This isn't what I signed on for (long)

[jedimaster91]

My apologies in advance. Some of this is likely going to come off sounding cruel and heartless, but I gotta vent and this stuff is waaaaaaaaay too Fratchy for the main CS site.

I work in medical imaging. I don't talk in great detail about my job often because it's a relatively small modality, a lot of the techs in the area know and/or have worked with each other in the past, and it doesn't take much to get recognized.

Back in the day, the hospital where I currently work merged with a larger system. Within the last few years, that system has again merged with another system. Old Entity was never the greatest place either to work or be treated there. It bleeds money and working conditions are such that everything is constantly understaffed and most of the remaining staff is ambivalent at best. Since the merger, it's gotten worse as New Entity had to show off its new muscle by laying off a lot of staff. New policies have been enacted that tie our hands when it comes to taking care of patients. Not to mention how freaking incompetent a good number of our docs and nursing staff are. People think I'm kidding when I say if I were to ever get really sick, I'd opt to quietly die at home rather than be treated at my place of employment. I'm not.

And here's where I'm going to sound like a complete jerk, but it's got to be said: sometimes with some patients, it is not in their best interest to go through diagnostic tests. I know the docs' have to make it look like they're trying something (anything), but tell me how it's in the best interest of a patient who is in extreme pain to have to endure a diagnostic exam when you already know what the problem is? Examples below:

• Gallbladder function tests on symptomatic patients with known gallstones. That gallbladder needs to come out anyway. We're radiating them for pretty much nothing.
• A corollary to the above, carrying out imaging well past normal parameters. After such and such time, certain things are considered abnormal. Why drag the test out longer?
• Bone scans on patients with known compression fractures. Said fractures were visible on CT, so they're pretty bad. CT takes less than a minute to scan. Bone scan is 20 minutes minimum, more likely an hour. On a hard table. For someone with a busted back.
• V/Q lung scans when the patient is a candidate for CT PE Protocol (and/or already had a positive CTPE. Moar radiation!). It's better, it's faster, and lung problems such as COPD don't affect it as much.
• Corollary: Scheduled V/Q scans on outpatients. If you're worried about a PE, that patient needs to be admitted to the nearest ER. STAT.
• Long exams on patients who clearly can't tolerate them. This includes stress tests for people who can't lay flat, bone scans on people who are so severely contracted we can't see anything, patients who can't empty their bladders (tracer gets excreted through kidneys) and we can't see through it thus rendering the exam unreadable, patients so completely out of it that they interfere with the exam. Like the ones who keep pulling masks off during lung scans when a radioactive gas is running through. Which contaminates the patient, the bed, me, and possibly the scanner.
• Basically any other test where regardless of what it shows, the treatment plan is not going to change.

Guess what, doc? Patients have rights too
Which means they can say no and you can't make them do it. Had a patient recently who was scheduled for a bone scan. We were checking to see if she'd knocked her hip replacement loose, but due to her medical history, she was getting the long version: an hour's worth of imaging, maybe more. Understandably, her hip hurt. A lot. So we got her to the department and she refuses the test. I ask about pain meds and she tells me she just had morphine right before coming down and it's not doing a thing. So I ask for clarification if she is refusing the exam and she said yes.

Legally and ethically that should have been that. It's not my job to talk people into things they don't want. It is my job to explain why it was ordered and are they sure they don't want to do it, but I cannot force them. Something you should always, always remember if you ever go to a hospital or doctor's office is you have the right to say no. And so long as you're of a sound mind (and we don't have paperwork stating otherwise), medical staff are ethically and legally bound to honor that.

Apparently someone missed that memo because we got a call as we were almost ready to leave from a pissed off nurse with a more irate doctor behind her demanding to know why we hadn't done the scan. Again, "patient refused" should have been the end of it. Oh no. Doc wants it done right freaking NOW. Sorry, end of business day and this is not a STAT study. It's a 4 hour exam from start to finish and we're not starting it at 3 o'clock on a Friday. Call the call tech in the morning. Doc forces Care Manager to call in the call tech Friday night and sends a nurse along with the good drugs "should the patient encounter any pain." Patient gets back in the department and refuses the exam again. Whereupon the call tech says ok, that's that then and sends them (patient and nurse) back to the floor.

There was a third attempt sometime the next day which the patient again refused. And somehow the floor tried to turn it around on us and say we refused to do the exam. Um, no. The patient refused. None of this is on us. We came in after hours to try again. Twice. You can't say we refused to do it. The scan was still on my list of things to do Monday morning, and had the doc insisted on yet a fourth try, I was ready to call compliance.

So, TL;DR, this crap happens all the time. I'm pretty sure they're breaking labor laws left and right since technically I'm part-time but have been working full-time hours for a year and a half now. Still getting part-time benefits, though. And there was a kerfluffle awhile back about them not wanting to pay us for working through lunch unless we turned it in that very day. Which I was swift to call shenanigans on. I work it, you pay me. Doesn't matter when it gets turned in, you owe it.

Despite everything I still love the work itself. What I now hate is the environment. The inane policies. Lack of adequate staff. Constantly being questioned and blamed for things I have no control over. People in other areas insisting they know my job better than I do. I want out, but I can't quit right now. Mr Jedi doesn't make enough.

[Andara Bledin]

I'd report them.

I'd take notes, cover my ass to the extent possible, and report them to every agency I could identify, starting with the labor board and whatever board covers medical ethics violations.

[HYHYBT]

You sound like my respiratory therapist relative, also in a fairly small place that was bought by a large company a while back. And I'll just leave it that vague, partly for the same reasons you gave and partly because it's secondhand information anyway.

[KitterCat]

Sounds like City Hospital in Martinsburgh,WV. After the care Mr. Kittercat received for a dislocated torn shoulder I wouldn't go to them neither. Your better off dragging yourself to another county then go there.

Report to as many agencies you can find, and start sending out resumes. There's got to be something better than that toxic environment your in.

[EricKei]

jedi -- If you feel that you have good reason to report these people to Compliance, you probably do. Is there a way to do so that would not be traceable to you? e.g., maybe have the customer complain about it "of her own volition" ? -- In other words: "I kept telling the techs that I did not want the test, so they packed up and took me back to my room (etc); the nurse and the doctor kept trying to force them to do it, against my wishes!"

Cat - I live in a quasi-rural town (~25k peeps) with only one "real" hospital (as opposed to small clinics). It has been made abundantly clear to me by many, many people that, if I have anything wrong with me that's more serious than the flu, I might be better off walking to the next big hospital -- which is in a town sixty miles away -- rather than go to the local one.

[AccountingDrone]

There is a reason I require anything that intricate gets done at Yale-New Haven. Their staff is amazing, they have great patient ombudsmen [ombudsmans?] and excellent facilities. They have managed to keep my sad ass alive for decade. Right now Greenville NC seems to have misplaced my roomies mother ... she called an ambulance around noon for diziness, got hauled to the ER, and about 9 hours ago when she called to check on her, she was supposedly admitted and sent to a particular ward/room. She gave them half an hour to get her settled and called up there. Somehow she wasn't up there, she was still in the ER. Gave them half an hour, called back to the ER who was convinced she was admitted. Finally, at about 6 she was supposedly sitting in the lobby waiting for a taxi to get home. So she started calling the house looking for her, and it is now almost midnight, she doesn't seem to be at the hospital and she doesn't seem to be answering the phone ... what next, a damned police wellness check?

[Andara Bledin]

After a few hours, I'd have police checking in.

Possibly unwell elderly parent, hospital that doesn't know whether she's admitted or not, and 6 hours of no contact afterwards? Yeah, cops are going to be called and a potential abuse case brought up... >_>

[AccountingDrone]

She finally got home, we got her at about 1230 ...

*sigh* Anybody in Greenville NC need a room free for helping a crotchety old [80] lady? No money, just a room ... She can't keep living alone, she gets dizzy spells and at 80 she shouldn't be trying to drive for groceries, and we can't seem to find any way to get her up to Connecticut right away.

[jedimaster91]

Right now Greenville NC seems to have misplaced my roomies mother ... she called an ambulance around noon for diziness, got hauled to the ER, and about 9 hours ago when she called to check on her, she was supposedly admitted and sent to a particular ward/room. She gave them half an hour to get her settled and called up there. Somehow she wasn't up there, she was still in the ER. Gave them half an hour, called back to the ER who was convinced she was admitted. Finally, at about 6 she was supposedly sitting in the lobby waiting for a taxi to get home. So she started calling the house looking for her, and it is now almost midnight, she doesn't seem to be at the hospital and she doesn't seem to be answering the phone ... what next, a damned police wellness check?

Ugh. If I had a dollar for every time I had to call multiple departments trying to find a patient....Computer still says ER. ER says, no that person has a room and they sent them up already. Floor says nope don't have 'em. Check with ER. So after calling ER (again), Xray, CAT Scan, Ultrasound, the transport office, the floor (again), somewhere the patient magically turned up still in the ER.

And we just got reamed about hours again and how we're so far over budget I dunno how they're counting. The day that pushed us over was the same day of the aforementioned bone scan fiasco. That nurse tried to throw us under the bus claiming we refused to do the test. Good thing three of us had matching stories that pretty much depth charged hers. I think we've dodged that bullet. For now.

JHACO is due to be coming around any day now that the holiday blackout period is over. There have been some major issues in a different department (a cluster of fail that actually resulted in a patient's death. Responsible parties have already been fired), so we're hoping that juicy steak across the way will keep the wolves entertained and out of our hair. So you can imagine the crazed frenzy anyone in management is in right now trying to make it look like a decent hospital. I got handed a form as I was getting ready to leave and bosslady is like fill this out. JHACO may want to know where we keep our "hazardous" materials. Which for us is the germicidal sani-wipes. Apparently the radioactive materials don't matter so much. They're behind a locked door no one else is allowed to have the code to anyway. Now, I dunno if they want to know where we keep our stock or where we keep the containers in the department. She wasn't clear on that. So I did the latter. One bucket here, one there, three in that room, etc. If it's wrong, I don't care. I have other things to do like actual patient care.

[MaggieTheCat]

M
And here's where I'm going to sound like a complete jerk, but it's got to be said: sometimes with some patients, it is not in their best interest to go through diagnostic tests. I know the docs' have to make it look like they're trying something (anything), but tell me how it's in the best interest of a patient who is in extreme pain to have to endure a diagnostic exam when you already know what the problem is?

I kind of went through this when I was being diagnosed with my hiatal hernia/gastroparesis. I had to go through like 4 different types of exams, the first being an endoscopy (where they stick a scope down your esophagus to examine your stomach) and after that they were like, "yup, we saw the hernia and you also have GP but you have to take these other three exams before we can schedule surgery or do anything else for you." So it was like 3 months before I could do the surgery, and one of the exams they required involved sticking a thin tube up my nose and then all the way down my throat into my stomach and then making me swallow water to see how well my esophagus functioned. It was absolute hell. It was the worst half hour of my life. I cried the entire time the nurse was doing it, and they couldn't give me anything for it because they needed me alert and awake so I could swallow properly. I would go through the surgery three more times before having that exam done again.