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Monday, July 20, 2015
Today is a special topic from inside the healthcare institution in the states.
This is being written at the request of Ross.
A colleague of mine, someone I have known since I was a resident, made a comment on a place another colleague is going to work as their next job. This is someplace my friend had once worked.
'I used to have to clean my own LMA' at this hospital, he said.
(Laryngeal Mask Ariways--LMA's come in two kinds--reuseable and disposable. The reusable one is photographed in the wiki link. A sterile processing technician is the one who will clean them, and if not, it is the surgical technologist who ensures the device is clean from biological cross-contamination in the LMA for re-use.)
"I used to stand there at the scrub sink where the surgeons go, with the little scrub brush for our fingernails, trying to get as much soap as I could up into the stem.' my friend confessed.
Why didn't they have proper cleaning techniques and staff for their patients?
'The hospital said they didn't have enough money. But they had enough for two thirty-thousand dollar big screen tv's in the doctor's lounge, and a million dollar (I forget what else it was in the hospital that he said--ed)'...
Another colleague of mine was back to our hospital after being asked to leave by the department. He was invited to leave by our group due to overstaffing, but asked to be available for vacation coverage.
He just did vacation coverage for another cardiac anesthesia friend of his who works in a brand new hospital outside of San Diego.
His friend does hearts, but not the Transesophageal Echo--TEE--click here for description of this study. When he inserted the probe on his first cardiac surgery patient at this hospital, the entire heart room staff silenced in awe. This is a whole new LEVEL of cardiac care! they exclaimed, in admiration.
At the end of the day, the surgeon offered him five hundred thousand dollars a year salary, just to come work, on the spot.
General anesthesia is contraindicated (not allowed to be given) in a few situations. If a patient appears to be in one of these categories, the patient must be evaluated and the anesthesiologist will make the call whether the risk is acceptable or not to proceed.
Recently one patient was at very high risk for case cancellation.
I did my job. I did what I had to do.
The surgeon was annoyed, irritated, and rushed because 'we were ten minutes late already'.
I was asked by this surgeon, 'I understand you have to do what you have to do to keep out patient safe, but can you finish it sooner and go straight to the room? I have another case to do at another hospital after this.'
I didn't bat an eye. I said, 'If you would like to me cancel the case for you I'd be glad to do it, if you'd rather not proceed with the surgery.'
The problem resolved under my treatment and the patient was able to go to surgery.
This surgeon cared more about the golf scores of the British Open than the patient on the table.
This surgeon said something derogatory about the patient, who was anesthetized, and I changed the subject on purpose. This surgeon said, 'I was just trying to make conversation.'
This surgeon has a boat...and spoke of many luxuries during the case. The conversation with the surgical technologist was about TV shows, motorcycles, and other material things.
I recalled a colleague, another female, saying earlier to me that day, 'I just can't get that doctor--I can't connect and I get along with everyone else. I just don't get it!'
What flashed before me, was first of all--this person is enslaved into the system big time! With the need to pay for the luxury.
And then? A quick sense and I could be wrong, of a gambling predisposition. It was just like I can sense the energy of 'chemical' in the aura of someone with addiction. This was my first gambling I ever 'picked up'. This is why I say I could be wrong, because I've never 'felt' this in anyone's aura before.
Sometimes things just blurt out of my mouth, without my being able to know what it is in time to stop it. This office is in a Nice Part Of Town, where the surgeon works. And I asked, 'Do you get a lot of business because of Yelp?'
The answer was no, because the only surgery specialties to look up are Plastics.
'Do you advertise online?' I asked again.
'Sometimes', was the reply.
I know bad reviews will haunt a doctor forever on Yelp. And it drives patients away. Sometimes I look people up I know, just to read how their patients feel about them.
I didn't say anything else, woke up the patient on time, and went on to my next case.
I also knew this surgeon, as 'Things Of This World' as possible, was still a soul loved by God, and learning their lessons too. I observed and took care not to judge. This article is to inform of what it's like, behind closed doors...
Everything went well for the patient, and nothing was mentioned to anyone except you here right now.
As I was walking out of the hospital, I saw a tall man with Birkenstock-type orthopedic sandals on his feet, and a slow, deliberate walk, as if he had pain.
I felt immediate and deep compassion for this physician.
On closer look, I saw it's a man I know who starts cases one hour before the rest of the normal scheduling time, and works so fast that no one has a chance to keep up with the patient workflow--not nurses, not anesthesia, not without cutting a LOT of corners to keep up. The production pressure that is put on the team is the worst, second to perhaps only one other orthopedic surgeon at the place.
I asked, politely, 'What's your plan for the rest of the day?'
Seeing patients. Then surgery at another hospital late in the afternoon.
I asked, with interest, 'How much sleep at night do you get?' I know of one spine surgeon who wakes up at three every morning to go to the gym before work.
'It's pretty normal', this surgeon said, about the lifestyle.
I guess it's all about efficiency, huh?, I said, validating him and his philosophy on patient care (one that doesn't match my own--I prefer patient safety first, and also, patient satisfaction.)
There are some orthopedic surgeons who not only make money for their services but also invest in the type of 'hardware' they use in their surgery. It's sort of like a 'double-dip'.
I'm not saying that this surgeon is guilty of doing this; what I am saying is that there are many financially-motivated people out there who know how to 'work the system'. As reimbursements go down due to managed care, this can be expected to be seen more often, due to the nature of people and what is motivating for them.
For our health as a society, as humanity, it is on us to explore 'what is going on' in organized medicine.
We need to look into the factors which underlie the 'way it is', and to decide 'what to keep and what to eliminate', in order to streamline and deliver care to those who need it most, regardless of ability to pay.
One patient said today, 'my insurance doesn't really cover this' procedure that was about to take place.
This is correct--many are 'catastrophic coverage' only--and not for routine things.
Even the routine coverage policies have insurance deductibles which can be very high, of ten thousand dollars sometimes, depending on the family deductible.
The answers and solutions to this situation are inside us, in our hearts.
Please explore how our current system makes you feel, and to imagine the direction you would like health care to turn...
A beautiful way of healing the sick is right around the corner...once we put our minds and our hearts together...as one family on Gaia...Namaste.
Aloha and Mahalos,