The ER physician phoned me and said; “The hospital is going to get dinged because I did not follow protocol. At the time, I was with the patient in the CT scanner completing his study to evaluate him for the cause of his face and hand numbness. She was referring to “the stroke alert” protocol. Hospitals that want to earn bragging rights, that come with financial incentives, must document that they are capable of evaluating and treating a patient with symptoms of a stroke in a timely fashion. A neurologist makes the call as to whether a patient should receive a clot busting medication. To delay waiting on a neurologist to arrive at the hospital, many hospitals utilize Telemedicine Doctors or “Docs in the Box”. Because I was obtaining additional views of the patient’s anatomy, I deviated from “the protocol”. Basically, they are agreeing that watching a nurse do a physical while they observe through a webcam is as good as being there themselves.
A patient then gets a CT scan to exclude bleeding in the brain. Back to the ER to connect with the Telemedicine doctor and then back to CT scanner to get a CT angiogram to look for clots. It there is a clot then a potent clot busting medication can be given to disolve the clot and prevent permanent damage. I broke protocol because I intercepted my patient in the CT scanner and had them proceed with the angiogram when bleeding had been cleared. He missed a trip back to the ER to wait for the Telemedicine consult. I was with the patient and was monitoring him personally in the CT scanner. The Doctor in the box is stuck in the computer and cannot be transported. Neither can he administer emergency care if needed. The next best thing to being there… maybe. Protocol was broken for a more efficient use of the patient’s time as well as the personal doing the scanning and transporting.
I liken treatment protocols or alga-rhythms to cookbook recipes. Follow the steps in order. Don’t deviate or ask questions. It’s ok for cakes, but humans don’t always follow the textbook when it comes to symptoms and medical histories. There is something to be said for a detailed history while observing a patient in person. Laying hands on a patient personnly also cannot be replaced by observing a physical from a screen; in my opinion. What kind of doctor-patient relationship is formed from a computer screen? If a physician cannot take time to come to the hospital, the patient is merely a set of symptoms and signs that need a diagnosis. There is no caring or compassion. Just the black and white facts. We all know life is black and white. Patients are not given a choice in the hosptial to see a physician in person or a Telemedicine Doctor. Most primary care physicians no longer go to the hospital, so the patient will be seeing a physican for the first time in their emergent situation if they are lucky. Most will be seeing an allied health professional that follows a “protocol” of treatments until the physican can “sign off”. If the argument is that an allied health person is just as capable of making a decision then why do we have the doctor “sign off” the paperwork. There is certainly not much of a relationship in ones time of medical crisis. Some might say that as long as the outcomes are good, personal touch and expertise is not necessary. But who defines a good outcome? When did we start to devalue human life so much that protocol takes precedent over good care?
Do we not get a say in our own health care since it is the insurance companies that are negotiating the price of our treatment? That about sums it up. It is about protocol, documentation, and utimately, reimburesment. Outcomes are numbers not people. There are “metrics” that are measured and rewarded not patient satisfaction and health.
How do we fix such a broken and impersonal system? First, by realizing that you and your family matter and deserve compassionate and quality care. Discuss how your healthcare will be delievered with your physican. Would you like care by someone with 11-16 years of education or 6? What happens in an emergency? As physicians, we need to treat patients like we would like to be treated. Healthcare is not about “dings” in “protocols”. It is about caring for those in need and giving them the attention that humans deserve. Do the right thing. Do more than just no harm, but care and respect those that intrust you with their most precious possession; their health. The best part of being a physician is to be allowed to come into another persons life and get to know them and their family in such a way that you understand their needs and desires. There is no protocol for that.
The best way to decrease your need for emergent care is to take charge of your health and nutrition. Eating a whole foods plant based diet and exercising daily can prevent the majortity of lifesytle diseases. To learn more about preventing and reversing lifestyle diseases, check out our website at http://doctordulaney.com