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Sunday, August 16, 2015

Wisdom of a Random Respiratory Therapist

I received an email from a respiratory therapist friend of mine who works for a hospital I will not name to protect my friend.

He said the patient had a shadow on the x-ray, and so the physician proudly said this was the reason for the breathing treatment.

He said another patient was diagnosed with end stage COPD, and the physician won't realize it's heart failure for a couple days.

He said an albuterol breathing treatment opened up one patient's airways so  much it made the patient's airways wet.

He said that the reason Duoneb is usually ordered rather than just albuterol is not because a study showed ipatropium bromide given in tandem benefits patients, it's because someone with a bright idea decided that if one medicine works great another given with it must work better.

Seriously, this is how medical research works, folks.

He reminded us of the study done once on 100 post op patients.  They were all given a bronchodilator QiD and were all eventually discharged.  So for the next 30 years all post op patients were given a bronchodilator

Of course he also reminded us of the interns who were ordered to do all the ABGs they ordered: the number of ABG orders diminished by 50 percent.

He said he told the nurse's aid the patient was wet, and she proceeded to change the patient's diaper. To her defense, she was new. He said the aid was a good sport and even she had a good laugh about it.

He said that most of what we do as respiratory therapists we do just so the hospital can get reimbursed. How else do you explain orders for three albuterol breathing treatments when all that was needed was one or none.

This doesn't make sense unless you understand that CMS Regulation says patients with any lung disease are only sick enough to be admitted if they fail three albuterol breathing treatments.

He said it's not the fault of the hospital, nor the physician, that so many frivolous therapies are ordered, it's the result of politicians sitting in leather chairs in Washington D.C. who have too much time on their hands and think that doing something is better than doing nothing.

Just to give you an idea of the idiocy of the medical profession, consider that Hippocrates defined asthma as all dyspnea.  Even while scientists have since extricated hundreds of diseases out from under the rubric term asthma, physicians still treat all dypsnea as asthma, and usually under the ruse: "Well, at least it can't hurt."

And yes, he said, a pulmonary diseases are also still treated as asthma.  I even had a very credible doctor once go into a 10 minute long discussion with me on how she believed albuterol helped people in CHF.  He said, "That ten minutes was a long time, because I had to somehow prevent myself from laughing."

He said that when posed with a problem, people who are making hospital regulations ask the question: "Does it make me feel good."  Sure, it feels good to come up with A solution.  Still, their solutions usually result in chaos.  What they ought to ask themselves is: "Will it do any good?"

He said these same people who, when they see a minor problem, say things like: "We have to do something." A better saying would be: "It's better to do nothing than something stupid," or "It's better to do nothing than just something that makes us feel good."

Bottom line, he said, is, rather than create regulations because they make sense, they make regulations because it sounds like a good idea and makes them feel good about themselves.  Yet the end result is usually chaos.  Chaos for an RT is RT Apathy and Burnout.

He said we RTs do not complain because we don't want to work.  We complain because too much of what we do is a waste of time or delays time.

Funny thing is, he said, I talk to many doctors who feel the same way.  They get tired of ordering therapies just to make the family think we are doing something, or just to make sure the hospital gets reimbursed. Regulations create doctor apathy too.  "Regulations cause chaos."

Oh, and one more thing.  I had a doctor the other day say to me, "Why are you always insulting my patients.  I said, "What do you mean?"  He said, "Well, you are always saying they are 'dim and clear.'"

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