Another email from a U.S. doctor:
"I am a physician in the U.S., and I love your socialized medicine pearls, the latest of which -- by another medical practitioner -- I want to comment on. I just wanted to tell you, we have JCAHO coming to our hospital this month. It is causing all the panic you note. What a dog and pony show! We'll do all this total b.s., and it's all about the show...nothing to do with really taking care of patients. It's all about jobs for doctors and other adminstrators who can't make it in the "real world", or so I am convinced.
Recently, there was a campaign that we all not use certain abbreviations, thought to lead to horrible mistakes in the ER; for instance, we have to write ml instead of cc for our IV infusion rates. Or write out morphine sulfate instead of MS. (Both of these we have done since day 1 that I have been in practice, which is since 1979, and I recall neither leading to a single accident. Oh well.). JCAHO, on their website, recommended an entire scheme to get us to use the good and not bad abbrevations, including making up songs and posters and well....here's a partial list pasted from their website:
Have the list printed on pens.
Send monthly reminders of the list to staff via computer.
Educate and monitor staff who document in the medical record.
Create an educational display for use during Patient Safety Awareness Week.
Educate affiliated health care professional education programs about the list.
Place articles in employee and physician newsletters.
Provide mouse pads with the list.
Convene regional/community meeting to develop consistent list for physicians who maintain privileges at two or more facilities.
Direct pharmacy not to accept any of the prohibited abbreviations.
Orders with dangerous abbreviations or illegible handwriting must be corrected before being dispensed.
Conduct a mock survey and question staff to test their knowledge.
Work with software vendor to ensure changes are made to be consistent with the list.
At every medical staff meeting, give patient safety updates, including information about the prohibited abbreviations.
Identify and promote "Physician Champions" who support accreditation-related activities and advocate for full compliance with the NPSGs.
Ask every staff person to sign a statement that he/she has received the list and agrees not to use the abbreviations.
Create a catchy name or theme: Do the "Write" Thing; "Dirty Dozen"; "Outlaw Abbreviations"; "Join the Patient Safety Posse"; "Operation BANEM" (Banned Items); Uncle Sam-style poster saying "You can prevent a fatal error;"
Promote a "Do not use abbreviation of the month" campaign.
Create a song incorporating the "do not use" list.
Create a slide show/presentation illustrating poor handwriting and dangerous abbreviations. Include actual examples from your organization.
Please feel free to use any of these practices that you feel may be helpful for your staff.
It gets much, much worse. I looked at the latest "FAQS" for the Patient safety guidelines, revision 8/30/04. It took me several minutes just to scroll, with just cursory reading, through the entire list. I opened the "printer friendly" PDF version...it's 24 pages LONG. This is obscene. These folks, I can tell you, have smoked too many "joints" and thus the name.
And yes, I came up with the even more juvenile "Operation, in response to Operation BANEM above: Forgive Us Clearly Klutzy Emergency Medicos, (You can figure out the acronym!) since we do such an obviously horrible job, killing hundreds of thousands via time-tested abbreviations.
Of course, none of the problems could be from overcrowding, over-utliization, overbearing bureaucracy, overabundant lawsuits and fear of same or other REAL reasons medicine is so messed up!
Your previous correspondent did leave out other factors: Insurance. Medical insurance, both private and govt. is horribly construed here. It is dissimilar to any other insurance, and because of the low pay copays of employer-offered care, or no-pays of govt. programs such as Medicaid, care is overutilized. People run in to the ER I work in with paper cuts and knee scrapes. Heaven forfend they would put a bandage themselves or an antiseptic at home. I am not exaggerating.
No one cares or worries about the true cost of care. So the "free lunch" theory is in place, as everyone assumes the "system" can pay for everything. And they have to pay less than the price of a baseball game ticket. A family of four have to pay out something like $200 US to go to a ballgame here, on average. No big deal, but to shell out that for an ER visit...oh my, we are gouging them!
Also, I can't forget that doctors' organizations are guilty also... licensing laws have kept down the supply of doctors, and there are other mechanisms that physician groups have tried over the years to restrict the supply of "providers" to keep up licenses. I know that is heresy to my own group, but it's true.
My contention is that all groups are guilty....govt., insurers, pharmacy companies, patients, employers, physicians, lawyers and patients and their families. There is not a single group NOT guilty in the medical care "crisis". Which is why we'll end up with socialized medicine, because it is such a muddle and so many groups are involved in the muck-up, that the political will will be to turn to the govt. to fix the crisis, though they are the MOST guilty of all!
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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