Our policy is… (copy)
I know I’m going to lose this one before I enter the order, but I enter it anyway. My patient has a cavity in a section of lung. There’s lots of things that can cause something like this including TB so, until you know what’s going on, you place the person in isolation to protect staff and visitors alike. The patient underwent bronchoscopy a few days ago and had a blood test to screen for TB. Both results are negative. I cancel the order for isolation.
In less than an hour I get a message from infection control saying I can’t cancel isolation since the patient has not had “three negative morning sputum examinations”. Three morning sputum exams were used to exclude TB many years ago and became the standard used to remove isolation. That was before the availability of the TB Gold blood test and the widespread use of bronchoscopy. The bronchoscopist analyzed several ounces of salt water that were flushed through the cavity. The negative results of the combined tests are far more sensitive than the morning sputum standard. This knowledge has yet to be incorporated into the isolation policy, though, and when science and common sense come up against policy, policy nearly always wins. Isolation is resumed.
In this case, no one is harmed. The isolation is a minor inconvenience. Its not worth the energy I’d spend arguing (and I’d still lose) but it got me reflecting on some things that have come my way over the last few months. I mentioned previously that my hospital medicine group was outsourced and I now work for a company owned by a private equity firm. My “white glove onboarding experience” was tedious at best. After providing all the required documentation, I still needed to get on Zoom and show my passport to someone on another continent to prove I could be legally hired. The 40 plus years I’ve spent in this community counted for naught.
Joneen and I are planning to age in place – i.e. avoid institutions as long as possible. With this in mind, we’re in the midst of a renovation at home to get bedroom, laundry and entrance all on the same level. Those of you who’ve gone through this understand the disruption and chaos. For a couple of introverts, having strangers in your home at 7AM each morning is akin to torture. Its almost like a stress test to see how much we REALLY want to stay here. As part of the financing, my advisor recommended a home equity loan to smooth out tax burden and preserve investment returns.
Given that our mortgage is paid and we have almost no debt, I assumed this process would be relatively simple. In the past, with a local bank, I would have been right. Going through a megabank, though, has turned out to be quite an ordeal. After nearly an hour on the phone listening to all the required disclosures (and being told what a great deal we’re getting), we provided exhaustive financial records. This was followed by a string of additional requests
from “underwriting”. I have a hard time understanding what some of this information has to do with my ability to repay a loan and, in some cases, understanding what they’re asking for. Its almost as if some of the correspondence is being written by a poorly trained A.I. instead of a person – maybe it is. Apparently, I wasn’t being responsive enough and someone from the mothership called and asked why I hadn’t provided my last pay stub. I tried to explain that I was between employers and not planning on working much anyway. I wondered why it mattered given my age (most folks are retired by now) and my longstanding relationship with the institution. She said I shouldn’t take it personally that its just policy. Six weeks in…still waiting.
There’s nothing wrong with policies. In a former life, I used to write lots of ‘em. At their best they help things run consistently and fairly (and keep lawyers at bay). A person I greatly respect (Herb) is fond of saying, “our policy is to follow our policy”. In many organizations, though, policies become outdated and workers, out of fear, substitute compliance for thought, initiative and even compassion. Its hard to get yourself fired or disciplined for following a policy, even if its not the right thing to do.
How much have we dispensed with personal interaction in the pursuit of efficiency and convenience? How much do we do with a keyboard what we used to do in person? We don’t shake hands, look each other in the eye and have conversations like we used to. Why should it surprise me (or hurt my feelings) when a behemoth organization dehumanizes me? If you don’t know me or have a relationship with me, then policy is what we have. It’s the deal we’ve made (with the devil?). We’re certainly not going back.
I wonder if we’ll like where we end up.
