Homeschooling (A column I recently wrote for the Greenville News)

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Ask my children what they like most about home-schooling, and you may get a variety of answers.  ‘We like Latin’, or ‘We like wearing pajamas to school’.  They may tell you that they like specific topics, like physics or astronomy.  Or they may say it’s because recess consists of unique activities, from swimming to archery to playing on the trampoline.  Their answers are as varied as their four personalities.  But if you ask their mother and me what we like best, the answer is straightforward.  We like being with our children.

People educate their children at home for many reasons.  For some, it is a way to cloister their families from the world.  That seems, to our modern, connected, socially conscious society, like a backwards idea.  And indeed, in rare instances, the children do not benefit, but develop an unfortunate paranoia, transmitted from worried parents.  On the other hand, a few minutes with the news, a few hours looking at the statistics on drugs, crime and sex in our culture, and a little ‘cloistering’ doesn’t seem so bad.

Others home-school because it frees them to teach whatever they think is appropriate, as long as certain educational standards are met.  Scripture doesn’t conflict with learning; in fact, reading it can be a learning experience in itself, and a series of lessons in culture and history.  There can’t be a concern over separation of church and state when the state isn’t involved.  Furthermore, the home-school family can ask pointed questions about controversies without being accused of being Cro-Magnons:  ‘What are the weaknesses of arguments for and against evolution?’  Or the more heinous, ‘Could it be that global warming isn’t a problem?’  The scandal!  It’s getting harder and harder to have divergent ideas about anything in our modern world of alleged diversity; except at home.

I’m sure that our family was motivated by a little of all of it.  We like keeping the children safe under our watchful eyes.  We like teaching poetry and Ancient history in a time in which beautiful language is lost in abbreviated e-mails and text messages, and few children know the stories of the great empires.  We like the fact that our children can start to learn the critical skills of rhetoric and argument, so that they aren’t one day ambushed by college professors who would happily bully away their deepest held beliefs.

But under it all, behind it all, remains the fact that we simply love being with them, and want to enjoy their lives as long as possible.  Here’s the hard truth.  Modern life takes our children from us, and their childhoods from them, too soon.  In the best of worlds, we have them until they are around 17 or 18 years old.  But then, in addition to the way they naturally speed to maturity, they’re kidnapped by organized activities, they’re in school all day, they spend evenings finishing loads of homework, and they go to sleep.  Little time for play; little time for contemplation or imagination.

In school, public or private, schedules are set by the state, or by private institutions. The individual needs of families for time off, or spontaneous time together, simply can’t all be met when thousands upon thousands of families are involved.

So last year, when we were contemplating the next step in our children’s educations, and as our oldest was about to enter middle school, it just seemed right to step back and do what we had considered all along; keep them home.  It wasn’t a reflection of distrust of the teachers they had before, or the teachers they would have had later.  It was an expression of our heart-felt desire to enjoy them, to shape them, to share with them, hour to hour, day to day, at home or on the road.  We decided to home-school because we just missed them when they were away.

As the world wonders how to fix education, how to fix children, how to ensure that future generations are capable and inspired to greatness, everyone could learn a lesson from the home-school movement.  And the lesson is this; it’s really not about the school or the teachers.  It’s about the connection of parent to child.  That’s where love and discipline are learned, that’s where education is inspired; that’s where faith and morals are born; and that’s where the future is forged; minute to minute, day after day in the close proximity inspired by love.

A patient reborn

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Hal made me crazy. A few years ago, it seemed like he came to the emergency department weekly, sometimes daily, looking for drugs. He had every ridiculous, contrived, superficial complaint imaginable. He was loud, angry, and often threatened lawsuits or other trouble. I think he even threatened us with violence once. Furthermore, his family was well connected. He was the worst sort of drug-seeking, drug-abusing, soul-draining patient you can imagine. And many of you can imagine them very clearly!

He came back today. Without a vacant look, without any unsubstantiated illness or bizarre injury, without profanity or threats. He looked different. He looked…normal! His hands were thick and calloused from his job. He was showered and shaved. His clothes clean and neat.

Since I had last seen him, he experienced cancer, then apparently experienced drug rehab. He is doing well on Methadone. He was apologetic about the past. All I could say was ‘that was then, this is now,’ as I felt liberated to check into his new complaint, thoroughly unrelated to pain or the need for drugs.
He was, in an odd way, reborn to me. It was a perfect Easter gift. A person I thought was long lost, now once more among the living. I pray that he stays that way.

Old Hal made me think bad thoughts. Old Hal made me want to throw things and slam down charts. New Hal made me realize that in every nut, every abuser, every drunk, every psychopathic manipulater lies the embryo of a human being, waiting to come to life.

Thanks for the gift, Hal. And Happy Easter to you! He is risen, he is risen indeed!

God is great…

Ed

Easter reflections on guilt

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We all feel so guilty.
Society is burdened with guilt at every level. Guilt over allegations of inequality in everything from race to sexual preference; guilt about immigration; guilt about prosperity; guilt about global warming and vanishing species. Guilt about war and terrorism, guilt about assigning blame for war and terrorism, guilt that we might have made someone in another country angry enough to hate us.
Medicine is full of guilt too. Guilt that we haven’t done enough for our patients. Guilt that we haven’t done enough for society. I saw an ad for the Army Reserve Medical Corps., a noble organization to be sure. But the add said something to the effect that, ‘you went to school and trained, you practice medicine, how about giving something back?’ Guilt, guilt, guilt. Guilt itself may be the true post-modern faith; or perhaps more accurately, a sacrament of it.

The truth is, religion isn’t the source of guilt. Religion just identifies it openly. (Actually, research suggests that my grandmother is the cosmic source of all guilt–a force so powerful that alien species and killer asteroids are repelled daily by her intense guilt waves!)

Christianity specifically is targeted as a very guilt-ridden faith. Truth is, we’re pretty good at it. We remind the world of its sinfulness with atomic clock regularity. Those outside the faith don’t realize that we Christians plague each other with guilt too! Few sermons remind us of our redemption and of God’s love for us. Most remind us of our inadequacy.
The problem is, we Christians actually have the answer; we just aren’t talking about it. Guilt is a symptom of the disease of all humanity; the disease of sin. And that guilt will find its way out at every opportunity, whether wringing our hands over lust or over the environment. We all feel badly about something.

It isn’t isolated to western thought, or the Judeo-Christian tradition, either. The Buddhist knows something of guilt; Siddhartha was miserable at the sight of so much suffering in the world. The Moslem knows guilt, and fears the wrath of a very harsh God. The ardent environmentalist is guilty about his gas powered vehicle, or about the meat he ate as a child. The communist guilty that there isn’t total economic equality in the world. Guilt is all around.
Christianity does have an answer, though. At Easter, Jesus says ‘Whatever you did wrong, I take from you.’ All that guilt we have come to love so much, that feels like a normal organ of our bodies, all the actions that caused it, all the separation from God, he took to the Cross. He killed it with himself, then rose up, leaving it all in the tomb.
It’s easy to say ‘he died for our sins’, and not think about it. Yes he did, but he died for our guilt. Not just the legal reality of it, but the lasting effects of it.

There’s nothing we do, nothing we did, nothing we failed to do, no thought, no sin, nothing wrong about us that wasn’t crucified.

That’s what Easter says. We’re delivered from all of it if we only believe. And once delivered, we can drop it and move on, the shed skin of our old life, dessicating in the bright sun of Easter morning.
Happy Easter!

Ed

You want what?

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Tonight a young man came in by ambulance.  Upset at losing his job, he wanted to ‘get messed up’. He took 14 Klonopin (0.5mg), drank two pints of liquor and smoked some marijuana.  He fell off a porch (surprise!) and hurt his ankle.  He had no desire to hurt himself, but wanted checked out, and wanted us to hurry.  Then, through slurred speech, looking through red, half-closed eyes, had the audacity to ask for narcotic pain medicine, and to be annoyed when I said no. 

You want what?  You’ve got to be kidding.  This is the sort of thing that drives nurses and physicians crazy, and that can’t be conveyed to most people, who just think we’re  heartless, uncaring, money-grubbing scumbags. 

He won’t be discharged on pain medicine either, unless his ankle is broken!

Ed

On money, medicine and anger

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I just posted a column I had written about EMTALA.  For those not in emergency care, it’s a law called the Emergency Medical Treatment and Active Labor Act.  It exists, as the column says, to ensure that no one gets turned away because they can’t pay.  In a way, it’s a great law.  It keeps us from being greedy scumbags and sending folks out of our emergency rooms when they’re truly sick, but just don’t have the cash or insurance to pay.

On the other hand, it has opened hospitals and physicians up to enormous abuses, since many people know they can come for almost anything with no intention of paying their bill.

Now, I’ve written about this before.  In fact, a piece I wrote about this has been posted on Flea’s blog.  I was looking at comments and saw some anger, and indeed I’ve seen a lot of anger about columns on medicine and money.  Some from within medicine, as doctors express their frustration over falling incomes.  Some from patients, who think doctors are all rich fat-cats who are pillaging the public.

I wonder, why is everyone so angry?  It isn’t just the money.  First of all, doctors do make a good living.  The problem is, we tend to over-extend our money and always need more.  A lake house, a new BMW, private school for the kids, vacations and conferences at resorts.  Not everyone mind you, but especially subspecialists live life to the edge of their ‘financial envelope.’  No one wants to hear a lot of whining about incomes that fall from 600K to 450K.  That’s just the truth, no matter how skilled or dedicated the particular physician may be.  Their anger comes from somewhere else.  I have lots of opinions on that one.  Their anger comes from losing control of their practices.  And nowhere more than in emergency care.  WE all want control, in any business. But, imagine a computer sales person who had to do the sale, but couldn’t collect the fee and couldn’t turn anyone away for not paying.  Or an electrician forced to give service without a guarantee of payment; after all, don’t we have a right to electricity?  A contractor who built homes, but only 25% were paid for?  We have a right to homes, don’t we?   Of course, doctors are also angry from believing that medicine and money will make their lives rich and fulfilled; a lie that mankind has believed for millennia.
On the other hand, there’s this groundswell of anger among the public, because medicine just costs too much.  And it does!  In lots of ways, it’s too expensive.  Simple stitches shouldn’t cost $500.  They do because insured patients pick up lots of the lost payment from folks who can’t, or don’t pay.
The system is set up so that those who pay, cover their own bill and the bills of others.  Fair or not, it’s the way it works.  But it’s not unheard of.  It’s similar to the way the costs of shoplifting are passed on to other consumers in retail stores.  Someone is going to pay, because the store can’t absorb all of the cost of stolen items.  Not that I’m equating non-payment with theft; it’s just a finaincial analogy.  But there’s a parallel.  When someone says to me that they wanted to see their doctor, but owe them money, and the same person drinks alcohol every weekend and smokes two to four packs per day, has a camera phone and a fresh tattoo, it’s hard to believe they simply can’t pay a bill.  In that sense, the theft analogy may hold some water.
But in the end, two facts remain; health care is expensive, and someone has to pay or else the system will not survive.

Aren’t the doctors all rich rapists of the public good?  Probably a few.  But most of the ones I know didn’t come from money or medical families.  They worked, studied and went to school.  (My mom is a nurse, my dad a preacher.  I paid for my college with a scholarship, and my medical school with loans.)  Most doctors started practices, and gave up time with family or other interests.  They did what capitalism demands in order to succeed.  But they’re perceived as being cruel opportunists who are cheating everyone.
I’m curious, is the populace angry at Bill Gates or any other entrepeneur?  Are the masses furious at the success of Oprah Winfrey?  Somehow, it’s different.  Entertainment, computers and electronics, these fall into a different category of success.  They apparently constitute proper success; success at giving people what they want.  No one bats an eye at television shows about rappers or athletes and their elaborate homes, or extensive car collections.

But doctors!  Oh my!  One reader commented on my column on free care with a very annoyed letter to the editor, ranting about doctors and their six figure salaries.  But what about seven figure salaries of football players?  What about the six figure salaries of contractors, brokers, owners of car dealerships, plumbers, researchers or academics?  Are they inherently evil?

My friend, Dr. Carol Rivers, hit it on the head.  People are happy to pay for what they want, just not what they need.  It’s frustrating to have to pay a medical bill.  But it’s less frustrating to buy a new truck, get a new lap-top, go to a concert, buy a pay-per-view sporting event.  People in our society spend money like crazy on what they want.   It’s just that health care is not what they want.  They want health, like everyone, but a huge number of people consider paying a doctor or hospital bill unfair.

At 14 years in practice, I can make some predictions.  It isn’t going to stop.  Doctors will still be frustrated and so will patients.  In the end, we’ll have national health insurance.  The medical bills will come out up-front, in taxes, and won’t seem so painful.  Then, the entertainment money can come out of the rest, for fun, as desired.

The health care system won’t be the same.  It won’t be ‘like now, but free’.  It will probably offer less amenities, less consumer options.  But maybe the people will be happier.  I don’t know.

I do know that all of the anger makes me tired.  I’m not angry about money, really.  I was insulted to see one person comment that doctors ‘just don’t want to see poor people’.  How sad an assessment.  I’ve spent a lot of my life taking care of poor people, people I knew would never pay me, people who needed what I could offer.  I have spent entire evenings trying to get them sent to psychiatric facilities for their suicidal thoughts, or stabilizing their critically ill children. I don’t have any problem with the poor.  All I really have a problem with is the anger.

I wish patients weren’t angry about health-care.  But people do, on some level enjoy their anger; enjoy their indignation.

I guess, if leveling it at doctors makes them feel better, we’ve at least accomplished something therapeutic for them in the end.

So, that’s one furious tirade?  That will be $75 please!

Ed

Working for Free (A recent Greenville News Column)

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It’s tough to be priceless, but someone has to do it

People in our society have a lot of needs, and many of those are needs they simply can’t pay for.  For instance, attorneys all over America are appointed by courts, from time to time, to represent the interests of citizens who are accused of crimes but can’t afford representation.  This is the ‘price of doing business’ as it were, in order to practice law.  And it is actually a right, unlike so many things thrown about as rights these days.

Recently, as reported in the Greenville News, the South Carolina Bar Association addressed one of the fundamental problems of this right.  That is, a right that requires someone else’s labor means that the person (in this case attorney) providing the service may have to provide it for free, or at less than market value.

I can understand the concern of South Carolina’s attorneys.  One of my relatives is an attorney, and she has been appointed a number of times to represent clients who couldn’t pay.  And it was more than a financial hardship; she has been appointed to clients she felt ethically compromised in representing.  It’s tough to muster up the stomach to provide legal counsel to someone like a repeat sex offender or violent criminal who might, in the end, be free to rape or kill again.

In the News article that addressed the Bar’s concerns, the President of the SC Bar lamented to the Board of Delegates (the Bar’s governing body) the fact that no other profession was required, under threat of penalty, to provide its services without proper compensation.  If it’s any comfort to the members of the Bar, let me say that I know another.

Physicians in emergency rooms, and every other on-call admitting or consulting doctor in our hospitals, practice under a law called EMTALA, or the Emergency Medical Treatment and Active Labor Act.  It basically says to me, as a physician, that if my hospital accepts federal money in the form of Medicare, I have to see everyone without any financial screening.  I can send a bill, but I can’t require payment at the time care is given.  Everyone gets seen, regardless of ability to pay.

Theoretically physicians can provide a ‘medical screening exam’ and decide it wasn’t an emergency, then send folks to their (often non-existent) family doctor.  But thanks to litigation and regulatory interpretation (the unique domains of our legal brothers and sisters), the screening exam can involve everything up to and including surgery.  So when someone comes to the emergency department of a hospital, we have to do everything necessary without any promise of compensation.

What if we don’t?  Well, it’s ‘hoist the Jolly Roger’ and lawsuits all around; for everyone from the emergency physician to every other health-care professional involved.  And it’s not just a regular lawsuit; it’s a federal offense to violate EMTALA.  (For the uninitiated, Federal lawsuits are like arm wrestling with a vampire.  Even if you win, he’s still going to suck your blood.)

Next, there are penalties like loss of Medicare privileges for providers and facilities.  In some cases, EMTALA lawsuits have even invoked civil rights violations.  Such penalties could destroy a physician’s practice or close a hospital.  So the members of the SC Bar Association can rest easy, knowing that they aren’t alone.  Other people have to work for free as well.

I’m truly sympathetic to the concerns of the legal profession.  Some of my best, most valued friends are attorneys who are worth their weight in gold.  I’m just making it clear that the situation of SC attorneys is no more unique than the situation of physicians.

And it isn’t going to change.  America’s health care system, while excellent, still needs a safety valve for the uninsured.  For the foreseeable future, that’s going to continue to be me and my colleagues in emergency rooms and public hospitals around the country.  And physicians, who make comparatively large salaries and like to drive pricey cars, aren’t going to get much sympathy from the general public on this one.  But then, neither are attorneys, many of whom have similar incomes and spending habits.

Medicine and law are professions that are simply so valuable that sometimes, our services are priceless; which means free.  It isn’t ideal, and the system needs work.  But if it were otherwise, someone might die needlessly, or fall victim to gross injustice.  And that, in fact, is too high a price to pay for everyone involved, whether doctor or lawyer, patient or client.

What is good in life?

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Remember the line from Conan?  I don’t think my quote is exact, but it was something like this:  ‘Conan, what is good in life?’  ‘To crush your enemies, to see them driven before you, to hear the lamentation of their women…’  OK, Conan may not be the best role model.  But it was a very memorable line!
What is good in life? Tough question, with lots of answers.  But I know one good thing.  The relationship I have with my wife and children.  I enjoy medicine, but it’s just what supports my family.  They are my true calling, as I said in the intro to my book ‘Cats Don’t Hike’.

I was reading to them tonight, listening to my daughter, so proud of her reading ability, reading ‘Ten Apples Up on Top.’  I was reading ‘The White Stag’ to the boys, which is the story of Attila and the Huns.  We laughed and talked, after I had helped them get ready for bed.  These are the best times.  These are the reasons to be.

A while back, one of my boys said, ‘I want to be a scientist.  But I don’t want to work too much because I want to stay home with my kids.’  I was so proud.
That is what’s good in life.  Connection and love.  Nothing in medicine trumps it.   And it’s good to remember, we practice not because medicine is an end in itself, but so that other families and individuals can go on living well and long, and enjoying their own connections, their own laughter and their own bedtime stories.

Ed

Scary times (formerly incarnated in the Greenville News)

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We’re playing a new game at the Leap house.  It goes like this:  I walk up the stairs at night to put the children to bed, and all four of them burst from the laundry room in the dark, screaming.  My heart rate climbs to about 200 and I almost collapse.  Then, I have to restrain myself from chasing them around the house in order to punish them with tickling, or mouthfuls of sauerkraut.

Or there’s this one:  I write in a loft at the top of some stairs.  Whilst embroiled in finding the right word, the right phrase, the right transition, head in hand, one of my little Ninja’s stalks up the stairs and says, ‘Gotcha!’  I jump, (the obvious goal of the game), my hands hit the keyboard at odd angles and I somehow change the article to 30 point Franklin Gothic in the Czech alphabet. I struggle to escape the chair and get my hands on the little sneak, as he or she laughs and runs away to hide.

There’s no end to the fun.  Of course, now that I know what heart attacks look like, and how sudden cardiac death can happen in men my age who happen to enjoy fast food, it give me a little, shall we say ‘pause.’  But hey, as I’ve said so many times, you have to go sometime.

I guess I deserve a scare.  Life has a way of coming around to get you for your earlier sins.  As a young boy, I did the same things to my parents.  I didn’t realize how humbling it is to have your child catch you totally unprepared.  I even think with a little sadness of the way I treated my poor cat, Tim.  Every chance I could get, I would launch myself at him from behind couches and chairs, boxes and doors.  No joke, he could launch himself three feet vertically from a standing start.  Heaven knows how many furry lives I robbed him of in the course of his feline life.  I moved on in my pediatric scaring, and developed a bad habit of sneaking up on an elderly neighbor of ours as she worked in her rhubarb patch, or pulled crab-grass.  Poor Mrs. Ray survived all of my little raids with little more than ‘I’ll get you!’  Lucky for me, she was an old friend, and never shot me.  I’m pretty sure she was capable of it.

Let’s fast forward to my honeymoon, in the condo on the Outer Banks.  Exhausted from weeks of wedding preparations, Jan and I mostly slept and ate leftover wedding cake, prepared for far too many guests than we actually had.  For some reason, I jumped out and scared my new bride a few times, too.  She found it less than entertaining, and certainly less than romantic.  Though it was probably less scary than waking up and realizing she had actually married me.

You see, I really deserve it all:  the shouting, the repeated scares in the course of an afternoon, like the kids were little flying aces, racking up kills.  It’s Karma, as the main character would say on ‘My Name is Earl’.  But the kicker is, I just can’t get them back.

On Thanksgiving, I tried to get the whole bunch of my children, with cousins thrown in for good measure.  As they tromped off into the woods, I put on my old Air Force fatigues and a gorilla mask.  I ran to the edge of the trail, wheezing through the mask (a thing I’m certain real fatigue-clad gorillas never do).  As the children walked past me, and as my adult family members watched from 50 yards away, I jumped out and roared.

Not only were the children not scared, they looked at me as if I were an utter disappointment.  Even the littlest among them yawned and walked on by.  I guess in the imaginary world of children, where monsters inhabit every dark corner, a gorilla in the woods is not even worthy of a squeal.  I was crushed, and slunk back to the kitchen to pound on my chest, throw leaves and eat a banana.

Tonight I stood in the bathroom for 15 minutes, behind the shower curtain, waiting for Sam, Seth, Elijah and Elysa to brush their teeth as I had earlier instructed.  I felt like Norman Bates stalking children.

They never showed.  Foiled again!  But rest assured, I’ll get them.  Even if someone has to wake up to an air horn.

On families

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A family is a small kingdom. Their house is the castle, to be cliché. It is mutable, its location flexible. But the royalty, the humans that live within it, define the kingdom. Small children understand this very well. The idea of father as king, mother as queen, themselves as princes and princesses, resonates inside their hearts. It becomes, in the best situations, a kind of fairy tale made real.

The family kingdom is a complex dynamic. Too often considered authoritarian, with a king who does just what he wants and others who bend to his will, it is really, in its glory, a place where the king leads and protects his royal family, always looking for ways to increase its honor. It is a place where the good queen civilizes and counsels her king and her children, and is herself treated with gentility and respect. And it is a place where children get wisdom, nobility and learning without fear.

This kingdom is meant to be a safe haven. The basic family unit, in more modern terms, is designed as a small enclave where couples come together in love, and in that love support one another. The family is a thing through which the whole world is made safer by small increments. Ideally, it leaves the world richer by populating it with sane, productive, creative citizens. Ultimately, each generation supplies society with young men and women who go on to create new kingdoms of their own.

But not all kingdoms are good, not all are safe, and even the best kingdom is always in danger of collapse, either from inside or out. Anyone who has read history can cite examples of the fall of kingdoms, good and bad. There were kingdoms that decayed because subjects were treated worse than enemies and ignorance was desirable to promote slavery. There were kingdoms of awful intrigue, where emperors were murdered by princes for power and empresses beheaded for producing no heirs. There were kingdoms so horrible that the only option was escape. There were also royal families in which monarchs were not really cruel, just heartless or without joy. And there were golden kingdoms destroyed by jealous invaders.

Not all families are safe kingdoms either. In medicine, we see their citizens every day. We see lonely, overworked wives whose husbands left them for the excitement of what they saw as a kind of dark rebirth, disguised in the language of passion and adventure. We see devoted husbands whose wives were tired of marriage and moved on to different lovers, led away by the phantom of false romance. And we meet children whose kingdoms collapsed around them, through no fault of their own, but who always wonder what they did to make their dream end.

What all children want, what all adults want, are the defining boundaries of love. Everyone desires the interlocking arms of parents and children whose love for one another is so great it flows over onto everyone who touches them. What everyone wants is a kingdom intact.

Nonetheless, like dangerous empires, some marriages have to end. Violence and substance abuse drive husbands, wives and children to safer lands. Deep betrayal and distrust also end families. In these settings, children and wounded parents have to find security and peace of mind.

But in too many cases marriages end, beautiful kingdoms dissolve, for reasons that are poorly examined and for imaginary dreams that never become as real as the life left behind. In the end, when the ink is on the page, the agreements arrived at, the houses sold, the money divided, the children parceled out, what really happens is much more painful.

When the family kingdom dissolves, everyone becomes an exile. They may stay in the same town, or same house, but everyone, husband, wife, teenage son and infant daughter, is forever banished from the place they wanted most to be safe. Even the ones who leave become lonely expatriates. Their freedom never gives them real contentment.

Those who leave or are left all wander the world looking for what they lost, always lonely for the spouse or parent they expected to have for a lifetime. Some find new love, some re-establish the joy of their kingdom that passed like Camelot. But whether they do or not, the pain of their exile remains for life. And no one, no matter what, is ever the same again once it all falls to dust.

Social Screening

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We have a computerized patient tracking system in our department.  It’s a great thing, because it helps us to follow our patients’ progress through their visit, helps us to keep an eye on their wait times, makes bedside registration and ordering of meds, labs and x-rays more practical and makes it easier for annoying doctors to find lab results without harassing the unit clerk.  Furthermore, it allows me to print legible discharge instructions and prescriptions that don’t look like I was having a seizure while I wrote them.

It has, of course, its down sides.  The learning curve is steep.  Physicians and nurses have been seen grasping computer screens and shaking them, like the head of some mortal enemy.  Touch screen technology might better be termed “punch screen”, at least for the first month.  I have coined the term “screen rage”; a new entity for which disability can only be right around the corner.  It gave me vertigo for a while, switching screens and clicking so frequently.  Those who can’t type are (expletive deleted)ed.   Some staff have been found in corners, rocking back and forth and moaning softly.  And the paper-less system uses enough trees to give the Lorax apoplexy.  Or Loraxaplexy.

We’re getting there.  In a few months we’ll wonder how we functioned without it.  But I’m troubled by some of the charting requirements.  You see, our nurses now have to do all of the JCAHO mandated screening for communication barriers, immunizations, drug and alcohol abuse, spouse/child abuse and nutrition. It’s built into the requirements of the documentation screens.  Before, when it was all done by hand on stone-age paper charts, we wisely ignored some of it.  But now, with the templates in place, there’s just no escaping political correctness.

I realize that progressive, caring physicians and nurses are all excited about this opportunity to make the world a better place.  But on the whole, for most real professionals seeing real patients, it’s just one more screen of information that burns time and takes nurses away from our long lost mission, which is that of actually taking care of sick people. Do we remember that?  When we cared for the sick and dying and weren’t instruments of social engineering?  I remember.  But then, I’m getting older now.  And the problem is not only time, but the fact that screening will inevitably lead to a requirement that we intervene in some way in every positive finding.

I find it ridiculous that nurses have to chart:  ‘communication barrier in home, pre-verbal child,’ when a family brings their infant to the hospital.  Is there a translator available?  ‘Pardon me, I speak infant.  Can I help?’

Generally, other than tetanus, immunizations shouldn’t be in the realm of our practice.  Because as sure as we keep asking about them, we’ll have to start stocking them.  Then, dopamine won’t be started on time because little Timmy needed his OPV.

As far as nutritional screening goes, it could take all our manpower and more if we end up counseling people not to be fat and to stop giving their infants Pepsi in their bottles.  ‘Remember Rufus, if you just lose 200 pounds, you can attain your dream of walking across your yard again!  So let’s sign a no-donut contract, OK?’

Our nurses are supposed to ask about infant, toddler and elderly drug and alcohol abuse.  Really, does it seem likely that little Tiffany is knocking back a fifth of Tequila every day?  Does Ricky, age 3, look like he’s got the crack monkey on his back?

And as for abuse, let’s be practical.  A smiling college student with an ankle sprain probably isn’t in the ED because she’s being abused, any more than a young man from a motorcycle accident.  Focus, focus, focus people!

However, if we’re going  down that path and (apparently) can’t turn back, I have some suggestions for additional screening.  I mean, maybe I can become one of those progressive, enlightened and benighted few who direct policy in meaningful ways.

Let’s consider adding the following fields to the computer, and finding a way to bill for ‘screening time’:

Sun exposure screening (Why don’t you talk to Illsa, our department model and tan expert.)

Relationship contentment (Unhappy marriages can lead to depression.)

Pet immunization  (Rabies is a drag, especially if you catch it from fluffy.)

Dangerous implements in the home  (Do you have firearms, archery equipment, fishing hooks, sharp knives, heavy sticks, hot stoves, electrical appliances, power-tools, nails, tacks, cap guns, cans of food or anything else which might accidentally or intentionally cause harm to you or someone in your home and that should be removed?)

Job satisfaction  (Could head off violent workplace rampages.)

Environmental responsibility  (Do you recycle, drive a fuel hybrid, use cloth diapers or remember to turn your computer off when you aren’t using it?)

Political tendency  (Are you leaning the boat right or left?)

Sexual  satisfaction  (Are you buying bootleg Viagra?)

Medical finances  (Have you paid a medical bill in the last year?)

Fashion  (Are you aware that you shouldn’t wear thongs or Lycra?  Ever?  See ‘nutritional screening field’.)

Disability potential  (Do you want a vague, unverifiable disease in order to avoid future gainful employment?  Call Jim-Bob, our disability access consultant to arrange a meeting.  Let the phone ring.   He’s taking lots of Lortab.)

Pain  (Would you like to enter our raffle for a lifetime supply of oxycodone, including recliner, plasma TV and satellite subscription?)

Cultural literacy  (Which of the following items is the thing known as ‘a book’?  What is your favorite reality show?  If your house were on fire, would you take the kids pictures or your collection of professional wrestling videos?)

Just imagine the research database we could generate.  And the lives we could make just a little better.  I’m all for it.  So maybe I shouldn’t fight the screens.  Maybe it’s time to jump in the water myself, however deep and icy it may be.

Could we just become the ‘screening department’, and forget about those icky emergencies altogether?  I think I’ve had an epiphany.  I’ll be a ‘screenologist’.  Thank God for those new computers.  They may have saved me from the practice of medicine.