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Deane Waldman Headshot

The Bane Of My Existence - Come With Me To Work.

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2009-01-20-MyBane_225.jpg
Bane = "something that ruins, spoils or destroys; a deadly poison, as in wolfsbane." Pictured above is the Monkshood plant from which the poison aconitum is extracted, also called wolfsbane. My bane is different, more deadly, and much more insidious. My bane has the audacity to masquerade as our protector! My bane is called regulations, and my bane is destroying healthcare. Come with me to work and you will see what I mean.

This morning I saw six outpatients in clinic. Along with all the redundant, unnecessary paperwork, multiple forms and mandated signatures, I had to ask each patient whether he or she was trying to quit smoking and if they had thoughts of suicide. These questions are mandated by the Joint Commission - the regulatory agency that reviews hospitals and can take away accreditation, which effectively closes them.

Interesting discussions I had with my patients...as they were all in diapers! I am a pediatric cardiologist. Nonetheless, I am required to ask questions about smoking and suicide and then document that I did so. Why must I waste my time? Because the regulations say so.

When I finished with the morning patients and returned to my desk, I found a threatening email. I had to complete another Learning Session (online) and take a test within the next two days or else. The session was on part D of Medicare. The "or else" was that if I did not do so, my hospital would be...OUT OF COMPLIANCE: the worst of all possible healthcare sins. I had to complete this Learning session even though I am I repeat, a pediatric cardiologist and Part D of Medicare is the drug benefits program for senior citizens. Another unnecessary, time-wasting task added to the pile.

When I went upstairs in the hospital to see inpatients, I had search all over looking for patient charts because (get this) we are not allowed to put the patient's name on the outside of the chart! HIPAA (Health Insurance Portability and Accountability Act) forbids it. Talk about an error just waiting to happen.

You say, but regulatory mandates must certainly have been shown to have a positive cost/benefit ratio. The gain (confidentiality) must have been proven to be worth the cost (inefficiency; increased errors; more expenses). But wait! There never has been a cost/benefit analysis for HIPAA. I kid you not. Indeed, HIPAA, like almost all regulations, was passed with no hard evidence of a problem in the first place.

Meanwhile, my hospital is preparing for another surprise review by the Joint Commission. They will evaluate our medical and financial outcomes. But wait (again)! The Joint Commission does not measure medical results or dollar efficiency. They do not look at outcomes at all.

Joint Commission reviews evaluate only one thing: compliance with regulations and these reviews are purely punitive. There is a (very big) stick and no carrot. Anyone who knows organizational behavior understands how bad that is for quality. People are focused on rule following. No one is seeking best outcomes. Hell, no one is even looking at patient outcomes.

When you wonder why people are leaving healthcare or not going into it in the first place, think about my day, one that is repeated ten of thousands of times throughout U.S. health care facilities.

Regulations are the bane of the health care worker's life.

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