tag:blogger.com,1999:blog-3138625163039637769.post2948765977881020340..comments2024-03-12T14:43:01.539-06:00Comments on Asystole is the Most Stable Rhythm: That's A Negative, Ghost RiderAlbinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-3138625163039637769.post-90268137840365908552009-08-04T23:06:42.409-06:002009-08-04T23:06:42.409-06:00MDCSR. What I said.MDCSR. What I said.WWWebbhttps://www.blogger.com/profile/03491098272113630084noreply@blogger.comtag:blogger.com,1999:blog-3138625163039637769.post-20517648322372579952009-07-18T21:33:15.043-06:002009-07-18T21:33:15.043-06:00I liked the book, but I think that part of the sol...I liked the book, but I think that part of the solution was requiring them to communicate in English, rather than Korean, since the ability to get the crews to view each other as colleagues just was not going to work in Korean. Too much of their class structure is a part of the language.<br /><br />Good patient care is about everyone working as colleagues. If you observe something and do not pass the information on to the doctor, you are not doing the doctor or the patient any favors. <br /><br />If a doctor chooses to ignore information from nurses, or others, by definition that is ignorance. Pretending otherwise is just a way to maintain as much of a power differential as possible, no matter how harmful to the patient.<br /><br />The same is true of nurses or doctors ignoring medics, and medics or nurses or doctors ignoring basic EMTs. Intelligent people have the ability to listen to alternative points of view without having to play psychological games. <br /><br />Nurses have a responsibility to refuse to follow an order that they believe to be dangerous to the patient. So do paramedics. This has been upheld by courts. Following an order, just because a doctor gave the order, is not a valid defense against malpractice. All medical providers can be sued for malpractice.<br /><br />One example is a patient with an endotracheal tube. HeThe patient was biting down on the tube, apparently due to a lack of sedation. The doctor ordered me to transport the patient without sedation. I refused, since there was no patent airway. Even on a 1 mile trip, an airway is essential. When the doctor realized that I could not be persuaded, short conversation. A polite, but adamant refusal to transport the patient until there was a patent airway. This is not something that is common, but the doctor's priorities were misplaced and that needed to be addressed. If I had transported, I would have been just as much at fault for any negative outcome as the doctor. <br /><br />The hierarchy does exist, just as a hierarchy exists in the military. The military does not encourage encourage officers to ignore information. Some forget this. That does not make it right. The military also educates everyone about their duty to refuse to obey unlawful orders.<br /><br />When someone is shooting at members of the military, their ability to discuss orders is going to be significantly restricted. <br /><br />In the hospital, there are very few situations that actually require immediate obedience. Few doctors are actually being shot at, when they are dramatizing their position higher up in the hierarchy, but that is hardly a good thing. Remember, the doctors are not at the top of the hospital hierarchy, the administrators and others are. No doctor would ever be displeased when treated badly by someone higher up in the hierarchy. This is a part of the actual hierarchy. <br /><br />The ultimate responsibility lies with the doctor, but if the doctor is giving orders that the nurses, medics, EMTs feel are dangerous, then the doctor had better be prepared to perform those orders himself/herself.<br /><br />Doctors, who know how to communicate, do not seem to have this problem. Why is it that the shortcomings of the doctor are the responsibility of those lower on the hierarchy? That is the way caste systems work, not a hierarchy designed to improve the care of patients.<br /><br />Why is expansion of this hierarchy, far beyond what is relevant to patient care, something that is defended? If we are defending hierarchies, maybe we should just keep it simple. Men are at the top and women exist for their cooking, cleaning, intercourse, and child rearing abilities. After all, there is a hierarchy.Rogue Medichttps://www.blogger.com/profile/07598646309630074992noreply@blogger.comtag:blogger.com,1999:blog-3138625163039637769.post-5607750159928257722009-07-18T21:28:47.926-06:002009-07-18T21:28:47.926-06:00<3K--I figured you'd have had some experien...<3K--I figured you'd have had some experience with looking at these similarities in your line of work (you do still work, right? hahahah).<br /><br />Shared responsibility is an interesting concept right? Ultimately the MD's ass is on the line if things go south so we as nurses enjoy an interesting buffer zone that allows us to question (and sometimes criticize) an MD's decisions from our 'safer' vantage point. <br /><br />This became very clear to me the first time I had a cardiac patient in the Arctic and had to decide if I was going to medevac him. I would have rolled my eyes in the south if the doc had been humming and hawing on this case...and once I realised that it was my call, oh let me tell you there was humming and hawing and much gnashing of teeth. :)<br /><br />OMDG--hahaha, I also hope you don't get additional hate comments! :) <br /><br />That is why I added that I wasn't irked by your post and that I enjoy your blog(...obvi, I have it on my blogroll)--I just figured if someone went to the link and read that post (and it was their first exposure to your blog) they might get the wrong idea. <br /><br />Obviously you've given more sober thought to these concepts than most individuals...and your comments on the matter made me think about the white-elephant-in-the-room-hierarchy issue, which is why I wanted to link to it. <br /><br />I think it is important to stir the pot and get people thinking and talking about it...Albinoblackbearhttps://www.blogger.com/profile/15222730484450544498noreply@blogger.comtag:blogger.com,1999:blog-3138625163039637769.post-28205595486797924902009-07-18T17:28:53.872-06:002009-07-18T17:28:53.872-06:00Thanks for the link.... I think. I hope I don'...Thanks for the link.... I think. I hope I don't get additional hate comments from people who want to get pissed off. <br /><br />It would be nice if a rational level-headed discussion could take place about this subject, since there is an actual hierarchy between doctors and nurses, though we're all supposed to pretend that there isn't. I'm sorry you have had negative experiences with some doctors, but I'd be lying if I said that I'm surprised. I hope I treat the nurses who take care of my patients with respect, and don't make them feel like a buzzing mosquito!<br /><br />Glad you like my blog!OMDGhttps://www.blogger.com/profile/17937425894428802591noreply@blogger.comtag:blogger.com,1999:blog-3138625163039637769.post-32798280251881528032009-07-18T11:49:53.187-06:002009-07-18T11:49:53.187-06:00There are some really good articles on exactly thi...There are some really good articles on exactly this topic, e-rock... When I was doing patient safety consulting, we did a bit of research on Crew Resource Management in healthcare, as it is the accepted safety norm used in air-travel. It is exactly about shared responsibility and power equalization to optimize safety. The problem lies is trying to reshape some if those dinosaur mindsets that many dr's and nurses share about power and responsibility. I still hear nurses saying, "I know, it doesn't seem right, but the dr. ordered it..." as the go ahead with questionable directions. I also still see Doc's saying to nurses things like, "I wouldn't have ordered it that way if I didn't want it done that way!" when asked a reasonable question. We have a long wayvto go to make this thing we call healthcare "safe", whatever that is. LOL... Good times...Keethttps://www.blogger.com/profile/14045997674311429691noreply@blogger.com