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Wednesday, November 2, 2011

Respiratory Therapy Apathy Syndrome (RATS)

When a respiratory therapist gets tired of doing BS procedures he develops what experts like to call Respiratory Therapy Apathy Syndrome (RATS). They start to suffer from uncharacteristic and unexpected mood swings and verbal outbursts even when they are asked to do something useful.

Respiratory Therapists (RTs), throughout history, have always been subjected to situations most people would fail to comprehend. While they are an essential part of the medical care team in hospitals, there's an old saying among RTs infested with RATS that much of what RTs do is either a waste of time or delays time.

RATS is a feeling that nothing you do matters. It's becoming passive when it comes to improving your profession. It's becoming submissive, or letting people you think -- or know -- are wrong win. It's being humble when you should be aggressive or assertive. It's being obedient and unresisting.

It's being numb to the presumed idiocy around you. It's being numb to everything and just not caring about the things you once cared about.

Actually, it's not so much not caring as much as feeling that your opinion doesn't matter. So numbness is a better description here. It's giving up and letting doctors win considering RTs know they can't beat the doctor clique.

At some point a 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 wants to do or what he thinks is right. He becomes an observer because he begins to think what he thinks doesn't matter.

How can an RTs take his profession seriously, when doctors, like actors, are trained to perform in a certain way in order to be accepted by other doctors. Likewise, doctors are trained to do what the government wishes in order to assure that the patient's admission is reimbursed by the Centers for Medicaid and Medicare Services (CMS).

RATs should not be confused for burnout. Burnout is the result of being overworked and under paid, and the cure may be rest and a raise. The remedy for burnout is as simple as changing a light bulb.

RATS, on the other hand, is lights out. It's permanent. Simply changing a light bulb won't affect it. Once you have it you hang onto it for dear life, unless dementia sets in (ah, dementia, the easy road).

It's insidious. It's ingrained. It grows roots like a cancer and digs itself deep into the respiratory thinkum which is attached to the medulla oblongata. The respiratory thinkum is invisible to x-ray, CT Scan and MRI.

What's the Etiology of RATS?

The etiology of RATS is suspected to be repeated exposure to the R-Isomer, a component of most bronchodilators from Epinephrine to Alupent to Albuterol to Xopenex.

Ventolin particles attaching to beta adrenergics aren’t' the problem. If the R-isomer is needed it’s needed. The problem is that once beta adrenergic receptors are full, the R-Isomers begin to pool in the blood. This is usually a result of continuous second hand bronchodilator mist exposure.

Once the accumulation of R-Isomers becomes abundant, these pooled R-isomers combine with Oxygen to form a new molecule we call VentoApothum. It crosses the blood brain barrier and attaches to the respiratory thinkum. This results in inflammation of the respiratory thinkum that usually leads to apathy.

 Another theory is that repeated exposure to the R-Isomer triggers an abnormal immune response similar to the allergic response. Inflammatory markers are released into the blood stream that attach to the respiratory thinkum, causing it to become inflamed.

 Scientists now believe that if you are exposed to something that causes inflammation, and you're repeatedly exposed to it, the inflammation will become permanent (kind of like occupational asthma). So with chronic inflammation of the respiratory thinkum, the patient now has RATS. It will never go away. It's chronic. There is no cure.

 The respiratory thinkum has now become sensitized.  Once the therapist is exposed to RATS triggers (see list below) the inflammation worsens than an exacerbation of RATS occurs.  This results in sudden and uncharacteristic outbursts and other signs and symptoms (see below). 

 More than likely the cause of RATS is a combination of the above.  Yet the illness may remain a conundrum for some time, especially considering most doctors don't give a hoot about it.

How is RATS diagnosed?

The only way RATS can be diagnosed is through keen observation and questioning, and looking for the signs and symptoms as noted below. 

What's it like to be infested with RATS?

To give you a better picture of what it's like to be infested with RATS, consider the following situations described by random victims:
  1. I work hard to help people who refuse to take care of themselves.
  2. We intubate and put on ventilators patients with terminal illnesses because their family members think they'll miraculously recover.
  3. We get tired of doctors intubating based on a number in lieu of using common sense. 
  4. We do breathing treatments on people because nurses and doctors believe bronchodilators are the cure for every annoying lung sound and all causes of dyspenea. Many more bronchodilators are ordered just to assure the hospital meets government set criteria for reimbursement.
  5. We RTs love our patients, yet we get annoyed at many of them because they know they don't need a bronchodilator, yet won't say anything because they think things like, "Well, since the doctor ordered it I must need it."
  6. RTs are often called to duty not because a patient needs a breathing treatment or an EKG or an ABG, but because the doctor doesn't know what's wrong with the patient, and doesn't know what else to do, so he orders something just so the patient thinks something is being done. And since patients don't know any better they just let this abuse go on.
  7. We RTs have read the studies doctors choose to ignore. You know the studies that prove inhalers work just as well as nebulizers. This might explain why doctors think nebulized bronchodilators (not inhalers) are akin to Tylenol as the world’s most perfect remedy for any ailment. RTs know this is BS, and most doctors don't care.
  8. Likewise, we RTs become irritatingly irate at RT bosses who care more about accurate charting and reimbursement assurance than the patient. A patient could die and nothing would be said, yet if an RT forgot to dot an i or cross a t all hell would break lose.
  9. We RTs become frustrated because the patient who truly needs RT services has to take a back seat to the patient who requires an RT service just so that patient meets criteria.
  10. RTs are the hospital's bitches. Our services are utilized by some nurses and doctors in lieu of using common sense and thinking. It's easier to call RT than it is to use your brain. These Nurses and doctors use us RTs to alleviate themselves of labor and responsibility.
  11. We RTs are well educated, trained and are experienced, yet when we make recommendations we're ignored and often punished. We are often discouraged from being team members, and this makes us angry, reticent, and apathetic.
Differentiating RATS from burnout:

This condition used to be referred to as burnout or even as the depression stage of grief. Yet a thorough examination of respiratory therapists from around the world has assured psychologists of the uniqueness of the respiratory therapist's plight.
It's become a condition where RTs have become the victims by abuse of their services. The end result is apathy toward the patients they love and want to help. The true victims are the patients who truly need respiratory care. The true victims are the respiratory therapists themselves.

This condition is known as Respiratory Therapy Apathy Syndrome (RATS)

Who gets RATS?

It's generally a condition that develops after repeated episodes of burnout due to BS procedures and nonsense calls for RT advice that randomly (and sometimes continuously) occur over the course of any given year. The older the RT becomes, and the more he learns, the more likely he is to realize the signs and symptoms of RATS.

RATS is also the result of the 12 biggest myths of respiratory therapy.

What are the signs and symptoms of RATS?
  1. Grumbling and griping at any new RT order, even those that they deem as needed
  2. New onset of swearing (swearing by someone who normally doesn't swear)
  3. Exhaustion
  4. Burnout
  5. Sore feet
  6. Lack of interest in job
  7. Silence
  8. Repeated absence or tardiness
  9. Lack of empathy for patients
  10. Refusal to go above and beyond the call duty
  11. Refusal to recommend new ideas because they feel they won't be accepted anyway
  12. Comments such as "I hate my job."
  13. Complaining
  14. Refusal to learn anything new because they have decided it's pointless
  15. Constant talk of getting a new job but feeling trapped
  16. Eye rolling
  17. Not caring
  18. Not getting stressed
  19. Not getting worked up
  20. Not having an adrenaline rush during emergencies
  21. Walking regardless of urgency
  22. Staying calm during emergent situations, even when everyone else is stressed out
  23. Staying calm and just doing your job
  24. Comments such as, "You should know me well enough by now to know that I don't care to take care of the patient first, lab, x-ray, or respiratory therapy.  We are all a team; we are all in this together. It's not a big deal that this CHF patient gets his albuterol neb before those procedures."
What are the signs and symptoms of worsening RATS?
  1. Saying things that might jeopardize your job
  2. Talking bad about your job even in front of doctors, nurses and your bosses
  3. Uncontrollable outbursts
  4. Not introducing yourself to patients
  5. Not talking to coworkers (nurses, doctors) who annoy you
  6. Contempt toward certain doctors and nurses
  7. Contempt toward patients who refuse to refuse treatments
  8. Lying in your charting
  9. Skipping treatments and charting "refused"
  10. Problems at home
  11. Sexual dysfunction
  12. Signs of depression
  13. Signs of stress
  14. Constant complaining or even the opposite, abnormal silence
What are RATS triggers?

Triggers are anything that causes an exacerbation of RATS your body becomes sensitized to things that don't bother normal RTS.  Triggers are things that increase inflammation of the respiratory thinkum.  It's often called a RATS flare up.

So, that in mind, the following are believed to be associated with sudden outburst, flares or exacerbations of RATS symptoms:

  1. Stupid doctor orders (the most common)
  2. Overbearing nurses
  3. Abuse of the word STAT
  4. Repeated pages for unnecessary procedures
  5. Needless intubations
  6. Ignoring common sense
  7. Incessant complaints about senseless charting errors
  8. When charting is inappropriately prioritized
  9. When RT wisdom is ignored
What is the treatment for RATS?

Currently there is no approved therapy for RATS mainly because most doctors refuse to acknowledge it as a condition. They think RTs are simply lazy and trying to get out of work.

Yet most experts to concur that RATS is a chronic condition and therapy is only palliative and temporary.

That said, Dr. Ven Tolin of PsyKologiscs Yippy College of Workers (PSYCOW) has listed the following recommendations for improving RATS: 
  1. Days off work: Get away from the problem
  2. Exercise: Proven to help you deal with stress
  3. Good diet: Works in conjunction with exercise
  4. Humor: Find ways to laugh off the problem or make fun of the situations that are the most frivolous (this blog is a good example)
  5. Sleep: The more you can get the better. Recommended 8 hours a night with a cat nap added in at some point during the day (or even your shift)
  6. Complaining: A good complaining session is a good way to learn you're not alone. While I don't necessarily recommend complaining, sometimes it does help get things off your chest.
  7. New job: Go to school and try to move up the ladder, or switch professions (simply switching to another RT job will not help).
  8. Hobby: Find something to do that you love, something that helps you feel needed, like volunteering, or writing a blog, or educating, reading, etc.
Controversial therapy for RATS:

Keep in mind that most doctors don’t want to acknowledge RATS as a condition and don’t want to ease RT pain and suffering. Therefore, while many of the following are proven to help, doctors usually ignore requests for the following therapies: 
  1. Ativan or Morphine: RTs often petition for this line of therapy and are flat out denied mainly because it helps with RATS.   (Warning: If an RT is ever ventilated most doctors recommend NOT using this line of medicine.  They like to see RT pain and suffering). 
  2. Xanax: It helps, yet the last thing doctors want are a bunch of relaxed RTs running around causing havoc.
  3. Alcohol: It’s legal and it does help
  4. Cigarette Smoke: Don’t call RTs hypocrites who smoke, because it’s proven to help ease many of the symptoms of RATS. However, some studies show cigarette smoke irritates the respiratory thinkum and causes random outbursts.
  5. Sex: Eases symptoms temporarily
  6. Long walks in the sun: Studies show sun rays absorb the R-Isomer into the atmosphere. However, the EPA is concerned about studies linking the R-Isomer to ozone depletion.
  7. The Absolute truth:  This would entail RTS to gain the courage to ask doctors for evidence and facts regarding the therapies they order, or to ask questions.  It's an extrapolation of the truth and questioning questionable behavior and seeking absolute truths.  It would be an end to doing things just because.  It would be placing the truth before keeping friends, the peace and happiness.  It would entail making waves.  It would entail a search for the truth.  It would entail honesty.
  8. Frontal Lobotomy:  Yep, this would take care of it all right. Yep, it sure would. 
Conclusion:  If you can't think of whether it's the S-isomer or R-isomer that causes RATS, just think R for RATS.  The R-Isomer is good for bronchospasm, yet if you're not having bronchospasm you don't need the R-Isomer.  When the R-isomer pools up in your blood it can cause you to become infested with RATS.  Yes, it's an incurable disease and there is no treatment. 

A disorder that is eerily similar is Responder Apathy Syndrome (RAS).  This might explain why RTs and EMTs get along so well. You can also read about it at the Urban Dictionary.


skippy said...

I love your blog! I'm a 25 year RRT. Work NICU,PICU,CICU,ECMO, Transports.
Done it all. How about talking about what your co-workers do that cause RATS? I work with RTs that falsify records, turn the rate up on a vent to get a good gas(then put it back down to original rate), leave the unit for hours, treat pts. like garbage, on there cell phone while sx.etc. And yes the director of my department knows and has proof of all these "incidents". And this RT trash is not fired! So the rest of us see these horrible therapists and were like "why do we keep working so damn hard"?
So what do we do? I'm sick of working with RTs that get away with everything. Another incident happened yesterday at work and I went to the director again about this RT. (She is the one who says she did a tx/cpt on a little pt. but didn't). Director doe's nothing!!!
I like what I do. I'm to old to start over and I can't just quit. And I shoudn't have to!
So what are we supposed to do? How do we stay sane?

Rick Frea said...

Sounds like you need an Ativan neb. come to think of it, after chasing kids all day, so do I.

Thanks for the nice comments about my blog. It's all in good fun. And I'm all for having fun on the job too because I do it myself. Sometimes I look forward to going to work just so I can get caught up on my writing. Some people look forward to it so they can pay their bills. You see, once we get our work done we're known to do all sorts of things, which also include: talk on the phone, play games, blog, Facebook, gossip, etc. I think this is all part of building morale. But what you describe here sounds a bit overboard. To talk on the phone while suctioning, or to simply not do a treatment, sounds like fire-able offenses.

Many of my coworkers have habits the I have trouble with, yet I find it better just to work around them. Although I can see how we can have a little fun writing about such coworkers. However I'd have to do it in more as a generalization because otherwise I'd be putting myself in a fire-able position. One lady got fired from a local library recently for writing about her coworkers and the types of "weird" people who populated the library. So I wouldn't want to get myself in that type of position. That's why I try not to write about people so much on this blog, other than by generalizations.

However, if you'd like to write something I'd be more happy to publish it, even anonymously.

Anonymous said...

Now I may seem negative... but why did you correclty call it "Respiratory Therapy Apathy Syndrome", abbreviated RTAS in the title of the post, but then call it 'RATS' for the rest?

Was it the RATS? I mean RTAS?

Rick Frea said...

Just being goofy.

Robert said...

Very good read. Unfortunately, I am now a sufferer of this syndrome. Hopefully, I can get it cured.