Doctors don't need admins to show them how to do their job....

First of all, I need to say that I have no business or knowledge to comment on the stuff below, but this is my blog, so I'll do it anyway. I am just a software developer and a health care administrator wannabe... I will likely find other ways to fill my life before I'll ever get there anyway.

I mentioned a few weeks or months back that I like Dr. Wes's blog. I love his posts and I also learn new things about hearts (real ones). As with other people that I like, I find it very disturbing to read that there are things that we do not agree on. I need to work on this, but this post is a commentary on one of his posts that I don't agree with.

http://drwes.blogspot.com/2007/06/clipboards-or-care.html

I don't know enough about the exact details of the deal to be able to disagree with the entire post, but here's what I didn't like

Once again, it appears that hospital administrators would rather turn to
non-medical auto-industry "efficiency" and "safety" experts, rather than asking
health care professionals to recommend the best way to improve care.
...
Do we really need yet another company or administrator to tell us how to do
our job? Is it all about safety and efficacy? Or might providing a better
nurse-to-patient ratio be far better at improving care?

I am sure we are all frustrated with the health care status: patients, doctors, nurses, etc. But I think that a big part of the problem is the administration. If administration is telling doctors and nurses what to do, it is wrong, administration should empower them to do their jobs and take care of all the non-medical stuff so that they can do their jobs.

In software development, we say that the modern project manager is no longer a supervisor, but a partner that helps developers to do their jobs without needing to care about budget, time constraints, getting approvals, having the right hardware or software to do their jobs, etc. They just tell us what to do in what order and when and ask us what we need to get this accomplished in terms of time, and resources. Then they make that happen: they supply the resources and let us do our job.

That's what hospital administration should do, no more, no less. From my perspective as a patient, it's not the doctors or nurses that I am complaining about, it is the administration. I think that medical office staff is shortsighted, I think they don't get it, I think they perpetuate the idea of doctors as "Minor deities" (BTW, wonderful post, Paul! Yes, I too love my doctor but hate the system). They act as if they don't care about our time or our pains. Customer service is so poor. I doubt that I am the only one that is more annoyed about trying to get an appointment or try to get a doctor to call back then it is to actually talk to the doctor. In Romanian we have an expression: "on the way to God you get eaten by the angels"... I can't think of a better metaphor for what's going on.

So why not let the administration learn more from other industries? They do need to learn. They can't do it from their peers, most of them seem stuck in the same hole.

Just this week I went to the hospital to have a procedure. I love to look around and see what's good and what's bad. So while looking around I see a chart: customers satisfaction surveys for nurses: 100% ... my, my, these guys are already perfect, there's nothing better to be done.
(I think that the book "If Disney Ran your Hospital" - by Fred Lee is wonderful and right on target on this). And, of course, the poster with: if you can't give us a 5 just call the nurse manager and she'll fix it for you - guiltying us into giving them only 5s. Oh, well!

The hospital is wonderful and the nurses and doctors were great. It was a good experience, not a memorable one, but good enough. I don't have complaints about doctors or nurses.

But they call the patients one hour and a half before the procedure is scheduled... Why? Why not 30 minutes, maybe even 15 minutes? After all, all there is to do is to sign a bunch of papers, and get undressed. They take a medical history and they put in an IV, but all this stuff is done in L&D in less than 15 minutes.

I didn't get the impression that there were too few nurses... maybe they are overworked, I don't know. They do plan the same number of patients, so what difference does it make to them that we stay there an additional hour? All I can think of is that if someone cancels or comes late they want to be sure that the doctors and nurses stay occupied. But is it worth? Shouldn't administration ask and find a solution to this particular scenario without inconveniencing the patients? Maybe this is what "lean" should mean?

Next Disney ride: colonoscopy

Here's synchronicity in action: I have been in high anxiety for months: March, April, May. And I worried myself sick. Yes, you can get yourself sick by worrying.

So here I was feeling anxious and sick, away from home and having no clue what's wrong with me. One day, while reading a Grand Rounds post, I read about The Midwife with a Knife (a perinatologist ;) ) having a colonoscopy. The diagnostic was ulcerative colitis. I look it up and I figured: that's me, that's what I have. The post was very reassuring about both the procedure and curing the disease and it calmed down my fears.

The conclusion is: if you need a colonoscopy, go get it. It's not such a big deal. Yes, the prep is disgusting, but as far as the procedure goes, these days in the US they put you to sleep and you won't remember or feel anything. Fasting for 36 hours is pretty bad, but after the first missed lunch you get used to it. If I had to do it again, I would skip work during the prep, so plan for two free days for this: get a good book. My doctors also timed the medicine so that the worst of the cleaning happened before bed, so I could have a good night sleep. It's useful to make sure this happens. And make sure you have some disper rash cream handy... hey, isn't it grand to have a baby at home?

I indeed have colitis... why did I need a colonoscopy? I could have told them that because "I read about it in a blog" LOL ;) See how I'm using the taxpayers dollars and increasing the insurance rates unnecessarily!

Anxiety was under control and I feel like after another day at Disneyland.

A post on comments about the hospital to follow soon, this was just a if you're sick get thee to the doctor and don't complain about the colonoscopy.

Synchronicity

My therapist recommended a book about synchronicity about a month ago: The Tao of Psychology by Jean Shinoda Bolen.

I read a few chapters and I was bored. It wasn't such great writing. Then, one day, I got it. I read a chapter in that one day in which it was important to read it, in which lots of important stuff apparently unrelated came together.

Synchronicity is about events that happen and that we find connections between. The author suggests that noticing them as well as being more open to intuitive and/or emotional or artistic thinking uses a different part of the brain than the rational thinking.

I am an engineer, in a family of engineers, married to an engineer... so rational thinking was always big in my life. I started noticing synchronic events as a game, but it soon became a very important part of my growth and much of it has helped me crack the nut.

What happens to me, things people say, things I read in blogs that seem to have no connection whatsoever become very powerful nudges , eye openers or food for thought.

I wanted to talk about this in a separate thread because I will mention it a lot. It's been part of my thinking lately. If you're looking for something interesting to read give this book a try.

I hate anxiety

I hate to be anxious. When I am anxious I can't achieve anything. All I am able to do or think is to beat myself up and criticise others. A lot of procrastination too. I need to force myself to do anything: exercise, cook, eat.

These days I achieved a lot. I started a few projects around the house, made progress at work.

The only thought that worries me now is that this feeling good won't last. I think though that this was a bigger than normal threshold and I will feel better than before.

I cracked the nut!

It's been hovering around for the couple of weeks, but I only figured the whole thing sometimes this week. I cracked the nut. I understand the cycle of my anxiety. I know how to stop it. And it worked just fine for the last couple of days. Is this all? Will I be happy forever? I am sure not, but I got a new threshold and it is higher.

So what is it? It's me! It's all about me being unhappy with myself. It's all about me wanting to do or be something else than I am. That's the cycle:

• I want to be able to do something or be someone else
• I get frustrated when I don't get it
• I try harder and I say I can do it
• When I fail, I get angry
• I project my anger on someone else or I find a scapegoat
• I get very critical about someone else
• I either say what I feel - and I am smart, have good intuition and good memory - when I am critical, I am in general right on target and it hurts... badly
• I don't say what I feel and I accumulate so much anger that it explodes at inappropriate times and in inappropriate places
• I feel very bad about it
• I start beating myself up and I find lots of situations when I was inadequate
• I am unhappy for days and I hurt someone I care about.

That's it! Whenever I got angry or frustrated these past few days, I asked myself: what is it that I am unhappy with myself about? Do I really need to do this thing? And anger and frustration went away.

I wanted to communicate better with my mother. Because I didn't get there fast enough, I was annoyed and angry at her and me. I am OK now, but I had to let our relationship go where it will go without forcing it.

I got upset with my husband this morning because he was watching TV while we exercised. I realized that I was unhappy with me because I think I should encourage him to exercise more intense and I think the TV stops him from doing that.

I got upset when he asked whether we had spaghetti sauce... because I thought it was my duty to have the spaghetti sauce handy.

Is it really that simple? And why did it take so long to discover this? I have made so much discovery lately. There's so much to write, there's so much I understood! I hope I will be able to write it down these days and maybe help the next person visiting this blog.

I hope it lasts because the victory is so sweet and the long trip is all worth.

People go to Disneyland for this kind of excitement

You like Disneyland, don't you? All the fun unexpected cool stuff that you see and feel, the fear and excitement of roller coasters, waiting in line discussing about the next experience, the different atmosphere and environment then in real life.

I don't need to go to Disneyland for this. Roller coasters make me dizzy and I'm not easily getting into the it's fun time mood. All I need to do is go to a medical facility. I am strange, very strange, extremely strange.

I find it fun to notice what's good and what's not, I like to see good changes, I get all upset if something is not good. I find interacting with medical personnel as exciting as a roller coaster: the anxiety over meeting someone new, the possibility of an interesting conversation, the possibility of discovering or learning something new about me, the pleasure of learning new words that I can Google at home. I can then make new connections about my body and feed the hypochondriac in me. Then the failure of connecting, the things they don't get, the fear that i didn't express it the right way. There's always the challenge of saying everything concise enough to not waste their time and the satisfaction that it was the right way to do it.

After my pregnancy loss I got to visit quite a bunch of medical offices and had all sorts of procedures done. I had good experiences and bad ones, excellent interactions and not so good ones. I got to feel listened and understood and I got to feel frustrated.

I am having fun profiling them: I like places where they display anatomy charts and calls for research studies rather then places where they display notices over notices about what they won't do: they don't make medical records copies for free, they don't accept x insurance, they don't fill in x form more than once a year, they don't accept checks, or credit, or cash, etc.

I saw places where they get you right away, where the doctor apologizes if they run late, where the doctor says he/she won't apologize for being late because he/she is taking his time with patients, where they know your medical history details, and where they don't even know basic facts about you or don't bother to look at the previous page in your chart to see when you were there last time or when you got blood work done. I saw places where they tell you what they are thinking, planning to do, and places where they wouldn't tell you almost anything but would then ask a million times if you are OK.

I think that they are all only humans trying to do their best in a pretty bad system. They could of course do better, but they are trying and progress is made despite all hardship.

I get to anticipate what's going on: I like to know the diagnostic beforehand, know what's next, know what the speech of the day will be about. The downside to this is the blood pressure monitor and the stethoscope: they get to measure my excitement without understanding the reason. My heart rate and my blood pressure run too high over there. Oh, all the fun I would have if they didn't have a blood pressure monitor!!!

For whatever it's worth, for me you are like Disneyland! So when's my next appointment?

Don't miss Paul Levy's post

Please read Paul Levy's post from today. It is a very interesting comment about how girls/women act. I found myself in some of these comnments. Very interesting.

http://runningahospital.blogspot.com/2007/06/advice-to-referees-and-managers.html

As always, thank you Paul.