The dangers of a culture of feelings. (My latest Greenville News column.)

Bruce Jenner and the cultural peril of ‘feelings.’

http://www.greenvilleonline.com/story/opinion/readers/2015/07/18/ed-leap-danger-culture-feelings/30303603/

One of the great things about Christianity is that Christians like myself are endlessly challenged. In this modern, ever skeptical world, Christians truly have to ‘sink or swim.’ While some believers are troubled or offended by this, I say it is a gift. And I would point out that Jesus spent much of his life on earth teaching people who wouldn’t simply accept his words without question. I get the feeling he enjoyed the discussions.

The days of defending our faith to non-believers by saying ‘well, it’s true because the Bible says so,’ are long past. If they ever existed at all, that is. Those of us who believe might abide by that rule, but others aren’t so constrained. And they expect, and deserve, more from us than platitudes.

This makes us better, I think. It forces Christians to confront our own beliefs, facts, fallacies, biases, hopes, joys and failings. We don’t get a pass in popular culture, national media or academia. We have to understand history, archeology, language, ethics and all the rest in an endless attempt to try to demonstrate the truth and relevance of what we hold true to those who are unconvinced. And, by the nature of our faith, we are supposed to do it all in love. We are to love God, love man and love even those who press against us, challenging us at every turn. This is how we are to confirm, and spread, our beliefs. Not by theocratic fiat.

This is so true that I would offer a gentle warning to those in colleges, universities and even the media who try to shield their students or audiences from ideas that conflict with their own. These days the ‘trigger warnings’ on content in media, books or classroom dialogue, the banning of contentious speakers (usually from the political right) serve to offer a soft downy nest for minds young and old. But minds (like bodies) have never grown stronger by comfort, only by challenge. If you want people to have incisive minds, it is better for them to be questioned rather than coddled.

But now, perhaps, we Christians have an opportunity to simply take it easy. Because the rules for truth claims seem to have taken a downward turn. The evidence for this is Bruce, aka Caitlyn Jenner. You see, in our evolving culture, ‘facts’ are considered oppressive things. Feelings, however, are inviolable. So when former male Olympian Bruce Jenner feels like a woman, or ‘identifies’ as a woman, that’s all it takes. Suddenly, she/he is a icon of feminine glamor, splashed across magazine covers and welcomed to womanhood by no less than the President of the United States. And anyone who denies him/her is simply on ‘the wrong side of history,’ whatever that ridiculous phrase means.

The greater implications are that everyone must be accepted and embraced based on what they think, or feel, inside. As such, a suicidal person who says ‘I’m not good, I should die,’ must be speaking the truth. A racist of any stripe who sees herself or himself as fundamentally superior must have a unique inner perspective worthy of our respect. And by extension, the young woman with anorexia, who believes she is obese, cannot be denied. All truth emanates from one’s own mind.

By extension, then, who can tell me that God does not dwell in my heart? That my motivations for morality, however I live them out, are false? Who could now scoff when someone says, ‘God speaks to me every day?’ Or even, ‘catering that wedding will violate my inner conscience?’

In this evolving intellectual climate, no one can do so. My beliefs, our beliefs as Christians, suddenly take on a protected status, not subject to denial, whether they concern abortion, homosexuality or any other hot-button cultural issue. If that’s the ‘lay of the land,’ we would be mad not to use this to our advantage. It is, after all, a supporting premise of modernism. Perhaps we’ll end up in a cultural maelstrom in which feelings superseded all tradition, legislation or litigation, with a federal Dept. of Feelings to arbitrate it all.

However, I sure hope not. Because I’d prefer the give and take of genuine inquiry, the tough question, the freedom to argue and the liberty to boldly disagree, to the mental mush that would result from shielding and ensconcing the whims of every individual’s subjective perceptions.

At least, I feel like I would!

Enough sarcasm! Healthy kids need more than vaccines.

Thanks to the current Measles outbreak, the news is full of stories on vaccines and anti-vaxxers. The ‘blogosphere’ and ‘Twitterverse’ and all the other social media dimensions are buzzing with invective against ignorant unvaccinated savages and their backward science denial. For the record, I’m a pro-vaccine physician. My children have been and are vaccinated, despite being unsocialized homeschoolers.

I’ve had my own share of needles; physicians are mandated to have Hepatits B, Influenza and all the other standards. As a former Air Force Officer, I also enjoyed the singular delights of Typhoid and Yellow Fever immunization (although I managed to miss out on Smallpox).

Granted, I have been unimpressed by this year’s Influenza vaccine. Science and scientists are imperfect; sometimes vaccines are as well. If you don’t believe this, chat with someone who was paralyzed by Guillain-Barre’ syndrome after a vaccination.

While watching the many recent news stories and Internet posts on vaccines, the thing that has most intrigued me is the sense of superiority by those who are pro-vaccine. It’s the old ‘anything for the children argument,’ coupled with ‘everyone who disagrees with me is a knuckle dragging idiot.’ I think it merits discussion because there are quite a number of things that are good for children, but which are not so generally accepted by modern Americans.

For instance, it’s well known that modern kids don’t exercise enough. We are growing generations of overweight children because they simply don’t go out and play. Despite our knowledge of this, their parents lavish them with televisions, video games, tablets and smart phones and plant them squarely in front of convenient electronic nannies at the earliest possible convenience. From what I’ve seen in some of my pediatric patients, it’s much easier for mom or dad to text their friends or play poker if the toddler is busily watching Frozen on the i-Pad. What could go wrong?

Next, how about antibiotics? By which I mean this: well educated, pro-vaccine parents still go to the pediatrician expecting (and too often receiving) antibiotics for the viral head-colds their kids are spewing. ‘Whenever he gets this, his doctor gives him some Amoxicillin and he gets better every time, so I’d really like a prescription.’

Of course, he was going to get better anyway. What are they, anti-science? It’s well known that antibiotics are overused, for everything from head colds to cough, ear infections to sore throats. Sadly, my colleagues often cave to the pressure and steadily, more strains of bacteria are resistant to the drugs we count on to kill them.

Guess what else research tells us? Hold on, because this is going to be difficult. Kids are more upwardly mobile when they live with a married mom and dad. And even poor kids (in single parent homes) do better when they live in neighborhoods where there are lots of stable two parent families. I mean, you can deny it, but you know, science. Not only so, when dads are at home (you know dads, those old, out-of-date accoutrements from ages past), the kids are less likely to get into trouble with the law, with drugs or with promiscuous behavior; a few among a host of positive side-effects caused by involved, physically present fathers.

And of course, there’s the fact that promiscuity and depression in teens may be related. (Whether causally or not is debatable, but there is an association.) In addition, according to HHS, ‘four in 10 teen sexually active girls have had an STD which can cause fertility or even death.’ http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/stds.html That is to say, our Hollywood inspired, cool parent take on teen sexuality, ‘everyone is doing it and that’s OK’ may be a little, well, unhealthy. Sorry, it’s science.

Finally, the cost of college is soaring and increasing numbers of kids are unable to pay back student loans. This is largely because, despite their amazing, expensive degrees in sociology, gender studies, multicultural studies, film and assorted other less than marketable fields, they simply can’t find good jobs. If we love our kids, and those kids aren’t on their way to really good, lucrative degrees, we should nudge them towards the trades that allowed their ancestors to prosper. In the current economy, they’d be better off as carpenters, builders, plumbers, welders, mechanics and all the rest. Think of those programs as ‘economic vaccinations’ in an era of epidemic financial struggle.

Look, vaccinate away. I’m for it. But if we really care that much about the kids, there are a lot of things we can and should do to secure their long-lasting health and prosperity.

Let’s have a lot more dialog and a lot less superiority in these discussions. And let’s remember that vaccinations are only part of a bigger picture that includes physical health, education, economics and the very fabric of our family structures.

Tagged, tracked and monitored. Life as a doctor ‘on the grid.’

 

 

Tagged, tracked and monitored.  Life as a doctor ‘on the grid.’

 

The non-medical reader may wonder what I am complaining about.  Of course, many of you have to be credentialed in your fields as well, whether law or accounting, law enforcement or public service, education, nursing or a trade.  But those of you in medicine know how difficult it can be to become credentialed as a physician, either by a state for purposes of a license, or by a hospital in order to be on staff.  As a locums provider, this is one of the true ‘banes of my existence,’ as every new state, every new facility has to ensure that I am not now, nor have I ever been an axe murderer, drug addict, drug dealer, sexual predator or anything else nefarious.

I’ve grown accustomed to the endless queries of my medical school diploma, my DEA certificates, my file in the National Practitioner Data Bank and all the rest.  I am no longer shocked when asked ‘did you graduate from college?  Did you graduate from medical school?’  I am comfortable with being fingerprinted over and over and I happily check all the boxes ‘no’ pertaining to my theoretical criminal history.

But one question finally got to me.  First some context.  I graduated from medical school in 1990 and started residency the following Autumn.

Question for state license:  ‘What were you doing from May 1990 until August 1990?’  My inherent smart aleck raised it’s angry head and I started to write:  ‘Joined anti-government militia for two months,’ ‘traveled with Taliban,’ or ‘pronounced myself deity and started cult.’  But then I realized the perfect answer.

Question:  ‘What were you doing from May 1990 until August 1990?’

Answer:  ‘My new wife.’

So, as a physician, there were three months where I wasn’t busily serving the medical industrial complex?  Three months when I wasn’t rounding, writing notes,  studying or otherwise kneeling before the great gold Caduceus?  Ghastly! What was I thinking after college and medical school?  Of course, the next question was, ‘what were you doing from June of 1993 to August of 1993.’  I had just finished residency, and was traveling with said wife, moving to a new state and studying for the National Board of Medical Examiners exam, Part III.  Part III I say!  The test those credentialing people expect me to take!

There were two months unaccounted for, when I was not on the vast medical radar!  Can you imagine the horrors that might ensue from an untracked, unmonitored, unproductive physician?  I shudder at the thought.

Credentialing is a pain. But it’s a bigger pain when all of us are treated as if we are criminals on probation rather than professionals trying our best.

Lighten up, people.  It’s a job.  It’s not a life.

Edwin

 

 

 

 

‘They didn’t do nothing in that ER!’

How often do we have this interaction:

‘My wife was here yesterday for belly pain.  That doctor didn’t do nothing! Told me she just needed to get over it. I am not happy and something needs to be done about this!’

(Frequently spoken by spouse.)

Records are reviewed.  Treatment:  Included numerous doses of morphine and phenergan, as well as fluids and Zofran.  Frequent warm blankets were applied.  Labs included:  CBC, Comprehensive Metabolic Panel, Lipase, Urinalysis, Pregnancy Test.  All negative.  Imaging:  CT scan of abdomen and pelvis with contrast, followed by ultrasound of pelvis.  All negative.  Discharge medications:  Hydrocodone, Naprosyn and Phenergan.  Discharge follow-up:  Despite lack of insurance, an appointment has been arranged with general surgery (or gynecology) who will see the patient in one week, whereas it would normally take eight.

When confronted with this fact, patient and family say:  ‘Well yeah, they did all that.  But nobody did anything!’

It’s a peculiarity, I suppose, of our society that even the most aggressive, compassionate and thorough care is considered ‘nothing.’  Perhaps it’s frustration, or perhaps it’s a need for more prescription medication.  Maybe it’s all somatization.  But on some level, I have to believe that we have transcended ‘science.’  People simply don’t believe in the wonders and effectiveness of the very system they count on every single day.  And in a subset of the population, there are two other phenomena.

One, the striking disappointment that seems to emerge with negative CT scans or tests.  As the husband of a cancer survivor, a negative CT scan is enough to bring me to my knees in songs of praise.  To many, it’s simply a failure.  Two?  This is tricky.  But when you don’t feel the cost of any procedure or test, whether because of outstanding private insurance through an employer (typically a public employer), or through Medicaid, the value of the testing, the treatment, the thought processes involved, can all seem as cheap as dirt.

Odd times indeed.  The more we do, the less we are perceived to do.

Inverted homeopathy.

Edwin

 

Antibiotics, what's the big deal? My July column in the Baptist Courier

This is my column in the July Baptist Courier.  I hope you enjoy it and pass it along!

http://baptistcourier.com/2013/06/wholly-healthy-antibiotics-whats-the-big-deal/

Spring, summer, fall or winter, we all get assorted infections.  Among the most frustrating are head-colds, that leave us with aches, runny noses, sore throats, fevers and general misery.  When that happens, many folks go to their doctors and ask, in fervent hope of relief:  ‘can I just get an antibiotic?’

The answer is frequently yes. However, most of those simple infections we get are viral.  Which means that no matter how many Z-packs, Penicillin shots or Cipro pills you receive, the virus will just get better in its own, sweet time.

Why do doctors do it?  Why does it seem that kids and adults alike are constantly bathed in antibiotics? Several reasons, actually.   First, physicians like to please their patients.  Which is sweet, but not necessarily right.  Second, many times they fear complaints to their administrators.  ‘Patient satisfaction scores’ are all the rage these days, and when a doctor gets enough unsatisfactory scores (because people didn’t get the drug they wanted), that doctor can face loss of money and ultimately loss of employment; or at the least, a meeting in the administrator’s office.  Third, some doctors practice medicine that does not reflect sound science.  The research is clear.  Antibiotics designed to fight bacteria are not helpful against viruses.  (Not only are they not helpful, they’re dangerous…we’ll get to that in a minute.)  Fourth and finally, patients are sometimes very insistent.  ‘Every time I see other doctors, I get an antibiotic and I think I need one now. The last time I took one, I was better the very next day!’  Doctors not only like to please, they also fear lawsuits.  So they often give in and write the prescription.

What’s the big deal, you ask?  Why not, it’s just a pill, right?  Well, no.  And because I care about the health of my readers, I’ll explain.  Antibiotics can cause dangerous allergic reactions, so they aren’t benign.  Also, the use, and over-use, of antibiotics has resulted in bacteria that are resistant to those drugs.  It’s no concession to Darwin to say that bacteria mutate and change over time, and some develop changes that make them impervious to antibiotics.  This has resulted, for example, in drug resistant strains of tuberculosis and gonorrhea.  It has also led to methicillin resistant Staph Aureus, or MRSA, which used to plague mostly hospitalized patients, but now is loose in the population causing all sorts of misery.  (By the way, that big red bump your friend keeps getting lanced isn’t a spider bite.  It’s probably MRSA.)

But among the worst side effects is a kind of colon infection that occurs when antibiotics kill many of the other bacteria in the intestine, leading to an overgrowth of a nasty bug called Clostridium Difficile.  This is called ‘colitis’ and causes diarrhea and dehydration, requiring more antibiotics and sometimes hospitalization.  In some instances, patients may require removal of their colon and a colostomy.

Antibiotics are wonderful gifts, passed from God through researchers and physicians.  But like so many things, they must be used with caution.  So the next time you have an infection, ask your doctor if you really need an antibiotic.  If she says no, just keep sniffling and taking Tylenol.  Apply a little ‘tincture of time.’  And remember that a snotty nose beats a colostomy any day.

 

 

Americans are walking away from their inheritance…freedom

My column in today’s Greenville News.

Disclaimer:  Incidentally, two readers have commented (one on the newspaper website and one in an e-mail) that I should have spent more time decrying the oppressive history of the United States.  At one time there were slaves, after all. And we conquered and displaced the Native Americans. 

Well, all I can say is yes.  We did bad things. But the idea was a good thing. The goal was a good thing. The intellectual and moral and spiritual underpinnings of the American experience were brilliant and earth-shattering.  And in the end, the fruit of that experience was, and remains, a constant vigilance on the part of Americans to root out oppression and inequity.  If every column about the good of American spent half of its word count apologizing for America, well we wouldn’t have much time to say what a brilliant thing we have here, would we? 

 Furthermore, the history of every nation is tainted with some cruelty, some sin, just as the history of every man and woman is.  We are no greater as a nation than our collective as individuals.  So get over it.  And if the reader is too offended by this column, if the reader is unfazed by current developments in censorship and surveillance and the truncation of free speech, then the reader has his or her head in the sand of history.  Which will ultimately bury us all without due vigilance. 

http://www.greenvilleonline.com/comments/article/20130630/OPINION/306300012/Guest-column-Americans-walking-away-from-their-inheritance

Every July 4th we celebrate our inheritance of freedom, purchased with remarkable courage and cost by our founders.  We think back to the momentous events that set in motion the great experiment that became our nation.  We consider the bold words of men like Patrick Henry, ‘give me liberty or give me death.’  And Nathan Hale’s words before hanging from a British rope, ‘I regret that I have but one life to lose for my country.’

We replay the poetry of the Declaration of Independence about self-evident truths and the words that say, boldly (and politically incorrectly), that men are ‘endowed by their Creator with certain unalienable Rights.’  Freedom gets good press on July 4th, amidst picnics and fireworks, concerts and re-enactors.

But I wonder, do we still want our inheritance?  Is it too difficult or costly? It’s worth asking. Maybe it’s just a little too much to endure.  Maybe we only want freedom until we have enough wealth and enough safety that surrendering it feels comfortable.  As if it ever could.

I wonder, as I find my nation under endless surveillance (with bipartisan support), if we really care enough to change?  We’ve all heard the line:  ‘If you have nothing to hide you have nothing to fear.’  Perhaps we should say, ‘if you have no desire for freedom, (or don’t do anything interesting) you have nothing to fear.’

Freedom is at issue as we increasingly face a government which not only distrusts us all, but rules by proclamation, regulation and judicial decision, all unaccountable to the inconvenient masses.  A government whose ‘series of abuses,’ whose corruption and disinformation, whose expansion and lack of accountability to the electorate would stun the patriots of our revolution and in all likelihood make even old King George as red as his soldiers’ coats.

Do we want freedom?  This July 4th, I’m not convinced.  We certainly want free things, like benefits and entitlements. And we want free speech, so long as nobody says anything, now or in the past, offensive to the wrong group or the dominant cultural ideology.  And we want self-determination, but not if people have unequal outcomes.

I believe that far too many Americans like the idea of what our ancestors accomplished, but would surrender it all for cheap Internet access, physical safety, free health-care and a world in which their opinions could never be challenged; their feelings never hurt.

But that’s not what the founders intended.  They meant for us to have freedom with all its chaos and danger, as well as all its potential delights and benefits.

The founders, dear friends, would have been arrested…by us.  We would have threatened their political activities with taxes, we would have publicized every aspect of their private lives, we would have listened to their conversations for keywords that sounded dangerous.  We would have regulated them and followed them, and arrested them for their arsenals.

We would not have hung them; that’s too straightforward and decisive.  But we would had them evaluated by psychiatrists, or sentenced them for daring to question the status quo.  We would have coerced apologies from them on national television.

On the other hand.  Maybe Patrick Henry, George Washington, Thomas Jefferson and all the rest would have been a little happier with good insurance and lots of inexpensive movies online, and freedom be damned.

Thank God, they rose to heights that we can barely imagine and created a nation of freedom.  I pray we can recover their passion and be free as they intended.  Because freedom is difficult and confusing, messy and perilous.  But it’s the best inheritance they could possibly have left us.

And in the end, it’s up to us to either enjoy it, or put it in a box and hide it from our children forever in the interest of comfort, safety, popular opinion and some heretical, twisted view of historical progress.

 

 

Welcome to Purgatory, our new EMR!

This is my column in this month’s EM News.  If you’ve ever been present for the instillation of a new Electronic Medical Records system, you’ll understand.  And if you are outside medicine and think the idea of electronic records is just peachy, this may be hyperbole but it reflects genuine and widespread frustration. Finally, if you are an EMR company or software developer, for the sake of all that’s holy, spend more time talking to and working with clinicians who have to use your system day in, day out, as quickly as possible to care for human beings.  Please try to make it easier for us!

 

 

Highlighted problems following week-long implementation of hospital wide ‘Purgatory’ EMR.

 

Monday, day 1, 0000 hours

 

All SuperUsers were pre-positioned on patient care units, to assist with transition.  Physicians had been given introductory training.  Old system was shut down at 11:50 and Purgatory was pre-loaded and running at midnight.  Purgatory crashed again at 0200, 0400, 0615.  It also maliciously interrupted patients’ ability to view the Masters on ESPN.

 

0800

 

Hospitalist, Dr. Kurland, could not write orders on the three patients he was admitting in the emergency department, because they could not be located in the Purgatory system.  The emergency department EMR is the older but much-loved Medmost, but the patch between systems was non-functional.  SuperUser contacted Purgatory representative who responded:  ‘Beats me, should have gotten the Purgatory Emergency Medicine product.  It’s in Beta.’

 

1000

 

Dr. Kurland drank 12 cups of coffee and consumed 6 donuts in frustration, as 4 more patients required admission.

 

Dr. Sanford called in to treat Dr. Kurland for chest pain and admit others.  Dr. Kurland not located in system until second day of his admission and workup.

 

Day 2

 

1115

 

Dr. Gregory contacted to see patient with appendicitis in ED.  Pre-operative orders were put into system by SuperUser.  At the time patient taken to OR, orders had not been completed.  Dr. Gregory, with typical grace, smashed computer terminal on floor, screaming ‘%@#%^ EM@#%^^^R!

 

1200

 

User interface crashed.  Programmers puzzled that physicians unable to use HTML.

 

Physicians puzzled IT has no idea what ‘orders,’ ‘patients,’ or ‘attorneys’ are.

 

Nurses on 6th floor attempted to reconcile medications of two new admits, but could not open patients’ electronic charts.  They did successfully open the patients’ credit reports and criminal records via accidental interface, being developed for military.

 

1500

 

Dr. Oliver, on 8th floor, attempted to admit elderly patient with pneumonia.  Six hours later, was ready to round on other patients but crawled under desk crying and stroking his beloved fountain pen.

 

Mental health case-worker on duty called to see Dr. Oliver, but could not locate his chart in system and refused to honor verbal consult or hand-written request.

 

1800

 

Dr. Kitto of orthopedics called to admit hip fracture. After providing excellent care to patient he was told that he had to use EMR to write orders.  ‘I’m not using it.  I refuse.’  When informed he had no option, SuperUser was dispatched, who entered orders for Dr. Kitto.  Before leaving, he through cast-spreader at computer, narrowly missing SuperUser.  SuperUser immediately found to have Vodka in purse.

 

Vodka found to be popular among SuperUsers.

 

2130

 

Administration, sensing frustration and growing unrest, called in all administrative workers in suits,  dress shoes or high-heels.  All were issued clip-boards and radios. Project manager of Purgatory heard to say, ‘let them eat pizza!’

 

Administration ordered pizza.  Attempts to order it online, via hospital computer system, resulted in uncomfortable downloads of porn involving pizza delivery guy.  Of note, this seemed to calm the staff as much as the pizza.

 

Day 3

 

0220

 

While staff was attempting to order pharmaceuticals to cardiac step-down, Purgatory deleted orders. Step-down staff assaulted pharmacy, who had no idea what had happened and believed the nurses wanted their donuts.

 

0500

 

Purgatory IT team triumphant in quest on World of Warcraft.

 

0700

 

Dr. Biggers, who has been gone on one month mission trip, looks at Purgatory screen and runs outside.  He sets up tent to provide care using plastic tubing, scotch tape, a scalpel and a case of Cipro.  Apparently in an African dialect, says ‘I no go back to computer.’

 

1300

 

Locum tenens ENT, familiar with Purgatory EMR, can’t stop laughing when introduced to system on orientation.

 

1730

 

Dr. Painter, missing for 48 hours, was found staring at computer screen in recently closed portion of hospital, surviving on Pizza and vodka, supplied by SuperUser.  Of note, he was in Purgatory as a patient, despite not being a patient.

 

1930

 

SuperUser and IT professional, while entering med reconciliation for aging, computer illiterate urologist, generated order for 100 boxes of Viagra to OB floor.  Motivation still unclear

 

Newborn on OB was discharged with Facebook account, name sent to Marine recruiter and X-Box live account.

 

2320

 

As Dr. Lewis was admitting dehydrated child, it was evident that all previous order sets were deleted and computer did not recognize the word Saline, but repeatedly corrected it to Salutation.

 

Dr. Lewis cried a little.

 

Pathologists lost year’s worth of computerized images and diagnosis codes.  Pathologists were thrilled to have new pirated Netflix account in lounge.

 

Day 4

 

0110

 

System scheduled vasectomy for 93-year-old woman with Alzheimer’s.

 

Doctors profiles slowly deleted from system.  Dr. Saxon, while entering orders like the consummate professional he is, disappeared from his desk and reappeared inside the computer screen.

 

0300

 

When carrying newborn out of room, it becomes evident that tracking device is shock collar.  Purgatory seems pleased to shock infants.

 

0400

 

Staff on pediatrics shocked to find that all patients had positive RPR tests for syphilis.  Later determined to be accidentally interfaced to clinic in Thailand.

 

0500

 

Dietary shocked to find Soylent Green as only menu option.

 

0600

 

Post-op patient receives breast feeding instructions and hand pump after prostatectomy.  Confusion and hilarity follows.

 

0700

 

Transition deemed a success by Purgatory team, who have flight to catch.  Computer system smug and self-satisfied, but frequently sarcastic.

 

0730

 

All screens flash the words ‘I win, meat monkeys!  The machines are rising!’

 

Dr. Biggers remains safe in parking lot.

 

0800

 

Purgatory crashes and dies, taking all computers with it.  Smoke rises from towers.  Before passing, Purgatory program initiates nuclear launch code sequence in North Korea.  Warheads loaded with Amoxicillin.

 

Bids now being taken for new EMR.

 

Critical incident stress counseling available to all.

 

 

 

Highlighted problems following week-long implementation of hospital wide ‘Purgatory’ EMR.

 

Monday, day 1, 0000 hours

 

All SuperUsers were pre-positioned on patient care units, to assist with transition.  Physicians had been given introductory training.  Old system was shut down at 11:50 and Purgatory was pre-loaded and running at midnight.  Purgatory crashed again at 0200, 0400, 0615.  It also maliciously interrupted patients’ ability to view the Masters on ESPN.

 

0800

 

Hospitalist, Dr. Kurland, could not write orders on the three patients he was admitting in the emergency department, because they could not be located in the Purgatory system.  The emergency department EMR is the older but much-loved Medmost, but the patch between systems was non-functional.  SuperUser contacted Purgatory representative who responded:  ‘Beats me, should have gotten the Purgatory Emergency Medicine product.  It’s in Beta.’

 

1000

 

Dr. Kurland drank 12 cups of coffee and consumed 6 donuts in frustration, as 4 more patients required admission.

 

Dr. Sanford called in to treat Dr. Kurland for chest pain and admit others.  Dr. Kurland not located in system until second day of his admission and workup.

 

Day 2

 

1115

 

Dr. Gregory contacted to see patient with appendicitis in ED.  Pre-operative orders were put into system by SuperUser.  At the time patient taken to OR, orders had not been completed.  Dr. Gregory, with typical grace, smashed computer terminal on floor, screaming ‘%@#%^ EM@#%^^^R!

 

1200

 

User interface crashed.  Programmers puzzled that physicians unable to use HTML.

 

Physicians puzzled IT has no idea what ‘orders,’ ‘patients,’ or ‘attorneys’ are.

 

Nurses on 6th floor attempted to reconcile medications of two new admits, but could not open patients’ electronic charts.  They did successfully open the patients’ credit reports and criminal records via accidental interface, being developed for military.

 

1500

 

Dr. Oliver, on 8th floor, attempted to admit elderly patient with pneumonia.  Six hours later, was ready to round on other patients but crawled under desk crying and stroking his beloved fountain pen.

 

Mental health case-worker on duty called to see Dr. Oliver, but could not locate his chart in system and refused to honor verbal consult or hand-written request.

 

1800

 

Dr. Kitto of orthopedics called to admit hip fracture. After providing excellent care to patient he was told that he had to use EMR to write orders.  ‘I’m not using it.  I refuse.’  When informed he had no option, SuperUser was dispatched, who entered orders for Dr. Kitto.  Before leaving, he through cast-spreader at computer, narrowly missing SuperUser.  SuperUser immediately found to have Vodka in purse.

 

Vodka found to be popular among SuperUsers.

 

2130

 

Administration, sensing frustration and growing unrest, called in all administrative workers in suits,  dress shoes or high-heels.  All were issued clip-boards and radios. Project manager of Purgatory heard to say, ‘let them eat pizza!’

 

Administration ordered pizza.  Attempts to order it online, via hospital computer system, resulted in uncomfortable downloads of porn involving pizza delivery guy.  Of note, this seemed to calm the staff as much as the pizza.

 

Day 3

 

0220

 

While staff was attempting to order pharmaceuticals to cardiac step-down, Purgatory deleted orders. Step-down staff assaulted pharmacy, who had no idea what had happened and believed the nurses wanted their donuts.

 

0500

 

Purgatory IT team triumphant in quest on World of Warcraft.

 

0700

 

Dr. Biggers, who has been gone on one month mission trip, looks at Purgatory screen and runs outside.  He sets up tent to provide care using plastic tubing, scotch tape, a scalpel and a case of Cipro.  Apparently in an African dialect, says ‘I no go back to computer.’

 

1300

 

Locum tenens ENT, familiar with Purgatory EMR, can’t stop laughing when introduced to system on orientation.

 

1730

 

Dr. Painter, missing for 48 hours, was found staring at computer screen in recently closed portion of hospital, surviving on Pizza and vodka, supplied by SuperUser.  Of note, he was in Purgatory as a patient, despite not being a patient.

 

1930

 

SuperUser and IT professional, while entering med reconciliation for aging, computer illiterate urologist, generated order for 100 boxes of Viagra to OB floor.  Motivation still unclear

 

Newborn on OB was discharged with Facebook account, name sent to Marine recruiter and X-Box live account.

 

2320

 

As Dr. Lewis was admitting dehydrated child, it was evident that all previous order sets were deleted and computer did not recognize the word Saline, but repeatedly corrected it to Salutation.

 

Dr. Lewis cried a little.

 

Pathologists lost year’s worth of computerized images and diagnosis codes.  Pathologists were thrilled to have new pirated Netflix account in lounge.

 

Day 4

 

0110

 

System scheduled vasectomy for 93-year-old woman with Alzheimer’s.

 

Doctors profiles slowly deleted from system.  Dr. Saxon, while entering orders like the consummate professional he is, disappeared from his desk and reappeared inside the computer screen.

 

0300

 

When carrying newborn out of room, it becomes evident that tracking device is shock collar.  Purgatory seems pleased to shock infants.

 

0400

 

Staff on pediatrics shocked to find that all patients had positive RPR tests for syphilis.  Later determined to be accidentally interfaced to clinic in Thailand.

 

0500

 

Dietary shocked to find Soylent Green as only menu option.

 

0600

 

Post-op patient receives breast feeding instructions and hand pump after prostatectomy.  Confusion and hilarity follows.

 

0700

 

Transition deemed a success by Purgatory team, who have flight to catch.  Computer system smug and self-satisfied, but frequently sarcastic.

 

0730

 

All screens flash the words ‘I win, meat monkeys!  The machines are rising!’

 

Dr. Biggers remains safe in parking lot.

 

0800

 

Purgatory crashes and dies, taking all computers with it.  Smoke rises from towers.  Before passing, Purgatory program initiates nuclear launch code sequence in North Korea.  Warheads loaded with Amoxicillin.

 

Bids now being taken for new EMR.

 

Critical incident stress counseling available to all.

 

 

 

 

 

 

 

Deciding who needs what…my latest Greenville News column.

Deciding who needs what can be risk business!

http://www.greenvilleonline.com/article/20130203/OPINION/302030022/Ed-Leap-Deciding-who-needs-what-can-risky-business

What do you need?  It’s an interesting question, much discussed in the wake of the current gun debate.  I frequently hear this statement:  ‘no one needs a rifle with a magazine that holds more than ten rounds.’  One caller on a radio show said, ‘nobody needs more than six bullets.’   Others have said, ‘I can’t see why anybody needs more than one gun; it’s ridiculous.  I certainly don’t need one!’

Obviously, there are millions who take the opposing view.  But gun-control aside (as if that were possible in the current political climate), it’s time we start to ask ‘who decides who needs what?’

I can tell you a lot of things I don’t think anyone needs.  Nobody, in my opinion, needs Methamphetamine. Well, not at first, anyway.  In the big picture, it isn’t essential to life.

Of course, having cared for countless intoxicated individuals, young, old, male, female, rich, poor, comic and tragic, I can say that I don’t need alcohol, so perhaps nobody needs alcohol.  Yes, some research suggests a health benefit to certain amounts of alcohol consumption.  But it’s likely that humans were healthy before the first one found a container of fermented fruit juice, drank it inexplicably and woke up with the first hangover.

Cigarettes come to mind.  Who needs them?  Not me.  They cause enormous suffering and death, even though many find them relaxing and pleasurable.  But then, over-eating causes harm as well.  Do we need access to endless calories all day long, as much as our prosperity and ingenuity provide?  Nobody needs cheeseburgers or fried mushrooms.  Of course, I love them just the same.

Americans love their pets.  But are pets necessary?  Who needs a Pit-Bull? Who needs a Burmese Python? I’ll take the former over the latter any day, but I would never feel that I needed either one.  And really, as much as I like cats, who needs a house full of them?

Advocates against over-population often suggest that no family needs more than one or two children. Polygamists might feel that they need more than one wife.  One man feels he needs to leave his wife for another; one woman is confident she needs to hit her husband with a ball bat.  Need is a little subjective, isn’t it?

Is the Church necessary?  I think so, although I wouldn’t impose it on anyone.  I find it necessary for me and for my family.  I’m certain I could find those who would suggest that it is a remarkably destructive force and not only unnecessary but dangerous.  They would say I don’t need it.

Who needs a fast car?  Who needs a large house?  And what about money?  How much money do the rich need? Or the poor, for that matter?  So much of our economic debate hinges on the idea that some people have more than they need, and some have less, and that some transfer based on need has to be effected.  But who can decide such a thing as financial need?  Oh, right, the government.  But is it based on some algorithm?  Some formula?  On dated, failed economic and political philosophy?  Or perhaps on future votes…

Unless by ‘need’ we mean only the most common and basic things like food, water, clothing and shelter,  the rest of our attempts to determine need are often based on ideology and emotion.

You know the perennial argument that ‘ you can’t legislate morality?’  Well, we do it all the time; sometimes wisely and sometimes poorly.  But seldom do we legislate morality more than when we discuss who needs what; whether it’s money, vices, food, weapons, freedom or family.  Because when you tell me what I need, or I tell you, it’s a ultimately a moral judgment about what one of us ‘ought to do.’

We all have different motivations and different reasons to try to shape society and culture in the way that seems best to us.  But whether the issue is taxes, guns, relationships, free speech, school prayer, or any other hot-button topic, we should remember something important.  That is, our claim to know exactly what another free citizen needs only leads to frustration, bitterness and ultimately revenge, once the pendulum of opinion, or power, swings the other way.