Thursday, March 15, 2012

Don't Worry About Them, They're Stable

I stared at the computer screen blankly as I tried to remember what I was typing. The medical floor was humming with various rings, dings, and shufflings. A maintenance person was cleaning the floors with a mini Zamboni like contraption that made more noise then a mack truck. It was six o'clock in the morning.

As I tried to center myself, I realized that what was really causing my blood pressure to rise was a series of alarms coming from the telemetry bank in the corner of the nursing station. Apparently multiple patients hearts were not behaving as they should, and the mass of wires and circuits was sputtering repeatedly for attention.

I watched as nurses and techs walked to and fro without paying an ounce of attention to the alarms. At one point, I stopped a nurse to see if she could turn the volume down.

No, we can't do that.

When I asked if anyone was attending to the patients with the concerning heart rhythms, I got an equally unsatisfying answer.

Oh, don't worry about them, they're stable.

My blood was starting to boil.

So why in God's name do we have alarms notifying us of stable conditions?

She shrugged her shoulders and moved on.


Health care is suffering from a complete failure of signal processing and differentiation. Overwhelmed by a morass of competing alarms, buzzers, and notifications, medical workers are unable to separate forest from trees, tress from branches, and branches from leaves.

Physicians have especially learned how to modify their work flow. We ignore the warnings that pop up every time we type in our emr. We click through the reminders that accompany each patient chart. We sign thousands of papers a day with only giving the most superficial glance at what we are putting our name on. We skim through each others note's trying to wade through the gelatinous mess and extirpate the crucial sentence or two.

And where does the fault lie for such bloated systems? We have become slaves to our government, slaves to regulation, and slaves to the technology folk who created our systems but have no idea the effect of information overload.

When alarms, notifications, and paperwork become so abundant, they lose the ability to inform us appropriately.

Let me say this again. More is not always better. We have lost our way in medicine.

We have no idea how to communicate that which is most important.

1 comment:

Karen said...

There was one time I told the nurse that the patient is in pain and wanted to talk to her, she said, "Don't worry about her, she's fine." Then she walked away. That's pretty sad.