Curbside Consult with Dr. Jayne 11/28/11

Now that Thanksgiving has come and gone, we’re officially in that nebulous zone called “The Holidays.” For many, this includes hectic family gatherings, school programs, and travel to see relatives. College students return home to agitate parents and siblings.

For physician offices, it marks the beginning of cold and flu season. For IT teams, it often it signals a lull in the implementation of projects because no one wants to deploy new technology when physicians and staff are alternating time out of the office with packed schedules (usually required to accommodate said time out of the office.)

I officially boycotted Black Friday by purchasing nearly nothing, despite needing to pick up a new external hard drive. I was happy to see my municipality issuing tickets to big box retailers that opened at midnight, citing laws preventing 24-hour operation of retail enterprises. I’m not the neighborhood Grinch by any means, but I am glad to see someone countering the steady pressure of rampant consumerism. I did buy some coffee (a delightful peppermint mocha) while visiting with a friend, but I’m sure that didn’t make a blip on the Black Friday cash register.

One good thing about The Holidays is that travel often brings people to town that I don’t get to see too often. I had the rare chance to sit down with my longest-standing friend. We started our healthcare careers together at the tender age of 13 as hospital volunteers, aka Candy Stripers. Cecilia always wanted to be a nurse and I always wanted to be a doctor, so it was a friendship forged of common interests with a sprinkling of adventure.

We started volunteering on the mother/baby ward (yes, they were called wards back in the Cretaceous period,) refilling plastic pitchers with ice chips and answering the nurse call light system. My favorite part was using the Addressograph machine to stamp paperwork when new patients arrived, assembling charts in large plastic three-ring binders. I guess that means my interest in health information goes back to the very beginning (or maybe I just liked the smell of mimeograph ink).

After a while, I tired of being the ice chip police and transferred to being the “checkout girl” at the gift shop. The computerized cash register made the job fun. I enjoyed the tally reports that it created for the end-of-day close. Maybe that’s where my interest in technology comes from.

Being Candy Stripers gave us unlimited access to the hospital (in the pre-HIPAA era, things were very different.) I still can’t believe they let teenage girls do the “pharmacy run,” driving a cartful of drugs to every ward including the locked psychiatric ward (at my hospital, robots now do that work). We saw the hospital from the ground up – from central stores to sterilization to food prep to pharmacy to nursing and beyond. It gave you a solid understanding of all the different people needed to make patient care possible. It allowed you to be close to the action, but not too close (thankfully, we weren’t on duty the night that a baby was delivered in the lobby bathroom.)

Cecilia and I thought it would be cool to work together when we grew up. I could have a private practice and she could be the office nurse. Although I did ultimately end up with that practice (at least for a while,) she specialized in cardiac nursing and prowled the telemetry and post-surgical step-down units. The hospital where we started faced a declining census and was torn down to make room for outpatient offices. I still have a brick from the demolition. Ironically, a decade later they’re thinking about building a bed tower there due to rising hospitalizations among the increasingly aged population of our home town.

Being a nurse on the front lines, Cecilia really has seen the transformation of healthcare delivery first hand. She has nearly a decade more experience than I do, working in the trenches while I was still slogging through medical school and residency. She has worked through every buzzword you can think of. We always commiserate about having to deal with patient-focused care that’s actually profit-focused, centers of excellence that really aren’t that excellent (but the administrators think that if you call it that, it makes it automatically great,) and goofy regulations and policies.

Spending time in major hospitals throughout the country, we’ve both found that the more hospitals think they’re unique, they more they really are the same. Clinical care has been commoditized. 

It’s a bit humorous, but we both wound up in the same situation for clinical work. Although she works for a major health system just a few miles from her home, they don’t employ her – she’s staffed by an agency hundreds of miles away because the hospital doesn’t want to spend the money to employ full-time nurses. I’m in the same boat because my hospital doesn’t actually employ any of the hospital-based physicians either, relying on a staffing company to insure us and administer our schedules. It’s a long way from what we thought we were getting into way back when.

I can’t complain, though. Being a mercenary doc from the clinical perspective allows me to indulge my IT passions and still see patients. It does make one wonder, though,what’s next in healthcare. When the majority of workers at a hospital aren’t actually employed by the hospital, what’s that going to mean? How do you ensure training and consistency? How do you handle an ever-changing and increasingly complex environment? How does it impact patients? We’ll just have to wait and see.

So here’s to The Holidays. I hope you have the chance to connect with friends and colleagues old and new. Stay safe, stay sane, and take some time to recharge. If what we’ve seen this year is true, it’s only going to get busier in 2012.

Have a question about eggnog recipes, call light systems, or making the perfect ice pack out of a rubber glove and paper towels? E-mail me.

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