. They are usually well up on all the new technologies, and are very quick to question doctors or offer suggestions. However, while they are not happy, they do nothing to better their career field. After working for a while, they become frustrated and content and they give up. One of the reasons they are so frustrated is that they have decided that they are too old to get another job, or have families which makes changing jobs difficult. Yet, while they complain, they do not support change.

14. The optimists (or learners): These are the RTs who write blogs. They may or may not be more intelligent than complainers, but they love to learn. These are the RTs that consistently do research on the Internet and read magazines. These are the RTs that attend every seminar possible. These are the RTs who write the protocols and make recommendations for new equipment, and then write the policy and procedures for this new equipment. These are the RTs who learn about things like Graphics and educate the rest on how to use them. These are the RTs who make the best of their career even though they know there are a lot of forces working against them. Most important, these are the RTs every one in the department loves to talk to because they are good listeners (they listen because they love to learn). More often than not, they work with the leaders to solve these problems as they occur. They often let other RTs take credit for the work they do. They do this to keep morale in the department high. In essence, the optimists are the strings that keep the department together. A department without optimists does not run very well.

15. The leaders: These RTs, while far and few, take charge and lead. They make changes to the RT Cave and they are resented for it. They make sure everything is stocked. They make sure all the i's are dotted and the t's crossed. They are usually opposed to protocols because they don't want to "rock the boat", but they won't say so openly. They listen to the rants of other RTs, but they usually side with the administration on issues. They question RTs who question the status quo. You might hear them at an RT meeting saying something like, "Don't you think protocols might actually create more work for you guys." When they say things like this, they are catering to the complainers, who will work with them to stymie any change. The leaders do no like change because it goes against their philosophy of "do not rock the boat." It is also important to note that while most leaders are good people with normal home lives, they are often hated and revered at work. Complainers often do not get along with them, and optimists are often seen working with them "for the better of the department."

16. Glorified EKG technition: RTs who work for smaller hospitals are are required to do all the EKGs. There are times it feels like this is all they do, and, thus, they are basically well paid and highly qualified EKG techs. What makes this worse is that some omniscient physicians (see physician lexicon) don't even respect the RTs ability to interpret the EKGs and request the doctor be hunted down immediately and handed the EKG. Common Sense Physicians respect RTs to be able to interpret

17.  Lazy RT:  This is an RT who tries to get out of work by trying to convince a nurse all that wheezes is not bronchospasm and therefore a bronchodilator is not indicated. 

18.  Respiratory Therapist:  Provides therapy, educates, and offers expert opinions to doctors and nurses. Education, experience and thought are needed to benefit the patient.

19.  Respiratory Jockey:  Someone who just does what he's told to do.  Less thouht is needed.

20.  Old School:  Some of the wisest respiratory therapists among us are your "Old School RTs."  They've been wearing out carpets and tile on hospital floors since the 1960, 70s and 80s.  Their minds are filled with so much RT wisdom they're often utilized as living Respiratory Therapy Encyclopedias. Although, they continue to defend old-disproved theories, such as the one that says IPPB is useful for some patients.  They just don't want to let go.  Yet despite this flaw, we love them. 

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