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Wednesday, January 25, 2012

Doctor Lexicon

The Doctor Lexicon:

1. Stupid doctor orders:  ) Orders from a physician that lack common sense and have no purpose, and therefore having no benefit to the patient.  2) Orders that benefit the hospital by assuring the patient meets reimbursement criteria, although with no otherwise scientifically proven benefit to the patient. 3)  Doctor Orders written based on habit and with no scientifically proven value 4) doctor orders that are based on antediluvian theories.

2.  Normal doctor orders:  1) Doctor Orders written based on scientific evidence, or at least best practice medicine; 2) Orders form a doctor that benefit the patient

3. Antediluvian theories: Theories that are old and outdated yet are still worshipped by doctors like the hypoxic drive theory.

4.  Regular theories:  Based on a rational guess

5.  Scientific fact:  Proven by science, as opposed to proven by "oh, it sounds like a good idea."

6. Unfettered Doctor Power: Power doctors were given by people who refuse to question them. Power derived by patients who think doctors know everything. Power obtained because respiratory therapists find it easier to just do what the doctor said as opposed to questioning orders. Power obtained by RT Bosses who choose to place doctors on a higher eschelon than the respiratory therapists they represent. This is how we end up with bronchodilator abuse and stupid doctor orders.

5. Doctor Enabling: 1) Often results from Unfettered Doctor Power. Lack of questioning one person's authority results in that person abusing his power. It results in unnecessary breathing treatments, unnecessary nursing home stays, and other stupid doctor orders, etc. 2) Both patients and medical staff enable doctors to get away with anything they want. This breeds ego.

6. Doctor Ego: When a doctor's head swells to the size of a watermellon because he thinks he knows all and is never questioned by anyone because he has a nasty temper and is feared.

7. Bronchodilator abuse: When doctors order breathing treatments nonscientific reasons; ordering treatments just to cover their bases; ordering treatments just to make sure reimbursement criteria is met; treating all annoying lung sounds and all dyspnea with bronchodilator breathing treatments

8. Elitist Doctors: Doctors who think they are above and beyond every other person. They believe they know it all; Doctor ego; Unfettered Doctor power; Enabling. They have become totalitarian. They are able to do without being questioned. Doctors that haven't been questioned for so long they start to treat people like truck engines on an assembly line instead of as people.

9. Bronchodilator abuse: When doctors order breathing treatments nonscientific reasons; ordering treatments just to cover their bases; ordering treatments just to make sure reimbursement criteria is met; treating all annoying lung sounds and all dyspnea with bronchodilator breathing treatments

10. 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.

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

12. 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.

13. 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.

14.  Respiratory Therapists:  The people doctors call when they don't feel like thinking.

15.  Albuterol:  1)  Something doctors order when they don't know what else to do; It's what's ordered instead of using science.  See covering your bases, bronchodilator.  2)  The cheapest and most common bronchodilator.  A medicine doctors think is the Tylenol for lungs.  Holy water.  Scrubbin-bubbles.

16.  Real Doctor's Creed:  A document doctors vow to uphold in leu of using science in order to make their job easier, cover their bases, and piss off RTs.

17.  Bronchodilator idealists:  Doctors and nurses who believe bronchodilators will lead to world peace and perfect health despite science to the contrary. They will say they have the truth on their side, yet when you tell them to "prove it!" they get all upset and start to quiver in their pants. They do this because they know there is no proof to what they are proposing. There is the history of stupid bronchodilator orders that's for sure, but there is no evidence to back up the reason for all these orders. You'll even see insurance companies allowing breathing treatments to meet admission criteria because some doctor said this is what will help them get better quicker, but there is no real proof to back up that bronchodilators do any good for anything other than (ahem) bronchospasm.

18.  Idealist Doctor:  they believe that a perfect healthcare system where everyone receives equal health care at equal costs, and that all patients will a particular DRG can be treated the same.  They incorporate order sets.  They shun individual thought.  They throw temper tantrums when you question them.  They believe bronchodilators work for all wheezes and dyspnea. Idealists will tell you bronchodilators work for all that wheezes, or for all annoying lung sounds, or for all lung diseases

19.  Realist Doctor:  They understand a perfect healthcare system isn't possible.  They understand you can't treat all patients the same. They understand they don't know everything.  They yearn for teamwork and are willing to give up autonomy for the benefit of the patient.  They write orders based on science and create policies to encourage individual choice such as protocols that allow RTs to made point of care decisions to the benefit of the patient, RT, doctor and hospital.  They understand bronchodilators dilate bronchioles and don't order them on all patients unless the hospital makes them by initiating idealist doctor driven order sets.   The realist at the bedside giving the treatment sees the truth, that the treatment did nothing.

20.  Science:  It's proven to work.  It's based on fact.  Bronchodilators dilate bronchioles is a fact.

21.  Fallacy:  It's not based on science.  It's not a fact.  Bronchodilators will cure all lung ailments and annoying lung sounds is a fallacy.

22.  Malady:  A disease

23.  Myth:  See fallacy.

24.  Bronchodilators: 1)  Broncho - lung air passages.  Dilator = opens up the airway to make air flow through them better.  They relax smooth muscles that are squeezing the bronchiole passages and thus cause these muscles to relax.  Bronchodilators treat bronchospasm.  They relax the air passages.  They dilate the air passages.  2)  The cure for all lung dyspnea and annoying lung sounds.

25.  Tylenol:  Analgesic.  Pain reliever.  Fever reducer.  Doctors think it treats every other ailment too.  When all else fails order Tylenol.  It's the worlds most euphoric medicine.  Ideal medicine.  Cure all.  Holy pill.

26.  Scrubbin Bubbles:  The belief Albuterol will turn into suds and wash all the shit out of the lungs and cure them of all ailments like in that commercial for scrubbin bubbles foaming action.

27. 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.  

28.  Thought:  Call RT

29.  Autonomy:  The yearning for total control.  

30.  Team work:  Giving up autonomy.  Understanding you don't know everything and can't do everything on your own.  It's working together to solve a problem.

31.  Ignorance:  It's what you don't know.  It's not a bad thing so long as you admit what you don't know.  

32.  Bronchodilator lies:  Convincing yourself that bronchodilators treat everything, and every theory that disproves your belief is ignored.

33.   Fake Diagnosis:  So you're scheduled for a pulmonary function test (PFT), yet your diagnosis is diabetes.  The doctor knows most insurance companies only cover PFTs if the diagnosis is COPD, cystic fibrosis, or asthma.  Even though your doctor obviously thinks you need a PFT, your insurance won't cover it unless he lies.  This should explain why on the PFT order form he gave you to take to the hospital it has "asthma" on the line next to diagnosis instead of diabetes.

34.  To cover their asses:  Doctors don't want to be sued, so they order whatever they think is needed so it looks like they did their best.  Much of what we do in the hospital has no medical benefit whatsoever, and the only reason we do it is becasue the doctor wanted to cover his own butt from potential litigation.

35.  Habit
: orders:  Doctors have a set list of things they order for each diagnosis.  After a while he simply writes orders based on habit and may not even know what he wrote.  For example, we have one doctor who orders breathing treatments for all his post operative patients.  I asked him why he writes this order once and he said, "What's a breathing treatment?"  Yet he continues to write the order.  It's for this same reason many foley catheters are inserted into patients and other invasive procedures performed.  Since no one questions the doctor, he has no incentive to update his ordering habits. 

Two basic Types:

1. Gallant Doctor: Gallant Doctor: This doctor knows how to take care of your asthma the right way. He keeps up to date on asthma wisdom, and goes out of his way to make sure you are well educated and on all the best medicines for you. He also works with you on a good Asthma Action Plan, and makes sure you feel comfortable knowing you can call him at any time. He also makes sure you schedule an appointment to see him every six months. Asthmatics who see Gallant doctors have the best chance of having well-controlled asthma. Thankfully, a majority of asthma doctors are this type.

2. Goofus Doctor: Whatever he learned in school umpteen years ago is exactly what he uses to care for you today. He's either too busy, lazy or sometimes simply too arrogant to stay up-to-date on the latest asthma wisdom. He will allow you to walk out of his office with only a rescue inhaler. Asthmatics who have Goofus doctors are Poor Patient Asthmatics who have a tendency to make unscheduled office visits, or trips to the ER, and are often mistaken as Goofus Asthmatics.

Generally, all doctors are either a Goofus or Gallant, but there are sub types of each Asthma doctor personality. Below are all subtypes of the Gallant Asthma Doctor:

1. The Gallants: Strong, Silent Type: She never gets excited, and has a ho hum or gloomy disposition. She often has a finger on her forehead and says, "Hmmm, I wonder..." She is well kempt, organized, jots a lot of notes and knows her stuff. She is very quiet and doesn't like to participate in small talk, but when it comes to asthma or your health she'll talk fluently. She'll assess you thoroughly while remaining taciturn. You might be intimidated by the silence, but she doesn't mean for you to feel uncomfortable. She's very friendly and polite, but also straightforward. She may also ask for your opinion, which may have you wondering if she knows what she's talking about. However, her intention is to involve you in the decision making. She will make sure you are well prepared and cared for upon leaving her office, but once she finishes the job, she will up and leave without shaking your hand or saying good-bye. While she's socially gauche with poor bedside manners, if you like a knowledgeable doc, she's the one for you.

2. Big Hearted Bully: Although he has the bedside manner of a rock and refuses to participate in small talk, he might simply be the best doctor in the world. He is focused and the key for you is to put up with his bluntness and his seeming arrogance. He does not go into detail as he expects you to do your own homework. He usually answers questions with one or two words and, sometimes, he simply grunts. If you annoy him with your petty questions, he'll grimace and moan. If you try to make suggestions, he'll intimidate you with his stare. Yes, you will get a thorough workup and he will take good care of you. If you call him with an asthma concern, he will go out of his way to meet you at the office. He's the only doctor type who will never write a prescription without seeing you first. His decisiveness and stubbornness may impress you, or it may vex you. Overall, if you are the kind of patient who likes a doctor to take control, he's your doc.

3. Columbo: She has a very friendly, nonchalant disposition and quite often has ruffled hair, with an overall disheveled disposition like the 1970s TV detective Columbo (collars up, tie crooked, spot of jelly on white lab coat). When things go wrong she scratches her head with an unreadable expression. She'll slouch in her chair with her legs crossed. She's been known to say things like, "Well, what do you suggest we do today?" Or, "What medicines would you like to try?" When you call her, she's the doc who asks, "Do you think you should come in to see me?" Or, if she meets you in the ER, she may ask, "Do you think you should be admitted?" After a while, you wonder if you are the doctor or if she is. On the other hand, if you are the kind of patient who likes to have more control, this might be the ideal doctor for you.

4. The Buddy: He's the doctor who is often late for your appointments. Even though your irritation level reaches its peak, when he finally does arrive, he cracks a joke you can't help laughing at. He's an amazingly happy person and has a knack for telling stories, especially when you are in an inconvenient position (like on the colonoscopy table, or with your mouth stuffed in the dentist chair). He has a positive disposition and can get you excited even about diseases you might have -- like asthma. He often downplays severity by saying things like, "Oh, you'll be fine," or, "I wouldn't worry about it if I were you." You might catch him saying something goofy like, "Well, today we're going to come up with the perfect concoction to fix you." Yet, if you can tolerate his sunny disposition, you'll participate in an awesome discussion unrelated to asthma. You may actually leave the office feeling like you learned more about his life than about asthma. Despite his quirks, you know he's taking great care of your asthma. So, if you like a friendly, upbeat person, he's your doc.

Along with being a Goofus or a Gallant, each doctor will have one of the following traits:

5.Totolitarian doctors: These are physicians who believe they know what's best for the patient and no one else's opinion matters. They do not like protocols because these allow other members of the care team to make decisions that might not be best for the patient. They do like order sets. These doctors have a tendency to get angry when things don't go their way.

6. Capitalist doctors: These are physicians who know they don't know everything and like to work with a team approach to benefit the patient. They encourage nurses and RTs to make individual decisions at the bedside, and respect the individual opinions and choices of other members of the patient care team. They like guidelines and protocols. These doctors are less likely to get angry because they are more open minded.

7.  Order set doctor:   A doctor who orders everything he can possibly think of.  He fills out every order set possible with the hope that something -- anything -- will work.  He covers all his bases by ordering as many procedures as possible.  Yes there will be duplicate orders and even triplicate orders.  Yes the unit secretary will go bonkers trying to sort it all out, and the nurses and respiratory therapists will snivel about doing all the "useless" stuff.  But that doesn't matter because the theory is that if you throw everything at the patient, something is bound to work. 

9.  Impatient Doctor:  1)   Impatient must have everything done right now, and lacking such promptness he becomes particularly irritable.  (2) A doctor who shares his adrenaline rush in a negative fashion and has everyone up in arms and flustered.  The tasks his co-workers are doing appear to be completed with all thumbs, and this makes progress slow.  The milieu of the room is tense, and even while someone might have an idea to benefit the patient, no one wants to speak because Mr. Impatient is highly critical, easily angered, and constantly says, "Come on!  Come on!"

10.  Patient Doctor:  (1) Peaceful;  ;partially patient and ideologically indulgent.   (2)  A doctor who remains accommodating, calm and composed and he encourages his co-workers to do the best they can.  He's open to ideas and ideas are flowing from one mind to another.  He understands his demeanor of equanimity disseminates a calm and productive milieu.

1 comment:

pdh1845 said...

thank you so much for your wisdom and courage. I have been looking for this site for seven years. since, I began my respiratory career if that's what you want to call it.