Thursday, February 17, 2005

Professionalism, JCAHO, and A Few Good Men Again

I have been thinking about this a lot recently, and a recent post at Medical Grand Rounds inspired me to get it down.

The Joint Commission on Hospital Accreditation is pretty much a joke, in my misanthropic view. Recently a circulating nurse told me she had to leave the room to get a medication I wanted to inject during a surgical case, because due to the JCAHO visit, they moved all of the meds out of the OR........... uh......... because we wouldn't want actual medications to be near actual patients, now would we? Next they'll tell us we have to keep the scalpels somewhere else, in case someone is trying to steal them or for our own protection or some other BS. Every hospital I've ever worked in goes bananas trying to get a good rating from the JCAHO and usually by making it impossible to get any actual medical care accomplished (hide the meds! put away the needles! memorize the Mission Statement!).

Where this gets to professionalism is that the institutions that control much of a doctors life and livelihood are often highly inane, capricious, capable of massive unprofessionalism, and largely beyond they oversight of the people they govern.

The AMA says it's wrong to take $$ from drug companies, but they have no problem taking it themselves. They have no problem making $$$$$ selling CPT codes in partnership with the government (on the backs of the doctors they supposedly represent). Professional? I think not.

When I took my Board exam, I was required to grant a blanket indemnity to the Board if one of their employees misused my personal information (which I was required to open to them). Usually this kind of indemnity (also generally required by Medicaid, Medicare, HMO credentialing and Hospital Privileging Departments) includes the words "if in good faith" or something, but not the one I had to sign for the Board. Was I going to make an issue of it prior to being certified?

When the Bulletin they printed contained massive internal contradictions in the instructions and was barely comprehensible as written English, what recourse did I have? How "professional" is that?

In the film A Few Good Men, the Nicholson character is asked if he's aware of the regulation forbidding the practice of a "Code Red." He says, "I submit to you that the man who issued that order has never faced the working end of a Soviet made AK47...but let's put that aside for now." (That's my recollection). And similarly, the rules I work under are mostly written by people who don't have the "professionalism" to consider their practical and ethical implications.

So I have to struggle to do my job in the face of bloated and often hostile organizations with barely a thimbleful of actual professionalism, and on top of it my behavior (actually, my personality) is subject to the scrutiny of people who themselves are usually petty, artibitrary, and incapable of working under the kind of pressure I face almost every day.

I'd love to make the rules myself, but I'm too busy taking out people's dysfunctional organs and when I finish with that I like to see my family, so I'll skip the committee meeting, thanks very much.

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