Oversight Versus Overkill in Meaningful Health Care

In the journey known as “progress in medicine” there have been many twists and turns in the road in an attempt to speed improvement. Some have been entirely taken for the sake of political correctness and governed by liability. Better checking and re-checking is necessary and laudable; but physicians have been performing these type of tasks naturally, carefully and automatically since the profession began. Now due to rare untoward circumstances the public focus has shifted to such close monitoring of medicine that this oversight has slipped into areas of care producing burdening repetitive documentation that not only slows down good health care delivery but also endangers it.

I will give just one example: Through the entire admitting process a patient who is undergoing elective surgery is asked to identify himself/herself at least five times, including their procedure. In the OR a patient is again appropriately identified and the intended surgical procedure is stated. The patient is anesthetized (put to sleep) and then a list is read off of patient’s name, age, position on table, permit in chart, antibiotics, people in the room, warming blankets, monitoring equipment and readiness of the staff and the procedure. I, as any surgeon who is in charge of  the case, has instinctively made a check of all of the above long before it is consigned to the computer. I ask if the patient has calf compressors on (necessary to help prevent pulmonary emboli in long cases). This is verified by the checklist. Before I leave the room to scrub I went under the patient’s covers to verify that the compression is not only on but also working. It was on, but they were not functioning. This was corrected with new equipment. On return to the OR after prepping and draping the patient, I had to verify with the anesthesiologist and the nursing staff via arm bands and charts that this was the self same person we identified fifteen minutes earlier. I was then allowed to proceed with  the case.

Oversight has led to overkill bordering on the silly, but more importantly encompassing the dangerous. Time out for repetitive tasks in the OR increases anesthesia time  and increases patient morbidity,not to mention cost.  No amount of identification of the patient would help if the compression was not working. Its not the fault of the staff; they can only verify so much; yet that extra step is necessary and there is not enough room on paper or time in the day to oversee every important process the physician performs naturally.

There are plenty more examples. I would rather like to hear other people’s experiences. Write me.