Barbarians at the Gates of the OR
It is time for pervasive panic and generalized pandemonium in my little hospital. We knew we had been fortunate these past few years to remain sheltered in our backwater, unnoticed in the shadow of the huge academic medical center just down the road. Other hospitals, we know, have faced these trials in recent years, but we had been spared. We had been a small island of sanity, a redoubt of reasonable people caring for patients with reasonable ways. No more, however. Today, wild-eyed administrators are running amok in the hallways. Nursing supervisors are lining up the cowering minions for inspection of hand washing efficacy like so many orphans from Annie. Surgeons with heads uncovered are being challenged and so are surgeons with heads covered when the OR nursing administrator explains that all heads must be covered but head coverings must be removed. Lose that lanyard or lose your life–you’re going to kill somebody with that thing. I don’t think I saw you wash your hands just now, did I, doctor? It’s the regulations, doctor. Please, don’t be difficult, doctor.
Trouble is at our gates–trouble in the form of the JCA (formerly the JCAHO, formerly the JCAH, the bastard devil-spawn of the lascivious American College of Surgeons and that harlot, the AHA) and the CMS (formerly so many different acronyms as to be unnameable). Two hospitals in our realm (one being the aforementioned high-towered University Hospital) have been invaded, inspected, and decimated by the event. Hospital administrators are left weeping and broken in their wake, clutching reams of citations and deficiencies. Oh, the horror, the inhumanity–the lost revenue.
We will not be taken so easily! We will be ready. Every effort will be made to put down this new plague. We will wear garlic necklaces if there’s an article in the Journal of Medieval Medicine (vol. 3, Sep 1199) that says that such efforts are laudable. New regulations will be promulgated, old regulations rigorously enforced and any lack of enthusiastic compliance will be judged to be a threat to patient care and dealt with aggressively. Those who do not comply will be reported to the committee we have for just this sort of thing.
There is only one problem–none of this zealous response has anything to do with the care of our patients. Just the opposite, unfortunately. Patient care is compromised amidst the capricious, unsubstantiated and unjustifiable new policies; policies that are conceived and become doctrine at administrative levels carefully removed from the influence of those difficult doctors who just won’t go along with anything. New policies appear as dogma based upon AORN guidelines–but now that they are written down on hospital computerized stationary, take on the rule of law. No matter that none of these guidelines approach the level of standards or regulations, that the JCA never required compliance with these phantom statutes, that there isn’t the faintest whiff of science or rationality behind them. All hair is to be covered, so, yes, doctor, you are going to have to shave that off for the good of the patient. Do you want your patients to suffer a horrifying septic death and skew our hospital statistics? Is that what you want? I’m sorry, doctor, but if you’re not willing to put the welfare of your patient above all else, well–I’m very sorry to say that I must report your lack of enthusiastic compliance to the Committee to Deal With Combative, Aggressive, and Inappropriately Behaving Physicians Who Have a Bad Attitude. Isn’t your ex-wife on that committee, doctor? Are you sure you wouldn’t prefer to just wear one of our ‘full-coverage hoods’ and sit quietly in the OR lounge? I thought you would, doctor. Smile, doctor–the patients get upset if the staff isn’t happy, you know, and patient anxiety has been proven to have a negative effect on wound healing. I know, nobody can see you smiling in that hood, but it’s really your entire attitude, doctor, that is really the important thing. Don’t you agree?
Thank you…I was starting to wonder if there were any sane people left?
Yes, it’s the triumph of bureaucracy over reason. My favorite professor at a large, Midwestern university years ago (an institution with which you have more than a nodding acquaintance) used to refer to this is “Bureaucrap.”
You’ve put into words the pictures we have in our minds, the actions we’ve witnessed in so many ways and the gut wrenching frustration we’ve experienced. Survival is the goal, not care, it seems.
Well said. It’s going on in education too, and elsewhere. When (not-so-)common sense and heart go out the window, rules take their place. Obedience to rules is quantifiable. Common sense and heart aren’t. And the bureaucrats love quantifiable.
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