Sticks in the Throat: Boxology

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January 24, 2014 | 2 Comments


  1. Rigid systems like this may look like they protect the staff, but I don’t think they really do – except maybe in the Cosa Nostra sense. You’re more likely to be faced with a staff member who is afraid to depart from the protocol, even while feeling deeply uncomfortable with it. In my experience the situation usually starts with cutting back on staff, and attacking the rights and dignity of those who are left.

    The fewer human beings on the job, the less time any of them have to react to individual situations. No problem, say the bean counters up top: just write a protocol so that no time-consuming decisions are needed. Plus, they say, it will let you move to a lower-paid, lower-skilled, high-turnover workforce without hurting quality! The protocol will tell them exactly what to do. The system may even be referred to as “idiot-proof” by these worthies, letting the staff know exactly where they stand.

    This mentality is bad enough when you’re dealing with a fast food chain that “can’t” give you a cheeseburger without pickles. When it invades healthcare, it’s disastrous. It’s an especially good topic for RxISK, because all too often it leads to replacing people with drugs. Insurers are happy to shell out $500 per month for diabetes meds, but recoil in horror at the idea of allotting $500 in staff time to help a chronically ill person lose weight or start exercising.

    Not to be simplistic, but I think the focus on the almighty dollar is to blame for most of this. The situation is bad enough in public services when managers are under pressure to cut costs fast (and maybe look for excuses to privatize). When Big Insurance, Big Pharma and Big Healthcare, Inc. are in charge, you’ve got hell on your hands. I regularly hear my fellow Americans express a fervent wish that their relatives will “just shoot me” rather than let them be put in a nursing home. Stories like Mr. Scheel’s go a long way towards explaining why.

  2. I would be interested in E-Mail information so I may contact you, since I also have a heart condition, and was on Plavix. That way we can compair notes!

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