Walking around the ER in Tiny Community Hospital, I had a few realizations.  In medicine, we hold onto some things very tightly.  We love tradition, we love the known.  We don’t always know why, but we choose ‘the devil we know,’ almost every time, no matter how pointy his horns.

For instance:  ‘No cell phones.’  First of all, has anyone ever seen a cell-phone interrupt anything we do?  No?  Neither have I.  Admittedly, cell phone use can be rude.  If I’m talking to a patient, I don’t want them ignoring me by taking calls or texting to the exclusion of our interaction.  And if I were a patient, I wouldn’t want my physician or nurse to do the same. But honest to goodness, cell phones are ubiquitous.  We communicate with them, schedule with them, navigate with them, learn with them and we entertain ourselves with them!  Even the sign that says ‘no cell phones’ is laughable.  Courtesy?  Please.  But let’s stop deluding ourselves that we can, or should, keep anyone from using their phones while they wait, sometimes hours, to be seen and treated.

How about HIPAA?  Great idea, privacy and all that.  But it has been done to death.  And the unintended consequence is that we have far too many log-on screens and passwords.  Furthermore, our computers time-out so fast we can’t keep up!  And yet, the real threat to privacy isn’t some poor knucklehead looking over our shoulders.  It’s corporations and government, insurers and ‘important’ people who see, and who may share, our most private information.  And none of them are defeated, or indeed affected, by passwords or anything else.

Another bit of silliness:  the idea that a family member or friend isn’t allowed to translate for someone who speaks another language.  Yes, it’s nice to use a service. But the contingencies of time and cost sometimes leave us with little choice other than 1) speak really loud and hope it gets converted into their language or 2) let someone with them do the talking.  In this instance, better is truly the enemy of good.

One close to my heart is the maddening way we treat test and xray results.  Having gone through cancer with my wife, I know the horrors of what we called ‘scanxiety.’  Waiting to know the answer can be heart wrenching. Fortunately, I was connected as a physician, and I was frankly a pain in the neck.  I got the answer as quickly as possible.  But for others, the waiting can be horrible.  Recently my dad had a CT of his lumbar spine due to severe pain.  It took days and days to get results.  Ridiculous.  In 2015, there is no reason for tests results to take two weeks; rarely even two days.  Unless the test is some exotic lab evaluation that has to be sent to East Egypt, we know the results the same day.  Making our patients wait is simply disrespectful, or slothful, or both.  Information travels at the speed of light people; let’s treat it that way.  The days of carrier pigeons and the Pony Express are long gone.

Finally (for today), there’s mental health.  We have woefully inadequate numbers of beds and psychiatrists and counselors for the mentally ill.  And yet, emergency departments have to hold vast numbers waiting on beds that will never materialize, and hiring sitters to do crossword puzzles while the mentally ill (or the pseudo-mentally ill manipulative) sit in bed and take up space in overwhelmed ER’s. We need a better system, sure. But we also need tort reform so that it isn’t so scary to discharge people.  And so we can stop doing a worthless dance that doesn’t make anyone better but merely imprisons them in uncomfortable beds in uncomfortable departments without anyone to actually talk with them.

Anyone else have a few?  What antiquated ideas, what anachronisms do we cling to in medicine?  And why should we jettison them?



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