The smartest doctors in the world: part 3

I was busted thinking again.

There has been more than once on this blog I've mentioned how I think holter monitors are not an ER procedure. I think that if a patient is so "questionable" that monitoring needs to be done, the patient should be admitted and placed on overnight telemetry.

If the patient is stable, then he can come back during the day time to have a holter hooked up by the people who are hired to do it.

I said to my boss that it's not that I don't want to do holters, nor that I do not like doing them in the ER, it's that I don't have time to do them.

"But the doctor ordered them?" she said to me.

"But..." I grumbled, "Just because a doctor orders something doesn't mean it's indicated."

Needless to say I was put in my place. I was lectured like a 1st grader who said his first swear word.

You see, I was rightfully so put in my place. I was wrong. And I realize that now that I have been informed the IQs of any doctor hired here at Shoreline is 200 (click here for part1 & 2).

Now I know my folly. Now I know never to question the brilliance of these doctors. Now I know that I shouldn't think, but rely on the brilliance of the doctors.

To punish me for thinking, the RT boss purchased nine more holter monitors. She did this so that I could never say again to the ER doc, "I'm sorry, but we are out of holters tonight."

No more excuses. One should learn never to question a doctor. After all, they did go through medical school and you did not.

Some things should not be the job of the RT

I see the respiratory therapist as a member of the overall team of medical professionals who does his part in making a patient more comfortable or, if it comes to it, providing his expertise and skill in an attempt to save the life or improve the quality of a patent's life.

I suppose it's for that reason that I do not enjoy doing procedures just because a doctor orders it. I flinch when a bronchodilator breathing treatment is ordered on someone just because he or she is short of breath, or just out of a routine of the doctor -- or per his protocol.

Likewise, I flinch when I'm asked to do cord blood gases. The only reason this procedure is done is after a difficult birth because the doctor wants it documented that the gases were normal in case of a law suit. I do not see the RT as someone who does services just to prevent the doctor from being sued.

Thus, if a doctor wants a cord blood gas, he should draw it himself. After all, the RT had to be taken from the bedside of a person who was having difficulty breathing to draw the cord gas.

This is also why I'm anti doing EKGs on patients just because the doctor wants to make sure he covered all his grounds just in case the patient decides to sue.

That's also why I think doing Holter Monitors in the ER is not the job of the RT.

I'm not saying these things don't need to be done. What I'm saying is it should not be the job of the RT on duty.

Now, say, the doctor asked the RT kindly if he'd do these things, I'm sure he would oblige if he wasn't overly busy.

Yet, be it as it may, we do as we are told. We do things we do not approve and we do it with a smile. And then we blog about it in a wry or flippant way.

STAT Holter Monitor anyone?

Anybody who thinks a holter monitor is an ER procedure please stand up now.

When I think of ERs, I think of emergency. When I think of ER, I think if they don't get help they will be severely compromised or die. So, what life threatening ailment is a holter monitor going to benefit.

And, when a holter is done on a Friday, it will not be read until Monday anyway.

So, I say, anyone who thinks a Holter Monitor is an ER procedure, please rise.

Anyone.

Holter monitors not emergency room precedure

I was just sitting here when I was called STAT to ER to do a holter Monitor. Normally I wouldn't gripe about ER calling me no matter what the reason when I'm just sitting here, but it was a STAT holter Monitor, so it warranted a groan and a gripe.

I don't know if all RT departments do holter monitors, but I know that most of the ones in this area do. However, we have other staff do them during the day shift, and RT just has to do them at night.

Which, one would think, would cover all holter orders, considering holter monitors are an outpatient procedure. But, lo and behold I get called to do at least one STAT holter monitor a week.

And, usually, it's during a time when I'm really busy.

When you are the only RT working, you learn to prioritize your therapies, and I can find very few things, aside from a STAT IS, that a holter set-up should be ahead of. Occasionally, I've been known to take over an hour just getting to the holter.

"This is the ER," one doctor told me once, "nothing in ER deserves to be put off for over an hour."

My short-of-breath patients on the floor are more important than this holter, that I shouldn't have to be doing in the ER in the first place, I thought. Yet I smiled and said, "Sorry."

If there are any readers of this blog out there who can think of one reason why a holter needs to be ordered in ER, please let this RT know. I can think of none.

Because the patient has chest pain?

Hardly. If he has that symptom he should be admitted.

What about if the patient had a fast heartbeat, but when she got here we didn't pick up anything on the rhythm strip or EKG?

If that patient is symptomatic, admit them. Otherwise, schedule them for an outpatient holter.

Another goofy thing we do after giving a patient a holter is give them this little log book for the patient to record any symptoms they might have such as chest pain, palpitations, etc.

If the patient is having these symptoms, they shouldn't be recording it in a log book, they should get themselves back to the ER.

Does a holter need to be ordered stat? Absolutely not in my humble opinion.

On the other hand, if the ER doctor called me and said, "Hey, if you guys have the time, and a holter monitor available, we would love it for you to put one on a patient so she doesn't have to come back in two days to get one."

If that happened I'd be ecstatic about doing the holter. In fact, it might cause me to have chest pain, and then I'd need a holter set up on me.