Thursday, October 05, 2006

Training the Noctor II

It has been decreed that the admissions unit nurses should be able to order chest x-rays. This is being done for the best of intentions, as it will speed up the process of assessing them and deciding on appropriate treatment and placement.

But, in order to order a chest x-ray one must be able to examine a chest so as to determine whether an X-ray is required and what it will add to the diagnostic process. Although it may appear to the untrained observer that almost all medical admissions get a chest x-ray this is far from the truth, and an x-ray in isolation will not make a diagnosis.

But the great and the good have decreed that it shall be so. Dr SM got raked into helping ‘teach’ the nurses. Having examined ten chests they were then issued with their stethoscope, presumably to be worn as a badge of a Noctor and henceforth were given the responsibility of ordering a patient be exposed to ionising radiation.

The problem is that the nurses did not know the underlying anatomy and could not distinguish between a normal chest and an abnormal one, let alone the difference between pulmonary oedema (fluid on the lungs) and fibrosis (scarring), pneumonia or a pleural effusion (fluid around the lungs). All noises were described as ‘wheeze’ even if it was not.

This is because they are inexperienced. When Dr SM was a first year medical student he equally wielded his stethoscope with as much ignorance, and it took five years of listening to countless chests under the watchful eyes of his seniors before he was given the responsibility of exposing patients to ionising radiation.

But it looks good on the balance sheet and the nurses get to play at being doctor, so that’s all right then.

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