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Is it "business as usual"?

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  • Is it "business as usual"?

    This morning, our Hospital's leaders held a meeting on how to proceed moving forward, with respect to routine, non-urgent procedures and visits to the Hospital. They decided that, in light of the only handful of known cases in our community, that it should be "business as usual" (an admin literally said that to one of my partners, before the admin probably retreated to her home office/bunker), at least for the time being. That we should continue to encourage our patients to come to the Hospital for routine services like screening mammograms and colonoscopies and such, sit in waiting rooms together with their family members, and not do anything to frighten the public or staff about this.

    Some of my partners and I are livid. While there are "only" a handful of known, proven COVID cases in our community and none in our Hospital, there are undoubtedly more that are unknown and untested in the community as our community has been very late in getting a testing protocol. Additionally, we are seeing students return from Europe and spring breakers return from ski trips in Colorado and beach trips to Florida, all places where robust community spread is known to be occurring.

    Are we out of line for our thinking? I know that there is no bleeping way that I would have my wife in for a screening mammogram today or next week, so how could I, in good conscience, encourage someone else to have one?
    Last edited by VagabondMD; 03-16-2020, 10:31 AM.

  • #2
    That was the mantra here last week. They seemed flummoxed when we put forth our (Physicians) concerns on Friday. This week is totally different. All none essentials cancelled and everyone is preparing for a surge.

    Talk with your colleagues. and have a meeting either in person with adequate personal spacing or virtual to express the concerns of the physicians of the organization. It worked for us it might work for you. Otherwise I am sure we could use another radiologist

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    • #3
      You are 100% correct. Yes, bad news. Same at my hospital. I made a big stink about it. I saw the OR schedule today and told the surgeons they are making a mistake.

      I was assigned anesthesia for elective cases. I have a "mild cold" = sore throat, runny nose, afebrile, not really coughing, but I told them I was going to get tested and then go home until the test came back negative (which the testing folks said was the right move) but our hospital is doing "elective" surgical cases. It is totally ridiculous. Our mayor has banned gatherings of greater than 25 people. Schools are out. People are hunkering in homes. What are the docs doing to prepare?

      We are doing elective cases. Ridiculous. I think this is a good reason to have FU money. So you can say, hey......listen.......no. We are intubating people from outside without wearing N95 masks (we don't have any) and we are bringing patients and families into the most disgusting germ filled buildings for $.

      Criminal in my mind. We might look back on this and say, wow.

      I want no part in it. I think my test will take a little time to come back. I won't go near any human until it is negative.

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      • #4
        "business as usual" is code for we don't know what to do because we are afraid we'll screw up. Their crisis management knowledge is in business or PR, not emergency medical disasters/pandemics.

        "If you need to be right before you move, you’ll never win. Perfection is the enemy of the good when it comes to emergency management. Speed trumps perfection. The problem right now is everyone is afraid of making a mistake."

        https://www.youtube.com/watch?v=GJwaeynSkFY


        It's psychosomatic. You need a lobotomy, I'll get a saw.

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        • #5
          Absolutely not. We have taken all our electives down, well, the governor basically said no more after Weds, and though hospital hasnt communicated (theyre doing good but seriously there should be an am email each day).

          We told clinic we will only see urgent/emergent cases and postop issues. No point seeing things that cant be scheduled and no point increasing contact between people unnecessarily.

          Its going to be forced upon them soon anyway, time for everyone to rip off the band aid.

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          • #6
            My colleagues are all onboard. I sent the following email to the Chief of Staff:

            xxxxx,


            I am aware of your committee's recommendation to continue routine, elective, and non-urgent testing and procedures at xxxxx Hospital, in light of the Coronavirus pandemic that is bearing down on our community. Truthfully, I have never before been ashamed to be part of the xxxxx staff, but I am today. Patient health and safety should be the highest priority, not revenue, volume, or market share.

            This goes against the CDC recommendations, and our American College of Radiology recommendations, and other healthcare organizations actions, including BJC, MD Anderson, and Duke, to limit elective and non-urgent procedures and visits.

            This is a very serious public health emergency, and we are openly signaling that it is "business as usual". This puts our patients, our staff, and our community in danger. Down the road, it will harm our reputation. I urge that you and the committee reconsider.

            Sincerely, Disruptive Radiologist, MD

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            • #7
              it was business as usual today, i sent patients home early

              im starting to call patients who have non emergent cases to stay home

              i did have a few smart patients who took it upon themselves to cancel




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              • #8
                Clinic has been adjusted down. Elective surgeries being cancelled. Not business as usual.

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                • #9
                  I'm not on MEC any more and I'm on vacation for the month, so I'm only hearing things second hand. There is "discussion" of things shutting down, although we are prepared in the ER (respiratory tent set up, staff spun up to speed, etc). I am hammering to move all department meetings to online, cancel grand rounds/noon conference, take the chairs out of the doctors lounge (so there is no place to sit/socialize), have the kitchen staff prepare take-away lunchboxes.

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                  • #10
                    Apparently we are short on face masks, surgical masks and N95s. We still have enough PAPRs, I'm told.

                    I'm reading in the ACEP forum about techniques for sterilizing/reusing these things. They are also talking about nationwide shortages of disposable gowns. (This one is easy to fix--aka laundry of cloth gowns, aka back to the future.)

                    I have never considered quitting medicine due to personal safety. But...no gowns, no masks...what's next, no gloves?

                    Yeah, tell the pencil pushers that this is most certainly not business as usual.

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                    • #11
                      Originally posted by VagabondMD View Post
                      My colleagues are all onboard. I sent the following email to the Chief of Staff:

                      xxxxx,


                      I am aware of your committee's recommendation to continue routine, elective, and non-urgent testing and procedures at xxxxx Hospital, in light of the Coronavirus pandemic that is bearing down on our community. Truthfully, I have never before been ashamed to be part of the xxxxx staff, but I am today. Patient health and safety should be the highest priority, not revenue, volume, or market share.

                      This goes against the CDC recommendations, and our American College of Radiology recommendations, and other healthcare organizations actions, including BJC, MD Anderson, and Duke, to limit elective and non-urgent procedures and visits.

                      This is a very serious public health emergency, and we are openly signaling that it is "business as usual". This puts our patients, our staff, and our community in danger. Down the road, it will harm our reputation. I urge that you and the committee reconsider.

                      Sincerely, Disruptive Radiologist, MD
                      I say it is too soft, but that's why my group doesn't let me go to meetings any more.

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                      • #12
                        Originally posted by G View Post

                        I say it is too soft, but that's why my group doesn't let me go to meetings any more.
                        I like your style. And yours VagabondMD

                        Our hospital system halted all elective procedures today.

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                        • #13
                          I've been off since everything really went down but have been getting email updates. Everyone is taking it seriously it sounds like, but to varying degrees. One system has closed all elective surgeries; the others haven't as of now. But we're in flyover country and have very few documented cases so far. I think doing cases currently in unaffected areas is ok. But there should be a plan to shut them down quickly.

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                          • #14
                            First, point out that the zoo and visitors center in Forest Part has been shut down. Set the table.

                            Second, there are three categories of elective surgery; non-urgent, semi-urgent and urgent.
                            The surgeon general discussed the need for physicians to exercise judgement based upon the patient profile and procedures. One answer is insufficient. His wife had a cancer related procedure. Perfectly fine because “not” performing the surgery may be life threatening.
                            Total knee replacement can wait and is a matter of scheduling. Examples of urgent and non-urgent.
                            Semi-urgent should lean towards postponement, especially for higher risk patients.

                            It is not business as usual. Any elective surgery should require department head approval based upon which subcategory and the patient’s need.
                            To do otherwise could be viewed as malpractice.
                            “Business as usual” does not meet the standard of care.

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                            • #15
                              I have no idea what my hospital has been doing to prepare, but I get the feeling nothing. I've received no direct communication from the administration whatsoever. I've gotten a couple of mass emails from TeamHealth regarding covid, but no specifics on my institution.
                              I know I've seen the ER staff wearing only surgical masks (often hanging off their face) and loose fitting surgical gowns. I've not see any N95 respirators on isolations carts. We don't have any confirmed cases yet.
                              My wife was really pissed when I told her this today. She can't believe that hospitals aren't better prepared or at least talking about it. She works at our local zoo and all last week they had meeting after meeting discussing plans to shut down and have employees work from home. In fact, she's home from work indefinitely already. Yet, I've heard nothing at my job. It's insane. And I'm a hospitalist. You'd think the admin would be talking to us directly from day 1 that the CDC told the country to prepare.
                              I've requested to only work a very part time schedule next month (6 days) and I'm prepared to walk away from this job if things start to get bad. I have no idea what I'll do next and it makes me really nervous, but I'm not going to stick around for the sh** show if these morons can't get their act together.

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