Stool can get so hard that clinicians need to pull on a glove and dig it out. It happens most often in very old, demented patients. They pull their knees up into their tummies, we slip ‘blue pads’ under the business end, and a nurse or physician starts working at the blockage.
It takes muscle. You lean low over the bed, left hand on the patient’s right hip, and dig deep with your right hand. Success brings relief for patients and makes a huge mess of the bed.
No one fights for bowel disimpaction on his or her scope of practice.
Nurses used to disimpact bowels in the ED. They know how. Now nurses usually say, “That’s not within my scope of practice”.
You never hear “That’s not within my scope of practice” for fun things. Prescribing medications, discharging patients, applying splints, and patient education are aggressively pursued.
Premier Wynne wants to increase nurses’ prescribing scope.
Pandering to unions does not improve wait times or patient care. If Wynne wanted to really improve patient care by changing nursing, she would call for increased after-hours care, productivity incentives, and a return to the unpleasant parts of nursing that now get pushed off as outside of scope.
Doctors cherry-pick, too.
Orthopedic surgeons love to delegate ‘simple’ reductions of wrist fractures in elderly patients. But pods hesitate about letting others reduce simple hip dislocations in the same patients. Hip dislocations take seconds to fix, pay hundreds of dollars, and require almost no follow-up. Wrist fractures require 20 times as long to fix, pay a fraction of the fee, and often require complex follow-up.
Everyone wants scope of practice to suit their needs, not patient needs.
Providers cherry-pick attractive bits of patient care and try to sell it as better for patients. It’s not better for patients. It’s just self-interest.
(photo credit: stellacreek.com.au)
Thanks for sharing this. I was teetering whether to vote Liberal or not but this continual assault on physicians by the Liberal government has sealed by shift away from the Liberals. To allow someone who has studied for 4-6 years total, not in medicine, to start ordering CT scans and prescribe controlled medications, as compared to a physician who has studied a minimum of 10 years but usually 15 years, devalues physician education. Politicians who have no knowledge of medicine making such decisions also devalues physicians. This government continues to devalue physicians on a regular basis.
The OMA, I might add, just takes it. Whether they do nothing or their oppositions to these government plans are ineffective, the bottom line is that the OMA is ineffective. We pay thousands of dollars to the OMA in dues and while they focus on physician fee-setting, it is these policy decisions which will harm medical care for patients, reduce physician influence and ultimately completely doom the fee schedule.
Thanks for commenting, Scotty!
As always, your enthusiasm cannot go unnoticed. Politicians will value what they know. We need to figure out how to articulate physicians’ unique value add. The CMA is working on this, but it is not easy. Medicine involves phronesis, clinical judgement. It gets into the philosophy of medicine (I can share my article that just got accepted into the philosophy edition of JCEP).
The OMA did respond here.
I appreciate you expressing your opinion that “…the OMA is ineffective.” Strong comments require solid support. Can you give some examples of where the OMA was ineffective? Furthermore, can you describe what ‘effective’ means to you in the realm of public policy? As long as we have publicly funded and run Medicare, physicians cannot call the shots. So, I’d be interested to hear what you expect the OMA to accomplish?
Thanks again for taking the time to read and comment! I’m surprised you have time in the midst of your (3rd?) residency!
Best regards,
Shawn
Great article Shawn. Are you going to publish it in Medical Post or elsewhere? You should.
Hey David,
Thanks for taking time to read and comment! I appreciate your suggestion and will consider contacting the Post about writing something on this huge topic.
Thanks again. Keep well!
Shawn