Physician Disagrees.

ImageIn 2002 I sat for the clinical exams for my RRT (Registered Respiratory Therapist) credential. The easiest part, at least for me, were the straight forward questions on the shit that could easily be found Egan’s Fundamentals of Respiratory Care textbook. The shitty part, and the part ironically that would tend to foreshadow what my career in respiratory care looked like, were the clinical simulations. The clinical sims walked you through theoretical scenarios. Some of the patients had blatantly obvious problems like pneumonia, COPD, asthma the stuff you knew you were signing up for as a therapist. It got fuzzy when babies with ambiguous symptoms came rolling through your virtual ED and all you could rely on were your clinical assessment skills. So, Patient Q came barreling through the door with a persistent 3 week dry cough, low-grade fever, and other symptoms that could mean everything yet nothing.

I’d go through a specific symptom, apply the solution that I thought was correct, and would receive the heart stopping response of:

PHYSICIAN DISAGREES

By the 3rd or 4th “disagreement” I thought for sure that I’d killed my virtual patient and shat away the hundreds of dollars that I’d spent on the exam. As it turns out my patient survived because of the choices I made. I walked out of the H&R block testing center fist pumping like 80s Judd Nelson. Now let’s apply that to my real life in respiratory therapy shall we:

I wish I had a nickel for every time I’ve had an opinion that was the “right answer” in the direction of patient care but was summarily ignored by the physician charged with caring for the patient. The difference in real life is that lives will not be miraculously saved by a test that happens to know which care plan is better. In fact …

*Bombshell Alert*

People get very sick and or die because of physician pride, incompetence, or apathy. I wish I could say that I haven’t seen it as many times as I have in this now almost 14 years as a therapist, but it’s true. When a physician would rather Google how to operate a particular type of life support rather than ask the real live person on duty who has experience with the equipment how to proceed (yes, this happened … to ME), then there is a major problem with how the healthcare team functions and the real losers in this game are, as always, patients. Do I blame all physicians? No.

I blame the set up of the healthcare “system”. Doctors are all too often placed in a position where they cannot be vulnerable, where they can’t say “I don’t know” or appear not to, hell where a patient with no medical knowledge whatsoever can waltz into their office and tell them what to prescribe. This type of system sets doctors up to be on the defensive. They have the image of the authoritarian on all things medical to uphold after all. It’s a sucky conundrum and a large chunk of the reason why I didn’t proceed to medical school.

The only solution I see in this age of information where the patient truly is more well versed about their disease process than the doctor, is a more team based approach where the doctor is still at the helm, but know when to trust the advice of specialist that have seen certain things a time or two more that she/he has. I’ve seen this set up before, mainly at teaching hospitals, and from what I’ve experienced it works. Granted, it then places the responsibility for competency in the lap of staff, but I’d rather have my opinion respected and expected than to just be a “knob turner” at the mercy of a doctor who is burned out, apathetic, and just doesn’t want to be called anymore. Mutual respect to the benefit of those we are charged to care for: Is that too much to ask? Me thinkest not.

Rosie.

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