[HSF] Standard of care for lawyers {OT}

[Tea Acuff]

John wrote:  
"By moving to  the university about 7 years ago, I traded a lot of advantages for 
the rather  dubious distinction of being a professor. John Felge"

Well at least you are a "bonafied" expert now, John. I think you made my point that for the attending to consult directly with the nurse and visa versa is a very efficient system, and with time a fairly trustworthy and transparent one. It is seemingly now a novel one and substandard one at that. To Michael's cry for help in a "broken" system (like Prasanna we all have choices to make, Michael) i can not tell that the layers and layers of protocol, and layers of caregivers, P4P, JACHO interventions or adoption of the latest best new intensive treatments have added much to better care. That they are primarily the work of third parties defending turf or "consultants" trying to justify their repetitive surprise inspections. This is a characteristic of medicine and doctors to NOT think through the problems that they create and instead come up with a universal "fix" (usually new inflexible rule or new expensive care intermediate) to solve the problem for them.

As for PA's, Ani, I have worked with the same one for well over a decade. She is another pair of eyes and a very consistent OR assistant. She halves my out of OR work day and likely shortens my OR day. However, she is not my night  and weekend on call surrogate, nor is she a source of net income to my practice. I did not critisize your system except to say that I have fair skepticism for your blanket dismissal of one that may be the most common in the US certainly out of academia. How can the most common solution be substandard? I can understand if you merely think it inferior. Don't kid yourself or me, Ani. Everyone here and certainly any lawyer will qualify you as expert. Point out possible disadvantages all you like (I like hearing them), but be both clear and careful if you wish to establish standards for others.

tea


----- Original Message ----
From: "Jbflegejr at aol.com" <Jbflegejr at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Saturday, April 12, 2008 2:00:58 PM
Subject: Re: [HSF] Standard of care for lawyers {OT}

Hal, I am now in an academic setting. I relied virtually exclusively on  
nurses in a previous life and that for 25 years. They did not open the chest for  
tamponading patients and that didn't happen often anyway. I lived four miles  
from the hospital and if I was at home, I could get here in less than 10 
minutes  during the night when no ordinary folks were on the streets. I doubt if  
intensivists would be much use there. The nurses did put in central  lines and 
arterial lines with none of the complications that I see daily in my  present 
setting and could have put in Swans but for some bureaucratic obstacles.  The 
cardiologists charge for S-G, called right heart cath, and could not allow  it 
to become a non-billable nursing procedure. I almost never saw pneumothorax  
during the first two postop days after I started routinely opening the  
mediastinal pleura a little bit so the mediastinal tubes would handle any lung  
leaks that might happen. We had a policy of not leaving any central lines in  
place for more than 48 hours and the nurses changed them. We did not have  
anesthesiologists or CRNA in the hospital at night those early years. Routinely  I 
kept the patients asleep and on ventilator until the next morning after  
operation which eliminated the need for early reintubation which I would have  had to 
do. With the patient ventilated and pacing wires in place the nurses  could 
manage with telephone guidance anything but bleeding. Sometimes when there  was 
a need for take back for bleeding I did it without an anesthetist and just  
gave a big dose of morphine and some curare. Often the anesthetist did not get  
there from home until the case was finished. We did not have in house 
anesthesia  coverage until it was mandated to maintain the obstetrical service. By 
moving to  the university about 7 years ago, I traded a lot of advantages for 
the rather  dubious distinction of being a professor. John Felge



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