Friday, December 25, 2009

Christmas Musings

Being Jewish, I don't do Christmas lights, but if I did, the display would look (and sound) something like this:

More information on this holiday extravaganza can be found at this link.

I'm on call for the day, working from 8AM through 11PM. Business is slow but steady, with a number of chest radiographs ordered for cough, various extremity studies for "pain", and a dozen or so exams for the aftermath of a fall. Overall, I think falls bring us more business than car wrecks, although the latter usually prompts a full-body CT. Of course, today's carnage includes head CT's on two 95-year-old's. Both showed atrophy. Imagine that.

I continue to be amazed at the minimal symptoms that bring someone into the ER, especially on a holiday like Christmas. Americans have been trained to seek care for the slightest twinge. We'll see how we like it when the lines are longer and the pampering is eliminated. That's where we're headed.

One of my friends was working the ER this morning, and we had a nice chat about IT's control over our lives. My friend is a very reasonable and easy-going guy, who orders far fewer CYA-type scans than some docs I know. This morning, however, he was not in a good mood. It seems his password quit working, and he couldn't get into the PACS system. Several calls to our "Help(less) Desk" yielded the message, "We are experienceing technical difficulties. Please leave a message." This did not go over well. I had to let him access the system with my login (don't even think of punishing me or him for that) while waiting for someone from the PACS team to get him back on. In the course of this snafu, he made a rather ominous statement, something we all need to think about. I'll paraphrase it and remove the expletives.

"IT needs to help us," he said. "Standing in the way of me getting to see the data and images on my patient will lead to someone getting hurt. And if that happens, I'm not going to take the rap for it."

I have to try to see both sides of this, but in the end, we have to err on the side of patient care. I understand that all the rules and regulations, and HIPAA and so on are there to protect the patient's privacy and that is critical. However, in an emergency situation, there has to be some compromise, some mechanism to go above and beyond the rules, for the good of the patient. If IT takes its rightful place as master of the computer/network end of PACS, then it has to be there with us to solve problems like this, even at 8AM on Christmas morning.

And now, if you will excuse me, I have to go look at the next dozen images of a 95-year-old who fell down while coughing. And as noted above, I am Jewish, not Christian, but I have great respect for the faith of my friends. After all, Jesus was just a nice Jewish boy who went into His Father's business. To Christians, the greeting of "Merry Christmas" conveys their joy and happiness of the birth of Jesus. It is a greeting borne of caring and not of malice. So, while it isn't politically correct, and I don't celebrate the holiday per se, I still want to wish everyone a very Merry Christmas and a Happy New Year!

Addendum: I just stumbled across this clip from the old TV series Northern Exposure. I hope you enjoy it as much as I did. (Many said at the time the show was running that I bore a strong resemblance to Rob Morrow, who played Fleischman. Of course that was one beard, and many pounds and gray hairs ago...)


A Doc 2 Be said...


Sorry I missed writing earlier to tell you my wishes for your family to have a very Happy Hanukkah.

PACSFerret (the other one) said...

Hey Doc D... As an IT bod I agree largely with your points (certainly re patient and some kind of emergency override). Was penning some thoughts as a reply but it got a bit longish so I rewrote as a post here. But as a separate thought - use the event as a positive to make the process better - either your IT lads don't have an escalation procedure or haven't communicated it terribly well - suggest they look at that!

Happy New Year