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Doctor Slams Hospital's "Please" Policy 572

Posted by samzenpus
from the paging-doctor-manners dept.
Administrators at England's Worthing Hospital are insisting that doctors say the magic word when writing orders for blood tests on weekends. If a doctor refuses to write "please" on the order, the test will be refused. From the article: "However, a doctor at the hospital said on condition of anonymity that he sees the policy as a money-saving measure that could prove dangerous for patients. 'I was shocked to come in on Sunday and find none of my bloods had been done from the night before because I'd not written "please,"' the doctor said. 'I had no results to guide treatment of patients. Myself and a senior nurse had to take the bloods ourselves, which added hours to our 12-hour shifts. This system puts patients' lives at risk. Doctors are wasting time doing the job of the technicians.'"

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Doctor Slams Hospital's "Please" Policy

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  • Not credible (Score:5, Informative)

    by Anonymous Coward on Thursday June 03, 2010 @12:12AM (#32440928)

    The source for this is an "odd news" blog, whose source is a "newspaper" called The Sun. You may have heard of it. National Enquirer anyone?

  • Re:Just wanna say (Score:4, Informative)

    by Moofie (22272) <lee&ringofsaturn,com> on Thursday June 03, 2010 @12:42AM (#32441134) Homepage

    Mine are.

    They cost me little, and get me lots. Common courtesy is a very good investment.

  • Re:Not credible (Score:5, Informative)

    by TouchAndGo (1799300) on Thursday June 03, 2010 @12:54AM (#32441200)
    Agreed, I can't find any other source for this news, and it's pretty bizarre to be quoting a tabloid as a source. Unless you're the Men in Black.
  • Re:big waste of time (Score:2, Informative)

    by 91degrees (207121) on Thursday June 03, 2010 @01:20AM (#32441358) Journal
    Doctors have no idea how busy lab staff can be, and they're short staffed on the weekends as well.

    And I simply don't believe the bit about having to say "please". It's not true. The Sun lied (again) [blogspot.com].
  • Re:Fire them (Score:3, Informative)

    by Phillip2 (203612) on Thursday June 03, 2010 @01:21AM (#32441362)

    The NHS is not perfect, but generally gives a high standard of care. The free market is not a universal panacea as the banking sector shows.

    The other point to remember is that this story came from the Sun. It wouldn't be the first time it has invented a story. The free market in
    journalism means saying what people want to believe, rather than what is true.

  • by drsmithy (35869) <drsmithy@nOSPam.gmail.com> on Thursday June 03, 2010 @02:00AM (#32441564)

    Seems like a happy medium would be for the government to pay for healthcare, but for private hospitals and doctors to provide it?

    GP is either ignorant or lying. There's nothing preventing you from getting private medical care in the UK if you're prepared to pay for it.

  • by Anonymous Coward on Thursday June 03, 2010 @04:01AM (#32442174)

    And I'm so embarrassed that I'm posting AC. The basic procedure as far as healthcare here goes is:

    1. Welcome to A&E! (4 hours later, because it's full of pissheads.) (24 year old 1st year doctor sees patient, who needs prompting several times to read records right in front of him - but at least there's an overworked more senior doctor in the corner consulted every 3 minutes.) "Well, I can't see anything much wrong with you, have some painkillers."

    2. "No, we have no money for diagnostic tests, that's all gone to administrators and contractor firms - we don't employ many in-house nurses and don't allow medical professionals (matrons and senior doctors) to manage hospitals any more. But have a blood test."

    3. "No, see 2, if you want something you'll have to go via a consultant in another department. See your GP. Yes, it costs more, but this sequence involves more positive government targets."

    4. (call up for blood test) I'd like a copy of my blood results. "Nooooooooooo normally that goes via the GP. If you tried taking responsibility for understanding your own health, where the hell would we be?"

    5. Oh, 3 involves going to an intermediate "triage" meeting where nothing happens, which splits 1 waiting list artificially into 2.

    Oh God, anyway, it goes like this for a month or two until eventually no consultant appointment is offered and you give up and pay for one privately. This works nicely because you can use them as a booster to get back into the state system with preliminary evidence of a problem and get proper diagnostic testing. It's cost them a lot of money because they're bouncing you from place to place but it looks like they're succeeding at various government targets by successfully doing one extra piece of unnecessary work at each stage, and each department gets its budget boost. It's so, so, so horribly corrupt.

    Oh, as for doctors: some are lovely, some are horrible. Speaking to others who have used the hospital (especially one family member with a lifetime medical condition), we're happy to tell the doctors to learn some manners (in the most polite way possible) when they are rude either to us or their staff. You can be as strict and as admonishing as required to ensure someone's clear about their fault and how to correct it without being condescending, making a public show, or getting personal. Indeed, you're not going to improve anyone by treating them like that.

    This all being said:

    This is another typical stupid rule I'd expect from Worthing bureaucracy. They had a checklist item to tick, turned it into a pointless rule which would make more bureaucracy to preserve their place and which would reduce workload for a reason other than "we lack tech staff because we have too many administrators". IOW, they'd no longer have to indicate that they missed targets (management fault), instead declaring that employees failed to fulfil processes (worker fault).

  • by Tsu Dho Nimh (663417) <abacaxi@@@hotmail...com> on Thursday June 03, 2010 @04:47AM (#32442332)

    Administrators at England's Worthing Hospital are insisting that doctors say the magic word [CC] when writing orders for blood tests on weekends. If a doctor refuses to write "please" on the order, the test will be refused. The managers said the move is aimed at easing pressure on hospital workers charged with performing blood tests by making doctors consider whether the tests are essential.

    WTF? I was a medical technologist - the staffer who would perhaps collect "the bloods", and certainly would be the one doing the lab tests. I can see several things wrong with this scenario:

    • If this is only a weekend protocol, it violates the K.I.S.S. principle of having things work the same way all the time, and of course they will forget that it's Sunday, bloody Sunday and forget to say pretty please with sugar on it at least half the time.
    • If one or more of the weekend docs are ordering tests that are medically unnecessary or ordering the tests all STAT (extremely urgent) so they can go home sooner, you review their test ordering patterns (easy to do with computers). If a pattern of abuse emerges, having the senior pathologist or the lab manager chew them out for it works wonders.
    • A pathologist, lab administrator, or hospital administrator with backbone can set up a list of tests that will be done STAT, and under what conditions. If Dr. Gottahaveitnow wants something that is not on the list, too bad. He/she can get an override from the lab director.

    • Medical technologists have their own way of dealing with the pile-up of STAT requests. We redefine the acronym to be "Start Test Any Time". We smile and say, "Certainly, I'll get right on it as soon as I finish the STATs from Dr. Wanna Playtennis, Dr. Tooimportanttowait, and Dr. Dammitiforgotmypreops. What is your pager number, I'll call you." That leaves them snarling at each other for cluttering the queue.
  • Re:Just wanna say (Score:3, Informative)

    by fireylord (1074571) on Thursday June 03, 2010 @04:51AM (#32442344)

    There's plenty of problems like this in hospitals. Doctors don't know what things cost, so they tick all the boxes without considering the cost-benefits.

    The Doctors are the people directing the medical care of patients, why should they become accountants?

    This is the NHS, care is free at the point of use, no medical insurance or patients' money issues are meant to be cosidered by the medical staff. If there is an issue with funding for services that is up to the hospital management to deal with, not the administration department.

    It's an obvious attempt at rationing care services, and yes if overnight bloods haven't been done when a doctor has stipulated needing them done for specific patients due to a clinical need for that patient then patient welfare is put at risk!

  • Re:Just wanna say (Score:2, Informative)

    by fireylord (1074571) on Thursday June 03, 2010 @05:51AM (#32442572)

    They are the only people competent to judge the cost/benefit of the tests/treatments they want. The alternative is to have accountants with no medical knowledge making this decision.

    As opposed to medical staff who have not great understanding of fincancial matters? It's a difficult paradox to solve

    NHS funds are not a bottomless bucket. Yes, care is free at the point of use. But the total care available is finite. If money is wasted on unnecessary treatments, then other, more necessary, treatments will get cut.

    A little background, i live not far from the hospital in question, i used to live in the town the hospital is based in. There was a plan to cut the number of hospitals/care facilities in our local area due to budget constraints. 3 hospitals were under threat of at least partial closure. Thanks to the inevitable local outcry in all 3 areas all 3 hospitals remained open, when honestly there is scant funding for this.
    The administration of this hospital is handling things poorly however if their criterion for rationing what could be vital patient care is based on a doctor's grammar.

    Since the demand for medical services is infinite but the supply is finite, there will always be rationing in the NHS. You may not like it, but, like the Second Law of Thermodynamics, you cannot avoid it. What you can change is where rationing appears. If you hide it in one place it will pop up in another. Much better to have it out in the open than to have it done by secret conclaves of consultants or the blind workings of an administrative machine not designed for the purpose.

    Sorry but this is just nonsensical, risking lives and health by implementing daft policies is not how the NHS controls the fincancial constrains upon it, your analogy is utterly irrelevant to the case!

  • by tsalmark (1265778) on Thursday June 03, 2010 @06:40AM (#32442770) Homepage
    The sun is affiliated with Faux News?
  • by xaxa (988988) on Thursday June 03, 2010 @06:45AM (#32442806)

    The sun is affiliated with Faux News?

    Yes. They are both owned by News Corporation [wikipedia.org].

  • by jo_ham (604554) <joham999@gm[ ].com ['ail' in gap]> on Thursday June 03, 2010 @07:37AM (#32443232)

    They used to be, but before the announcement of the UK election they made a big show of "flipping to Tory" (they like to think they personally control the outcome of the election, and thus were giving their readers the OK to vote tory). Since that time they have been much more right wing.

  • Re:Just wanna say (Score:3, Informative)

    by SanityInAnarchy (655584) <ninja@slaphack.com> on Thursday June 03, 2010 @08:03AM (#32443474) Journal

    No American hospital ever has to worry about whether an insurance company (or uninsured patient) will pay for a procedure or not.

    Mostly because the truly uninsured, those who are actually incapable of paying, are paid for by the public anyway. If you truly want to keep healthcare a private industry, stop funding emergency rooms and start turning people away at the door because they don't have an insurance card.

    If you don't like that, maybe you could look at the actual economics here: Proper medical care results in fewer emergency-room visits. If the public is going to pay for someone's healthcare anyway, it costs less in public money, not more, if you can keep it from becoming an emergency.

  • Re:Easy solution (Score:5, Informative)

    by Bakkster (1529253) <Bakkster...man@@@gmail...com> on Thursday June 03, 2010 @08:11AM (#32443554)

    They will often treat non-MDs who work with them as underlings, who job is purely to aid the doctor from doing those little jobs that they don't like to do.

    While it may not give them the right to act like a prick about it, a technician's job is to do menial tasks so that a doctor or nurse (or engineer, in other fields) doesn't need to. There are plenty of reasons for this, not least of which is that it keeps costs down. Not only does it cost more to pay a doctor to do so (and keep him from his other duties), but the technicians are certainly better at getting lab work done. And, since technicians can't provide patient care, it's best to give each task to those who specialize in it (nurse draws the blood, lab tech runs tests, doctor diagnoses and prescribes treatment).

    It's similar in engineering (electrical in this example, since it's what I do). The engineer designs the circuit, a draftsman lays it out physically, and a technician lays out and solders the parts. Yes, the engineer can do it, but it's not their specialty, and it's much more expensive and slower to have them do it.

    One could certainly make an argument that such jobs are 'below' engineers/doctors, but I wouldn't direct that kind of sentiment to a tech. It's certainly valuable work that they do that saves me a hell of a lot of time, and I try to show my appreciation (lots of 'please' and 'thank you'). It doesn't give me or anyone else the right to shit on a tech, but it is their job to assist the doctor/engineer by doing menial tasks that they don't have time to do.

  • by mdwh2 (535323) on Thursday June 03, 2010 @08:23AM (#32443666) Journal

    Liberal != left wing.

    Before they flipped to supporting Tory, they were supporting Labour, and weren't liberal then either (e.g., they supported Labour's plans to extend detention without charge; they let ex-Home Secretary David Blunkett have a column, who was responsible for all sorts of authoritarian laws). I agree there's still no evidence of them being a liberal paper (though at the moment, the Tories appear to be behaving more liberally than Labour, e.g., scrapping ID cards and planning to restore various lost freedoms).

  • by Camann (1486759) on Thursday June 03, 2010 @08:41AM (#32443860)
    Recommended reading [wikipedia.org] for anyone who'd mod 'Faux News' troll.
  • by KingSkippus (799657) on Thursday June 03, 2010 @09:08AM (#32444152) Homepage Journal

    When I watch a news station, I expect to see news, not commentary. Now, I know that it's not going to be straight, hard-core news 24 hours a day, but still, you have to understand that when I do watch a news station, it's usually because I'm killing some down time and just flipping channels, or there's something going on that I want to know more about.

    So if I have the choice between having a mainstream news station that may not do quite as good a job at reporting the news and that has bits of commentary (CNN) versus a "news" station that has craptons of commentary with a bit of really good news reporting mixed in (Fox), I'll pick the former almost every time. I don't have time to sift through the silliness to get to what I want to know.

    But really, when I want news news, I usually just go somewhere like BBC or NPR on the Internet. In spite of claims to the contrary, I've personally found that Fox is anything but "fair and balanced" in their reporting. Let's be honest, sensationalism trumps any political leanings any of these stations have. Anyone who has been around as long as I have knows that it doesn't matter which side of the spectrum they fall on when it comes to getting the numbers.

  • by Critical Facilities (850111) on Thursday June 03, 2010 @09:31AM (#32444466) Homepage

    Fox's political leanings seem clear;

    Indeed [fair.org], they are very clear.

  • by Anonymous Coward on Thursday June 03, 2010 @11:01AM (#32445730)

    But you have to look at what they're being hard on Obama about. Often it's that he is not being liberal enough.

  • by Anonymous Coward on Thursday June 03, 2010 @11:05AM (#32445808)

    yeah, our site looked into this and got comment from the hospital after reading the slashdot story ... pretty much all untrue.

    Link [geekosystem.com]

  • Re:Easy solution (Score:3, Informative)

    by tprime (673835) on Thursday June 03, 2010 @11:06AM (#32445816)
    I work with physicians every day and can agree that they can sometimes be challenging with their social skills. HOWEVER, the main point behind them writing in the chart is care for the PATIENT. There is a reason why orders are called "orders" and not "requests." At any job we all have our roles and a tech's or nurse's or any other non decision making clinician role happens to be to carry out the physician's orders. If this is to make them be nicer and less demanding, it is the most annoying piece of passive aggressive garbage I have seen in a hospital.

    Also, the patient's chart is designed to be a concise list of actions ordered, tests done, results and diagnoses, not a social commentary. Adding ANY extra word that does not directly affect patient care just makes it more difficult to read.

    There are far more impacting ways to deal with difficult physicians, most of them revolve around a hospital's medical staff dept. To the Parent poster, perhaps you should reevaluate your job if you do not like the environment in which you work. As far as I have seen, the same issues appear, in some ways, at every company where a clearly defined caste system exists.
  • by Onymous Coward (97719) on Thursday June 03, 2010 @11:18AM (#32446026) Homepage

    I thought Fox viewers had been shown to be substantially misinformed?

    Yeah, here we are [wikipedia.org]:

    • 67% of Fox viewers believed that the "U.S. has found clear evidence in Iraq that Saddam Hussein was working closely with the al Qaeda terrorist organization" (Compared with 56% for CBS, 49% for NBC, 48% for CNN, 45% for ABC, 16% for NPR/PBS).
    • The belief that "The U.S. has found Weapons of Mass Destruction in Iraq" was held by 33% of Fox viewers and only 23% of CBS viewers, 19% for ABC, 20% for NBC, 20% for CNN and 11% for NPR/PBS
    • 35% of Fox viewers believed that "the majority of people [in the world] favor the U.S. having gone to war" with Iraq. (Compared with 28% for CBS, 27% for ABC, 24% for CNN, 20% for NBC, 5% for NPR/PBS)

    The real thing to take away here is that you're a fool if you're not listening to NPR.

  • by jmac_the_man (1612215) on Thursday June 03, 2010 @11:55AM (#32446770)
    Jane Akre worked for a Fox network affiliate and not Fox News. It would make as much sense to not like Fox News because Joe Buck and Troy Aikman are horrible football announcers.
  • Re:Just wanna say (Score:3, Informative)

    by c6gunner (950153) on Thursday June 03, 2010 @03:04PM (#32449906)

    You clearly haven't been living in Britain for the last decade, haven't needed treatment in that time, or else you're just trolling. There are no 8 month waits to see a specialist. For any medical problem you have a right to treatment in the worse case within 18 weeks. That's not just seeing a specialist, that's to have the operation or whatever treatment it is you need.

    Awesome - maybe you can send some doctors and politicians to Canada so they can show the clowns here how to do it right. Meanwhile, I'd just be happy with a private option.

    Last two times I've been to A&E, both non-serious, the patient has been seen in about 30 minutes.

    The only time I've waited 30 minutes was when I walked into the ER with an arterial bleed that was spraying like a water fountain. Every other time, I've had to wait at LEAST 3 hours.

    Last time I needed an operation, again not too serious, it took a month and a half from first visit to my GP to operation done. 2 visits to the specialist and one pre-op included in that time.

    I booked an appointment with a dermatologist about a month and a half ago. I won't get to see him until October.

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