Going through medical training is an introduction to risk. My first real risk experience happened on a third-year medical rotation where I was following a gastrointestinal (GI) specialist. We were called to a code of a young man with AIDS and esophageal varices who was experiencing a massive GI bleed. The gastroenterologist was tasked with trying to band the bleeding varices while a code was being performed. Imagine a room filled with about fifteen people with every variation of personal protective equipment (PPE) surrounding a man who would gush blood out of his mouth with every chest compression. HIV and hepatitis C positive blood was sprayed from floor to ceiling and to every corner of the room.
Amazingly, the man survived this ordeal. The fact that we may be too good at getting a pulse restored in people at the end of life is another topic entirely. But everyone who left that room was in some personal state of shock. Was I exposed directly? Did the blood hit a susceptible opening? What are the odds of turning positive? We turned to our in-hospital risk-assessment panel.
Risk-assessment in hospital systems is a formal system. Even when this event occurred more than twenty years ago, the experience of being assessed for risk was mind-numbing, with no clear answers or direction. The process has now been more formalized and bureaucratized and been contaminated by lawyers and politicians. Today’s process is so bizarre that I do not participate.
I operate on patients on a regular basis installing pacemakers and ICDs. On the rare occasion that I may experience a needle stick (maybe twice in the past ten years), the dread of dealing with the risk-assessment team overwhelms my personal sense of risk. I personally just recognize the risk for what it is and face the next day without prophylaxis or medical monitoring.
We have become an over-bureaucratized system that has just been waiting for something like the COVID-19 virus to expose. Four out of five papers I sign when performing a procedure have nothing to do with medicine but instead, act to protect the hospital from liability in case there is a complication. Our lawsuit-happy culture drives more and more federal government and hospital proscribed paperwork. The bureaucracy has become fat and happy.
But what has become obvious with our current crisis is that all of this bureaucracy that stands between the doctor and patient is not only oblivious to the risks we face as clinicians, but is unable to plan appropriately to face the danger.
It is time for doctors to stand up and take back our profession. We do not need to be run by B-league administrators whose only focus is cost reduction. We do not need to face onerous recertification requirements by boards which are run by non-practicing (and grandfathered) MDs. We, the practitioners who actually see patients and face the risk head-on, should take back the responsibility and proper compensation of our care.
Our society faces a large crisis with the COVID-19 virus. This is the first real introduction to risk and mortality for most Americans. We, as doctors who have dealt with these risk calculations for our entire careers, need to help guide the public and prevent the type of panic that could dismember our entire social system. But let us not avoid the elephant in the corner – the bloated hospital and insurance administration that makes our jobs much more difficult.
Thomas D. Nielsen is a cardiologist.
Image credit: Shutterstock.com
