Please keep this information strictly to yourself—should your hospitalists discover that you’ve gained access, they may take steps to shut down this blog. Use this insight wisely, not just for your amusement, but to better understand the absurdity behind some of the orders we all encounter.
--------------------------------------------------------------------------
To Whom It May Concern:
In the spirit of evidence-based medicine (or, at least, medicine that feels evidence-based), we at the Real Doctor’s Creed Administration have made some updates to our guiding principles. These are, of course, grounded in the timeless medical philosophy: "If it sounds reasonable, why waste time proving it?"
For instance, research suggests that water is good for the lungs. Rather than waste valuable time with studies, let’s simply agree this makes sense and get on with it. After all, we often ignore inconvenient findings from studies anyway. Consider nebulizers and inhalers. The research clearly states that inhalers with proper technique work just as well as nebulizers. Yet, in our infinite wisdom, we prefer to order QID nebulizers (or Q4ever, meaning "until discharge"). And if respiratory therapy dares to discontinue treatments using their so-called "protocols," we simply re-order them. Because why follow protocol when you can wield authority?
Now, in 2024, we’re embracing the same spirit of untested brilliance with a groundbreaking update to the Creed. We propose that the effectiveness of a treatment be directly correlated with the amount of solution poured into the nebulizer. A simple, elegant idea, isn’t it?
Here’s how it works:
If a patient with COPD, pneumonia, pneumovirus, influenza, parainfluenza, COVID, or heart failure hasn’t improved after two days of Albuterol, Levalbuterol, or Duoneb treatments, don’t bother considering other explanations. Instead, refer to the Creed.
Add more solution to the nebulizer. Not because there’s evidence to support it, but because it feels like we’re doing something. For best results, try:
- 4cc of hypertonic saline (especially if mucus plugging shows up on x-ray)
- Pulmicort, because why not?
- Performist/ Formotorol (and don't bother d/cing the duoneb or albuterol as duplicate orders are okay with us
- Mucomyst (especially if mucus plugging shows up on x-ray)
- If the patient has been using Albuterol alone, switch to Duoneb. The irony of giving a muscarinic to dry out lungs and hypertonic saline and mucomyst to thin and increase secretions can be just ignored.
Ensure treatments are ordered Q4 or Q6. The goal is to maximize the length of treatments, ideally to the point of inconveniencing respiratory therapists. If they’re annoyed, it must be working.
By adhering to this new protocol, we uphold our longstanding commitment to decisions driven not by science, but by intuition, tradition, and the thrill of making things up as we go.
Yours in medicine,
The Real Doctor’s Creed Administration
P.S. If this update creates any confusion among staff, refer them to the nebulizer for clarity. It’s bound to fix something.
No comments:
Post a Comment