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.