America has worn the tradition of bad management into its culture. Everyplace you see has HR, writeups, phony achievement bonuses, and insane complaint resolution techniques. The machinery of the bureaucracy grows no matter what the nature of the product might be.
It is no surprise that Scott Adams’ Dilbert has become a cultural fixture in America. What once expressed the doodlings of a frustrated employee in an engineering firm, now echoes around the country as the rational illumination of a ridiculous machine.
Team Stupidity is the new answer to American Medicine. What started out once in life as a quality principle has turned up as as a way of dulling down any risk of medical care advancing beyond the dullest member of the team.
The Ivory Tower club enjoys Team Stupidity – after all, it explains why there are fifty of them, of whom thirty can’t find the way to the bathroom without a map. How can we have sufficient employment among the incompetent without Team Stupidity?
Here’s a story. A patient of mine went to the ER. He felt bad. His EKG showed Ventricular Tachycardia. This is a transient, self-correcting rhythm that resolves into Death before long. He was appropriately treated by Dr. Edison’s Chest Therapy, and was kept inpatient on telemetry and loaded with amiodarone, an ancient heartsman’s pal, Vaughan Williams III. The cardiologists like it because it does beaucoup magic – the internists hate it, because it screws up many systems. Anything called a “function test,” do it. PFT, TFT, LFT, you name it.
They discharged him home to me, in the usual chaos that characterizes a hospital discharge these days. I picked him up on 200mg amiodarone.
But no! Team Stupidity intervened, and called a halt to amiodarone. I had written a new outpatient prescription for amiodarone. Those can only be written by a cardiologist. A potential medication error was logged (yes!) and the prescription was arrested in limbo.
The parochial view of the physician would be that:
- This guy almost bought The Box.
- He was sparked out of a lethal rhythm.
- Cardiologists loaded him on a great heart drug while on telemetry.
- They said he should go home on this drug and stay on it until…
- The drug should be continued at home.
With The New Mindset, all minds are equal, and ‘no’ trumps ‘yes’ every time. See, if an intervention is NOT DONE, and the patient dies, it’s just nature taking its course.
Quality checking was just meant to put a new set of eyes, attached to a brain, onto the problem to make sure that something wasn’t absurd. But it got turned into a vote by a co-practitioner, eyes firmly attached to the brainstem, who gets a surge of control by saying ‘no’ over the heads of physicians.
When sudden death for the patient becomes a rational alternative, we are no longer practicing medicine. What should we call it, then?