Tuesday, February 09, 2016

Audiobook of the week



anyone who has worked in a gov't bureaucracy knows what happened: On paper, the "rescue" was supposed to be by a local group, so outsiders were told to stand down and let the locals take care of the problem...

Similarly, on "Paper", there were no local terrorists, so that the attack had to be spontaneous, and they looked around and found a movie to blame it on.

Why do I think this? Well, because when I worked for the IHS, often we had volunteer docs helping us out, and I would be called by the nurses for backup when they got over their head (e.g. a difficult delivery, or thinking they could care for a critical patient when we didn't have lab or x ray except on call after 5PM).

Why did they call me? Because I would come. Ah, but it was against the rules: I was NOT authorized to help.

The doc in charge of these hospitals were typical bureaucrats: the nurses would call him and he's say: They are doctors. Let them handle it.

Don't dare to admit some docs were not experts in some areas of medicine such as Obstetrics or acute trauma, or that they might not be aware of which hospital was best for certain transfers (e.g. neurosurgery), or if you needed a helicopter for longer transfers. Don't dare let them call for help when you have five critical patients in the ER needing transfer, because you can take care of them just fine.(long story).

But I didn't care if I embarrassed the visiting docs: The patient came first.

needless to say, I sort of got encouraged to leave the two problem hospitals I am talking about.

I should add: not all IHS places were like this, but two of them where I worked were a problem, and a problem made worse because I lived on site, when most of the other docs lived off the res and had to drive in which took time...yet when I came to fill in, often I was reprimanded.

(in contrast, our IHS hospital in Minnesota called everyone on the list when we had a problem: Often I wouldn't wait for the phone call, I would just go when I heard screaming in the parking lot, or a helicopter coming in, knowing it was probably something bad..often they were happy to see me, and that I was at home and could help).

Bureaucrats tend to follow the rules...alas, sometimes following the rules will result in a dead patient (or in Benghazi, a dead Ambassador and a couple more dead heroes).

to paraphrase the old saying:

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