Nurse K of Crass-Pollination brought to light one of Happy Hospitalist's blog posts relating an interesting experience he had with a "near code" experience. The following is a partial excerpt from his story:
Let me give you a story. I was doing my normal daily rounds on a patient when I walked in and just stopped. I stopped and I listened. I looked for signs of life in my 67 year old man who was admitted with abdominal pain. I stood there. Watching. Calmly observing.___________________
It struck me as odd. For a full thirty seconds I saw my patient breath exactly one time. I turned on the lights and noted a remarkable physical finding (another reason to always turn on the lights). Cyanosis. A physical finding in which the skin turns purple due to an increase in deoxyhemoglobin in the capillaries (I will never forget the cause of cyanosis due to my exposure to one of the greatest pimping attendings of all times).
So I calmly walked out of the room, walked to the nurses station and stated calmly:
"One of my patients is about to code. What would you like me to do?"
This is probably the quickest way to get a nurse to jump out of their chair and come bedside to your assistance. I think in retrospect I lost the golden opportunity of a lifetime to pull the code chord and watch every nurse on that floor flock to my room with me standing there saying
"What would you ladies and gentleman like to do about my dying patient?"
The deluge of comments on both blogs was crazy impressive and made for some really good reading. Nurse K even received this interesting and revealing comment from Happy himself:
At this point Dr. Happy is so blinded by arrogance that he actually sees nothing askew about calling "911" for a code in an acute care hospital. Okay, so if this isn't having an "arrogance effect" on you, let's try another "code-related" blog topic...
Jay, of Two Women Blogging, wrote an excellent article called Breaking the Code. In this post, Jay discusses a resolution that the AMA considered passing. The wording of this resolution was so shocking to me that I actually thought that this could be a hoax. It wasn't. Here is the resolution in its entirety:
Introduced by: Michigan Delegation
Subject: Identifying Abusive, Hostile or Non-Compliant Patients
Referred to: Reference Committee G
(J. Leonard Lichtenfeld, MD, Chair)
Whereas, Many patients are becoming more abusive and hostile toward physicians for many
reasons not limited to the economy, increasing co-pays and deductibles, unreasonable
expectations and demands, a lack of instantaneous cure, arrogance and/or the belief that they
“own” their physicians; and
Whereas, There are decreasing numbers of physicians both in primary care and specialties
especially in terms of access; and
Whereas, Increasing noncompliance with treatment can reflect negatively on physicians during
black box audits by insurance companies and oversight governmental agencies; and
Whereas, Abusive, hostile, and noncompliant patients result in increasing office resources
adding to office overhead and added stress on all of the office personnel, which can lead to
potential ill health; and
Whereas, The stress of dealing with ungrateful patients is adding to the stress of physicians
leading to decreased physician satisfaction; and
Whereas, Any complaint to any oversight investigative regulatory body leads to uncompensated
expenditure of time, resources, and monies to defend physicians or the “guilty until proven
innocent” principal; and
Whereas, Physicians need to own the data to simplify patient collection and identification to
defend themselves as well as alert outside investigating agencies to the potential nature of the
patient’s records; therefore be it
RESOLVED: That our American Medical Association ask its CPT Editorial Panel to investigate
for data collection and report back at Annual 2010 meeting: 1) developing a modifier for the
E&M codes to identify non-compliant patients and/or 2) develop an add-on code to E&M codes
to identify non-compliant patients. (Directive to Take Action)
Fiscal Note: Staff cost estimated at less than $500 to implement.
Ho-lee crap! The good news is that this resolution didn't pass. The bad news is that apparently no one in the Michigan delegation saw anything inappropriate about the wording of this thing. What is wrong with you people? Where did this kind of arrogance get its start? Is there a cure?
I'm no psych nurse, but when arrogance has grown to such a proportion that it distorts reality to this extent, I'd think it would qualify as some kind of personality disorder. Is there some kind of DSM-IV Code for this? If not, I think we need a code.