EPtalk by Dr. Jayne 2/3/22

For many companies, HIMSS preparation is in full swing, if my inbox is any indicator of the situation. Multiple marketing people have reached out inviting me to visit their booths for demos or conversation. I must say that the invites for happy hour appetizer and beverage events seem to be lacking, so I’m wondering if HIMSS is clamping down on food and beverage service in the exhibit hall due to COVID. If that’s the case, I’ll definitely be missing the scones.

As for booth invitations, I’m more likely to respond if a company has a compelling pitch and understands that I have to visit them anonymously versus trying to get me to make an appointment, since that undermines the whole anonymous blogger vibe. No invites for after-hours events yet, so I’m not sure how this year’s social scene is shaping up just yet.

For frontline physicians, the creation of Prescription Drug Monitoring Programs (PDMPs) brought to life key pieces of technology that made a tremendous difference in patient care. I keep receiving emails from my local PDMP, asking me to approve delegate requests for nurse practitioners and physician assistants that I worked with at my former practice. Our state won’t allow non-physician providers to have an account unless they’re sponsored by a physician, which in many cases was me. There has been a lot of turnover in the physician ranks and apparently some of the new supervising physicians either don’t have PDMP accounts and therefore can’t delegate to the midlevel providers, or somehow don’t think it’s important for the providers they supervise to be able to look for patterns of controlled substance abuse or diversion. This has been going on for more than eight months, and I feel bad for the providers who don’t have access to this vital information. It’s yet another illustration why a patchwork of state laws isn’t always the best thing for patient care. On the other hand, it’s also a pretty telling commentary on the leadership of my former practice, who could solve the problem by requiring that everyone makes use of the PDMP and that appropriate operational structures are in place to support the effort.

From Jimmy the Greek: “Re: this week’s Snowmageddon. I’m tired of seeing organizations talk about their ‘inclimate’ weather” preparations. Spelling counts. Take a look at this email – not only is the inclimate weather virus spreading, but now I have contact information for 200+ patients.” Jimmy forwarded me an email from his local physical therapy provider, who apparently doesn’t understand patient privacy or how to use blind carbon copy functionality on an email. The body of the email made it clear that the addressees were patients with appointments scheduled today or tomorrow and also mentioned that they’d be contacted to reschedule. I hope Jimmy gives them an earful when he receives his call.

Hot on the heels of my weekend piece about healthcare organizations that aren’t giving their employees time to recover from illness and injury, I’m mentoring young physician informaticist who emailed with some questions about professionalism. He was on a training call with one of his organization’s tech vendors. The lead presenter seemed tired and out of it, and about 20 minutes into the call, admitted that he was COVID-positive and was having a difficult time focusing and asked if they could take a break so he could hand off to his backup. As a physician, my friend was surprised that someone who was obviously symptomatic would be working, especially in a non-essential role. From a business perspective, he was surprised that the vendor hadn’t asked to reschedule the call, or that they didn’t start the session with the backup presenter in the first place.

Even with people working remotely, if they’re not well enough to work, they shouldn’t be working. In this situation the presenter knew well enough that they weren’t 100% that they arranged for a backup presenter. This situation speaks not only to poor individual judgment (which I guess you could probably attribute to COVID-induced brain fog), but potentially to corporate policies that push people to work even when they shouldn’t.

My young colleague was wondering about what he should have done if there hadn’t been a backup presenter. Should he have called a stop to the presentation after realizing the presenter was in some distress? He was also questioning whether he should say something to others at the vendor about what had happened. I think compassion dictates asking a struggling presenter if they need a moment, and if they don’t realize there’s an issue, then I’d probably ask them if we could reschedule. It’s difficult where a medical condition is concerned and one doesn’t want to pry or appear inappropriate pointing out that things aren’t going well, so I’m not sure if there’s a great answer here.

This ties in nicely to an article I read about the CDC’s recent update to workplace guidelines for COVID-positive healthcare personnel. Although many assume those roles are largely occupied by physicians, nurses, therapists, and others who are performing hands-on patient care, the CDC guidance also includes “persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting,” including administrative and billing personnel. This also may include a lot of healthcare IT workers depending on their roles. Many healthcare workers who aren’t in the weeds on the recommendations might not realize that work restrictions for healthcare personnel are broken into three categories:

• Conventional standard. Those with COVID-19 should be restricted from the workplace for 10 days or for seven days with a negative test – assuming asymptomatic, mild, or moderate illness with improving symptoms. Many organizations interpret conventional as applying when there is adequate staff or personnel are non-essential.
• Contingency standard. Those with COVID-19 may return after five days if asymptomatic, mild, or moderate illness with improving symptoms.
• Crisis standard. There are no work restrictions, but there may be prioritization considerations, such as having COVID-positive staff only work with COVID-positive patients.

We’re starting to come down from crisis standards of care to contingency in some parts of the country, and in others, it may be time to see a change from contingency to conventional standards. Regardless of the definition, if people aren’t able to perform the essential functions of their job, they shouldn’t be working. We need to stand up for each other when we see someone in the workplace who probably shouldn’t be.

How would you handle someone who is obviously too sick to work? Leave a comment or email me.

Email Dr. Jayne.