The Customer is NEVER Right - A Nurse Practitioner's Perspective
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The first virtual book club

A friend reading the book asked if I was willing to hold some kind of book club. My first thoughts were, "Now what have I gotten myself into. Not only am I not Oprah I am not even a fan of Oprah. Am I going to have to do this all the time now." Those thoughts because I wrote the book for the purpose of action as healthcare needs it desperately. The last thing healthcare needs is more talking. The time for talk is over as history shows that with all the talk that has gone on nothing has been accomplished to improve healthcare for healthcare workers. And I said that to my friend.
Regardless, she replied, "Okay got your point! A one-side book club it is," and she sent me her questions and comments to what she had read thus far. Questions and comments I found entertaining so I replied and even commented to her at the end, "That was not too bad." I also added that I was willing to entertain any other questions or comments she had because after going through the process of reading her questions and comments it was exciting that someone else saw my point. Becaue of that, I thought I would share the first virtual book club on the blog for those interested. Below is that interaction with my friend's words in [brackets] and words I added after replying to her in {brackets}.
{I wrote the reply while at work.} This might take a bit. It's 0412 and getting off at 0600. Tonight, Monday, I blew through some 26 patients between 1800-0100 and the father of a family plan of four will likely complain because I told him the ED was not for convenience. Yea, it didn't go over very well. The family plan is a story in the book too.
[Now on chapter 4 and loving it.  First, what does sic mean?  Ran into that word a few times.]
Chapter four! WOW! I am impressed. [Sic]. I know what it is used for but do not know how to explain it so here is the dictionary definition: "The Latin adverb sic ("thus"; in full: sic erat scriptum, "thus it had been written") added immediately after a quoted word or phrase." The number times I wrote {sic} it was either because I wanted to capture the mispronunciation or misspelling of someone. I also used it to let the reader know my words were intended as read. I believe my most common use is that I always say, "That is my two sense"; instead of the more common, "That is my two cents." I say it my way because I want to let others know I really invested sense in whatever it was I stated. Does that make sense?
[Chapter 1-loved the part about fifth vital sign as pain; got me laughing and almost snorting]
The fifth vital sign, pain. I no longer use the pain scale in my documentation because it is a silly idea. And as I say about bad ideas, it's not the bad idea, but worse, that a group of so-called experts got together and thought {the idea was a good one}. So now I document {only after an intervention}, better, worse, or the same. And as long as the patient is not worse they are going home. Rarely does pain get worse after an intervention. [Chapter 2-interesting about EMTALA and totally agree; love the part about hypochondriacs, so true]  I am a big fan of EMTALA but it has not been used to its potential because some, again the so-called experts, thought seeing everyone in the ED would be easier, {and} less confrontational, than to tell patients they were not emergencies.
[Liked about the attitude and abundance part; pg. 33]

Abundance and lack of patience. Those are the citizens of our great nation. If they only knew!
[Loved the guat. story about the man who was a burden and with glasses was able to contribute to his community-brother, etc -could see guat. vividly pg. 35]
The Guatemala stories put shame to the above, abundance and lack of patience. However, that is not to say that even in Guatemala there are some who seek the abundance when not necessary. It's just that in the USA it is more common and without reason.
[Chapter 3- loved the green and red zones of the ER-so true.  sad to say... p. 50]
I did not like the green/red zones. Because even the "haves" used the ED inappropriately but because they were the "haves", by default even without trying, we catered to them. It drove me nuts. {Friends of ours} and I worked there at the same time. Not sure if they still have that system {at that ED} and I did not think to ask someone {who does work there and} I had lunch with when I drove through Houston. {One of our friends}still works there. That was the first ED I worked at as a NP and I would have stayed there if they had kept me but NOooo! That ED was hoping 24/7.
[Likert scaling method-just started at my current job-hate it-scale of 1-5 I am being rated by every patient I see-really sucks the big one. p52]
Any method of rating healthcare workers is a joke and a waste of money in so many ways. I believe my second most recent blog talks about that, where the topic of rating healthcare workers and its effects has been studied. Yet the rating systems, themselves, have never been studied. Now that is crazy. That a profession, whose practice is based on scientific evidence, is rated by some unreliable {and untested} system. Again, its implementation after a number of so-called experts put their thinking caps on and that was the best they came up with. {NOT GOOD!?!}
[Chapter 4-p 56 laughed at the personality traits, couldn't believe about the mom with a son who had a sore throat when CPR was being performed.]
Yep, even CPR isn't sacred. That is not only a true story. It is a story I have heard before, in some version or another, the most recent I used in the Drug Seeking Patient blog link where a ED physician talked about a similar moment with a drug seeking patient. {A friend of ours} sent me that link and I linked it in the blog. Adding to the personality traits, when I was home in NY I cannot tell you the number of my childhood friends who have known me most my life, to include before I joined the Army and had not seen me since, who said, "You have not changed one bit since we were kids. You are still the same serious angry looking guy." I point that out because the quoted research {in the book} about personality said one develops personality early in life and change is very difficult. I cannot make that stuff up.
After the above reply she send me more so likely more to follow. I only hope I do not ruin the story for others.

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