Hospital executives are reeling this morning as they prepare to be surveyed on a new standard in patient care. "Of course," said one Mid-Atlantic suburban hospital administrator, "We are aware that people need to have their respirations, pulse, temperature, and blood pressure checked, but we are just getting over having to comply with the fifth vital sign that the hospital surveyors imposed on us: pain."
Leaning back in his $500 ergonomically designed chair and admiring the $50,000 renovation recently done on his office, he talked about the national uproar caused when attending physicians were required to evaluate a patient's pain.
I mean, for Heaven's sake, pain, really? How much do regulators think they can impose on us.
We were doing fine with monitoring breathing in our patients and even pulse. Adding checking patients' blood pressures and temperatures caused us capital outlays for equipment, but we've sucked it up and passed the expenses on to the patients.
But the nation's main hospital accrediting body requiring us to assess patients for pain, well, I started to rethink all that stuff about the 'dismantling the administrative state.'
You see, our doctors and nurses don't really give a shite (I visited the U.K. last year) about how much pain their patients are in. 'What about our pain!,' they're always telling me, Every time they hear a patient talk about healthcare in places like Norway, Canada, or Israel, they just feel the most uncontrollable urge to euthanize their patients! And who can blame them!
Oh yeah, that reminds me, have you seen that awesome documentary on that nurse, Charles something, who offed all those patients. Can you blame him? Heck, if I were a nurse with never any control over how many patients I could be assigned or when I'd be forced to do overtime, well, let's just say you'd be safer in the ward's utility closet the next time the medication cart rolled into your room.
I digress, and I really can't afford to since I soon have to leave for a meeting with our primary care physicians who are outraged that they actually have to see patients in person anymore. Anyway, long story short, we in the hospital community have just gotten used to all those ridiculous pain measurement questionnaires. I mean what a bunch of bs! Pain the fifth vital sign. What horseshite! Rate your pain on this or that scale one to ten based on your copay, deductible, whether you have some bogus "advantage" plan that costs ten times more than anything you'd be left owing in even 30 years of medical bills.
'Advantage,' my arse (oops, still remembering my trip to London last Christmas--lovely timing with my annual bonus. Advantage for insurance companies is what it means. Just imagine all those HMOs, PPOs, and whatever initials they use to make their members shout 'WTF' whenever their premiums and bills appear in their mailboxes. Talk about 'arses,' well they're laughing theirs off in offices almost as posh as mine everyday. In fact, the only other group I know that laughs their arses off as much as insurance 'predators,' oops, I mean 'professionals' is so called primary care physicians (PCPs).
What a joke (don't quote me)! They used to be called 'Gate Keepers,' but now the only gate they keep is their own, 'shut' except when they open it to get you the heck out of their offices. I digress I know. I'll have to tell my secretary to cancel my next meeting so we can finish this interview. Excuse me.
'Hey Sylvie, call conference room one and tell them I won't be attending. Also, cancel the sexual harassment training in the hospital auditorium. This is getting ridiculous anyway. Every time a new resident is caught pronging a nurse in the broom closet I have to call a sexual harassment inservice. 'Pound Me Too,' give me a break. The only staff around here not getting "pounded" are the ones who never get promoted.
'Oh, and Sylvie, did you get what I had mailed to you from Victoria's Secret? I had it sent here instead of home, of course. Finally, they're carrying a line of crotchless panties! Anyway, back to our interview, I'm up to my tuckus in alligators with all the crap this regulatory agency is putting on me. I mean "pain," really? What the f**k do they think Fentanyl and Oxycontin are for? (Hey, do you know I could retire on what I've made from my stock in these wonder drugs. I knew they were going to be a money maker when I saw all these losers around our town standing outside doctor's offices looking like something from the 'Body Snatchers.'
Great drugs. S**t, I can't figure out why the government and patient advocacy groups are always ragging ('sorry Sylvie, didn't know you could hear us') on these pharmaceutical companies.
This is America, still, isn't it? Where the f**k do people think they're living anyway, Oslo!
Anyway, about the "Sixth Vital Sign": it wasn't enough to make us measure pulse, respirations, blood pressure, temperature, and pain. Now we've got to measure a reflex that all the 'PCPs' are demanding.
On physical exams now these bottom-of-their-med-school classes losers want their patients to cross their legs to make sure that when the doctor taps their knees, their wallets fly out of their back pockets. Male patients have been a problem in letting PCPs into their billfolds--women have always been easy because the nurse could get into their purses when they were bent over for their rectal exams.
So now, hospitals will need to document that men's wallets are flying out of their back pockets when their knee reflexes are checked.
Six frickin' vital signs. I'm up to my gatkas in alligators with angry doctors who now are liking Steve Bannon more and more. 'Nuke the Administrative State' they're telling me--especially the so-called 'PCPs' who used to be reimbursed more for not referring patients, but now are getting all kinds of 'rewards' from 'specialists' for sending you to other doctors.
You see, PCPs are really what we used to call 'General Practitioners,' because they don't know anything in specific. Still, medical schools had been succumbing to the government and insurance companies and training these generalists to look at a mole, put their finger up your arse (Love that word--have you been to the U.K.? Hate their NHS, but the names they use for desserts, toilets, and elevators! Have you ever had 'spotted dick'?). In this country your PCP would have you in a urologist's office faster than my secretary put on her crotchless panties if you said you had 'spotted dick." But it's a dessert, really good too.
The British crack me up! Tony Blair, now there was a real brown nose for our country. He had his head so far up Bush's arse that "W' thought he was having a colonoscopy! And Margaret Thatcher--thought she was another Churchill by sending the Royal Navy to capture some tapas stand off the coast of Argentina. Seriously. The Brits are our best friends right. I love it the "loo" and the "lift." No wonder we had the American Revolution.
Only stupider thing is the NHS. Do you think I'd be sitting in a $5000 chair in a $50,000 office wearing a Brooks Brother's suit right now if we had an NHS? WTF. Tear down all commie socialized medicine, Mr. Gorbachev).
Anyway, I'm up to my arse in 'General Practitioners' now. They don't give a f**k anymore about doing anything but depression questionnaires. WTF, people are offing themselves! You need for the patient to do a f***g depression questionnaire and draw a clock every time they come in to know that?
Basically, the only thing GPs (aka family doctors and PCPs) know how to do now is review the 100 pages they make you fill out every year before your annual physical and then take 30 seconds with you going 'yes, yes' before giving you your prescription refills. Then if you say you're a little bit sad or anxious, they say 'Not my speciality.' If you say, 'Would you look at this mole on my back?' They say, 'Not my speciality.'
If you mention a symptom that relates to your heart, a nurse bounds in with a clipboard so you can sign away your checking account for any amount that their office won't be reimbursed because your insurer considers it excessive to do an EKG.
As your PCP is rushing out the door after your allotted 30 seconds, you ask if she's going to put her finger up your arse like she used to, to check your prostate and get a little fecal smear to test for blood. Now you've pissed her off. 'What do you think specialists like gastroenterologists and urologists are for? I can't push on your prostate and determine whether it feels like flan or a tennis ball! I'm not a specialist in fecal blood. Go see a gastroenterologist or if you don't want to do that, I'll try to get approval for you to crap in a box and mail it to Indiana or someplace in fly-over country.
As for your feeling a little sad or anxious, I've done my f*****g job--you completed your ten thousandth depression questionnaire, and that psychiatrist I referred you to last year after you saw that brilliant social worker in our so called 'behavioral health department' spent 10 seconds with you and put you on every psychotropic out of the pharmaceutical pipeline. Therapy's dead, man. Do you think I would be able to send my kid through college and medical school if I didn't own stocks in Prozac, Wellbutrin, and every other SSRI this and that, and the other.
You need help. Your expectations of a PCP show you to be seriously out of touch with reality. Do another depression questionnaire right now, and I'm also referring you for a circulatory study at the hospital to see it there's still blood and oxygen going to your brain. What part of 'General Practitioner' don't you get?
Every condition a patient can have falls into a speciality where some arse who could afford a long residency in something like eyebrow surgery gets paid $800,000 a year. I'm lucky if I make $150,000. Do you think I want to even spend 30 seconds with you once a year. Read my lips, I'm not a 'Specialist' in anything. That's why the original name for what I am has 'General' in it.
So think, you Neanderthal. If every condition you have falls in the category of the infinite number of things that doctors train in to become 'specialists' who can earn 5 or 10 times what I do, there's nothing 'general' left other than telling you that's 'not my speciality'.
And since "general" means you have no speciality, there's nothing I have to do except send you somewhere else, have you fill out 100 pages a year (not including a 10 page depression questionnaire every time you come in and a clock to ensure that you're depressed and demented). This is why someone like me who doesn't give a sh*t refers you to specialists faster than a bride removes her dress on her wedding night.
I send you to 'specialists' of wealth accumulation who own houses, swimming pools, helicopter and corporate landing pads and airstrips, tennis courts, bespoke jewelry, cars, artwork, and clothes that a 'generalist' like me couldn't even imagine and would send a Canadian, Israeli, Norwegian, or English doctor running to the 'loo.'
Put my finger up your butt, what planet are you from, you pervert?! Now go crap in a box, your EKG has been denied but you can pay me $2000 out-of-pocket to do one.
'Crushing chest pain,' you say. Not my speciality. Now complete another depression questionnaire and then another and another until we can send you to the sadistic, moronic social worker in our Behavioral Health Department. By the time he's done with you, you're going to blow the roof off the questionnaire and may even need 11 seconds rather than 10 with that prescription-happy psychiatrist who owns stock in every medication since Laudanum and Milltown.
Take care, okay.
So anyway, that's what I'm dealing with this in this healthcare market in America. Believe me, without opioids, how would hospitals, doctors, and nurses manage all the cretins who come through our doors?
It's hard enough for me with no background in anything except my HVAC degree before I was hired here. Now I've got to add the knee jerk wallet flying out the back pocket reflex to our hospital standards so that we can remain accredited and keep our status as one of the Mid-Atlantic's 10 top hospitals as rated by all the journals whose owners we gifted three days of golfing, lodging, meals, entertainment (escorts) in Boca Raton.
Oops wasn't suppose to say that. Off the record, okay?
Gotta run now. Nice talking to you.
'Sylvie, have you called catering to set up the executive dining room for today's medical staff appreciation dinner. Yes, prime rib, lobster (remember, don't serve this to that internist with a yarmulke), that crown something of lamb thing, the rare Japanese fish we had to have flown in past the endangered species inspectors, red velvet chocolate cake, etc. and remember nothing French--no Napoleons, French Vanilla ice cream, chocolate croissants, etc.. They're socialists. I draw the line at 'spotted dick'--even though those f*****g English having been making a bad name for the private practice of medicine since the end of World War II with their f*****g NHS because our urologists get such a kick out of the name, but that's the limit.
Oh, and remember, right after the dinner I'll meet you at the Hampton Inn on Highway 13. Don't tell anyone the crotchless panties are from a French designer and bring my Viagra from your top right desk drawer.'
Onward.
