This comes from a loyal reader and points out the insanity of what is going on with quality measures, pay-for-performance, etc:
Ok, so my husband—70 years old with no cardiac history at all—goes to his doc because he has a pain in his chest—non radiating—like a pulled muscle. He is getting over a cold and has shoveled snow several times before and during the pain. It has not increased—as a matter of fact it seemed to be a bit better. But he thought he should get it checked out. BAM!! To the hospital (even though the ekg in the office showed no changes from a prior Ekg and the pain was now about 3 days old). To his credit the dr. did make it our choice but my husband opted to follow his instructions—“You’ve been my patient over 25 years and I’d hate to miss something.” So he had the full workup except no cath when it became increasingly obvious that this was not cardiac pain—which is what I told him in the first place but then I’m only a retired RN with 22 years’ experience. He was discharged within 24 hours.
This is only in introduction to what really set me off. The RN admitting us told us that he would be getting heparin shots and TED hose to “prevent” a blood clot. When I objected she only said that blood clots were a big problem and this was their protocol. When I suggested that he might refuse she then said basically that if he got a clot it wouldn’t be the hospital’s fault because they offered the heparin. My husband then opted to go ahead with the heparin.
So when I got home I checked several places including the hospital’s own website, PubMed and a general Google search and I couldn’t find anywhere where they have studied this tx with people without a history of clots. More disturbing to me was the fact that we didn’t receive any info to make an informed decision—it was just presented to us as something to be done. I fired off a patient complaint to the hospital and the next morning received a call from someone in the hierarchy who explained to me that they use some sort of scale to rate patients as they come to the hospital and if your score is over 2 you get heparin. I expressed amazement that they would start such therapy on a patient who was only there for tests and was ambulatory and in fairly decent health. Well, he’s over 70 and if you’re 70 or above you’re a 2—he’s overweight so that’s another 2 and bingo!! Here comes the heparin!! I asked the lady for (1)a copy of the protocol; (2) a copy of the scale they use; (3) any journal articles or research that backs up the use of TEDs and heparin as a deterrent to blood clots; (4) the hospital’s rate of blood clots before and after the initiation of this protocol. We’ll see what they come up with—this is the hospital that I practiced at and they are notorious for starting protocols but not evaluating whether they really do any good or not. The other thing that entered my devious little mind was that wouldn’t most clots be prevented if the patients were ambulated on a regular basis? Oops, wait, that would mean we would need staff to get them out of bed and help them—much cheaper (better reimbursed, too) if we just stick them with some heparin and put those TEDs on—which most places state don’t work anyways.
I worked in this Alice in Wonderland atmosphere for 22 years—the last 4 were getting worse and worse and further and further away from why I went into nursing. I could afford to retire so I did. Now being on the other side of the mirror so to speak isn’t much better.
Thanks for listening—I enjoy your gazette and generally agree with your take on things. My dad was an old time GP and he would have told my husband you pulled a muscle—if it gets worse go to the hospital. Common sense no longer exists in medicine.
This example is great and I would love to hear more from you guys out there. Please send them to me so I may share them with the world.