Tuesday, December 28, 2010

A Visit From Christmas Present: A Funny Thing Happened On My Way To Pediatric Board-Recertification

I put THE-Christmas-Card-that-makes-it-Christmas under the Christmas Cross in the kitchen window this year.  And late on Christmas night . . . finally alone with my thoughts . . . and with just the blue lights on the Cross turned on to dance out over the fresh snow in the front yard . . . I had inadvertently created an ethereal, Dickensish backdrop against which to contemplate Christmases Past, Present and Future. 

It certainly gave "Blue Christmas" a new meaning . . . for all that it seems the Ghosts are prodding me towards a certain path and course-of-action.

Since I put up this post in July - on the American Board of Pediatrics' latest changes to the re-certification process (changes my career & experience in Asheboro only prove are about appearance as opposed to substance - but we'll get to that) . . . a couple of people have asked what I decided to do.

Despite still feeling "resentfully indifferent" about re-certifying my Pediatric Boards, I did ultimately (and still fairly resentfully) decide to continue playing the game (at least for a little while).  So during the last few months of 2010, I worked very diligently on the "Part 2" and "Part 4" activities that allowed me to enroll in the American Board of Pediatrics "Maintenance of Certification Program".  The decision ultimately boiled down to picking my battles. 

It all got done just as the holiday season rolled around.

You will have to read the original post and the links for the details of the ridiculous/time-consuming/expensive hoops we Peds have to jump through in order to prove we are what we trained and originally certified to be. 

Please note that when I say "we Peds", I mean the Peds who are not grandfathered out of the requirements in a completely unfair and arbitrary way.

But a funny thing happened on the way to this dog & pony show.  Actually, the "Part 4 Activity" . . . an interactive online exercise designed (by the American Board of Medical Specialties) to improve Patient Safety . . . turned out to be somewhat gratifying . . . and potentially useful . . . for two reasons.

First, I could only find one approved safety improvement activity in the exercise in which I was not already 90-100% compliant with JCAHO standards (one of the benefits of using Electronic Medical Records in an institutional setting is that a lot of the things - like medication reconciliation and arranging/communicating patient follow-ups - become fairly "cookbook). 

The only activity for which I did not "qualify out" (very frustrating and time consuming in and of itself) was a little exercise in improving hand-washing rates.  

Taking some fairly simple steps at the hospital where I now work (in stark contrast to the cheapskates at Randolph - the people who put Pediatric ventilators under tarps and rolled them behind doors when JCAHO came to visit - this hospital was only all too eager to help), I was able to improve my performance & compliance very quickly.  Since I already have a reputation on the LDRP unit as being a bit of a hard-ass when it comes to outside visitors to the nursery and infection control (what your baby is exposed to once you walk out the hospital's front door is one thing, but I just think a hospital should do everything it possibly can to prevent newborns and premies from being exposed to outside - or inside - germs), it was all good.

Given all the CRAP doctors often get from the rule-makers and the suits about rules and regulations, having it confirmed that one is already on-the-ball was actually kinda nice.

Pause to pat myself on the back.

But here's the thing about that:  Putting up a few alcohol hand-wash dispensers within easier reach is just not earth-shattering stuff compared to the huge personal & professional sacrifices I've made . . . and risks I've taken in the past . . . going to the mat for the safety of individual patients . . .

. . . especially when the aforementioned oily jerks and un-convicted felons running "non-profit" Randolph Hospital are pulling down the money that they are now.

And I'm still thinking that, "dime-a-dozen" though this Pediatrician may be, a girl deserves credit for her work. 

So now that I'm done doing my part to improve handwashing in my little corner of the world. . . and have gotten everything logged in with the American Board of Pediatrics (most importantly my VISA card tagged for $1,030) . . . and despite my aversion to sending more correspondence-that-no-one-apparently-reads to a regulatory body, I'm probably going to sit down in January and compose a scathing letter to the American Boards of Pediatrics and Medical Specialties . . . because I still think that, when it comes to accountability and transparency and patient safety and medical ethics, our "oversight" agencies are just playing the "it is better to look good than BE good" game with the public . . .

. . . in other words (playing with North Carolina's state motto), "To Seem Rather Than To Be .

(It was also apparently former Senator John Edwards' motto, but that's neither here nor there.  I did note that his eldest daughter is marrying a doctor . . . it's like the Ghosts are playing with him too.)

For all of the PR-centered blather about "teamwork" that these agencies now spew, it's for damned sure my hard-earned Pediatric Board certification did not mean a hill-of-beans to any of the aforementioned oily jerks and morons running Randolph Hospital when a newborn baby's life was in real danger and their nurses (supposedly a valued part of the healthcare team) called the woman they-trusted-most-to-fix-things in to help.

"Care you can trust" certainly flew out the window when Bob Morrison and Steven Eblin and Asheboro's mill-town "honorables" rubber-stamping their every move chose to protect and shield the Cone-owned medical twit who thought being a NALS instructor made him a Neonatologist (not that the Courier's Ray Criscoe or the N&R's John Robinson or "progressive" GSO blogger-king, Edward Cone-of-the-Cones, think that's "relevant" to anything in healthcare that needs to be fixed) . . . the guy who did EVERYTHING wrong.

Likewise, when little-ol'-disruptive me did my duty and reported what happened . . . my Pediatric Board certification meant NOTHING to the Medical Board, to DHHS/the NHSC, to JCAHO or to local, state & Federal law enforcement.

As for the second gratifying thing about this little ABMS-approved exercise in quality improvement, it was actually almost (key word: almost) funny to have EVERYTHING (and I do mean EVERYTHING) in the course underscore how right I was back that fateful night back in 1998 . . . and how right I've been all along about what is REALLY wrong in medicine (turns out I'm not so "crazy" after all) . . . and how badly Randolph Hospital and DHHS/the NHSC and JCAHO and the Medical Board and the IRS/law enforcement all SCREWED UP when it came to the case of Dr. Mary Johnson and what she did one night in the middle-of-the-night over twelve years ago in order to put a patient first.

Everything that has happened since adds up to the MOTHER of all "system failures" . . . not that anyone anywhere in a position of oversight is going to do something about it until I come-to-terms with the fact that I am going to have to sue-the-crap out of one - or several - of the aforementioned anyones, in order to facilitate that change I've hoped for for so long.

I mean, one might actually use the core principles of this course to help formulate & support a fairly wicked lawsuit against the state & Federal agencies that have let me swing in the wind for twelve years . . .

. . . the agencies that were not there and that did not care about the very bad things going on right under their noses.

In short, boys and girls, Mary Johnson did everything RIGHT that night long ago.  She played by a book that none of the "right people" in her "home"town had even bothered to read . . . a book that their lawyers - and the N.C. State Bar - ultimately burned in the sad/sorry joke that substitutes for North Carolina's legal system.

Of course, it's only recently become clear to the rest of the world, how POINTLESS writing letters about medical ethics to the politicos and overseers was.  Liars and cheats in power don't care about what other liars and cheats do (the best belated Christmas present I could get in 2011 is an indictment of John Edwards . . . every time someone promoted his wife's credentials as a "healthcare advocate", I wanted to scream, "WHY do you think C-Section rates are up 60% since 1996?  Could it have ANYTHING to do with the fear of lawsuits . . . where lawyers like our John-Boy can channel dead babies for lay juries?).

So readers, thirteen Christmases after being thrown to the wolves by a bunch of mill town Potters Scrooges for doing my job the way it was supposed to be done,  2011 is looking very promising indeed.

The Ghosts of Christmas Past, Present and Future are working in concert once again - through a mere mortal in the trenches - to make the world a better/safer place.

The chimes were ringing the three quarters past eleven at that moment.

``Forgive me if I am not justified in what I ask,'' said Scrooge, looking intently at the Spirit's robe, ``but I see something strange, and not belonging to yourself, protruding from your skirts. Is it a foot or a claw!''

``It might be a claw, for the flesh there is upon it,'' was the Spirit's sorrowful reply. ``Look here.''

From the foldings of its robe, it brought two children; wretched, abject, frightful, hideous, miserable. They knelt down at its feet, and clung upon the outside of its garment.

``Oh, Man! look here. Look, look, down here!'' exclaimed the Ghost.

They were a boy and girl. Yellow, meagre, ragged, scowling, wolfish; but prostrate, too, in their humility. Where graceful youth should have filled their features out, and touched them with its freshest tints, a stale and shrivelled hand, like that of age, had pinched, and twisted them, and pulled them into shreds. Where angels might have sat enthroned, devils lurked, and glared out menacing. No change, no degradation, no perversion of humanity, in any grade, through all the mysteries of wonderful creation, has monsters half so horrible and dread.

Scrooge started back, appalled. Having them shown to him in this way, he tried to say they were fine children, but the words choked themselves, rather than be parties to a lie of such enormous magnitude.

``Spirit! are they yours?'' Scrooge could say no more.

"They are Man's,'' said the Spirit, looking down upon them. ``And they cling to me, appealing from their fathers.  This boy is Ignorance.  This girl is Want.  Beware them both, and all of their degree, but most of all beware this boy, for on his brow I see that written which is Doom, unless the writing be erased.  Deny it!'' cried the Spirit, stretching out its hand towards the city.  ``Slander those who tell it ye!  Admit it for your factious purposes, and make it worse!  And bide the end!''

. . . Charles Dickens (A Christmas Carol)