late entry....what is good?

What is good? And how is it obtainable? What began as an ideal has been lost to the reality of profit, politics, and spools of red tape. I got into my current career for two reasons.....first and absolutely foremost, to do good and have a chance to impact people's lives in a positive and helpful manner by supplementing what was lost or never had. Secondly, to make a living of course. The second is of small consequence. I don't have aspirations of great wealth; just enough to live the life I choose and have enough left over for savings just in case shit happens (as it's prone to do), as well as hopefully provide for a family someday. Classic American dream....with one problem. While the second aspect is being realized to some degree...the first is not. My good friend Sean once said "twixt the cup and the lip, there's many a slip". Very true. He also was the first to introduce me to this phrase: wish in one hand and shit in the other....see which gets filled first. Oftentimes my naievity has gotten the better of me, even when I thought I had experience with the subject. In this case, it was my career. I've worked in the orthotics and prosthetics field for approximately 4 years, but I still am just coming to terms with what the job really entails. As my experience grows, so does my loathing of what I have to do. Which brings me to my first point, profit. As with all companies, we have to remain profitable. This is okay, this is the nature of business. Nobody is in business to lose money. However, the way the money is made is what bothers me. In my short time in Columbia I've seen things that I morally and ethically cannot accept. A few that come to mind are providing more expensive/intrusive orthotics than a person physically needs, providing orthotics that won't make much of a difference in the patient's lives/rehabiliation, providing unnecessary services, and providing expensive orthotics that anybody can find for dirt cheap at most pharmacies. The one that weighs most heavily on my head at this hour is providing unnecessary services. There can be no better example than the services I provide to inpatients at the hospital...mostly patient's in the icu. Over the last weekend and today, I provided cervical collars to at least 5 patients that probably didn't need them. The reason is this....some of these people are unconscious/intubated/drugged and the doctors can't completely clear their cerivcal spines of injury since the patient's can't tell them whether or not they feel pain there. The fucked up thing is that these patients have x-rays/cat scans that show that they have no fractures. But, just to be safe, the doctors put them in cervical collars regardless. Here's where the real fucked up part comes into play. Some of these patients are admitted to the hospital concious and aware. They tell the doctors that they don't feel pain in the neck, and x-rays/cat scans confirm no injury. But, for one reason or another, these patients have to be intubate or drugged. After that, overly stringent guidelines come into play and they have to have a cervical collar placed because they can no longer say they have no pain.....even if that fact has already been recorded. So, basically I'm putting an expensive brace on the patient that doesn't even need it. Some of them have it removed in as little as 24 hours. Last week, one patient only had the brace on for 20 minutes. Yet, I still have to do my job because I'm like a pharmacist. If it is ordered...it has to be dispensed. This not only cost the patient/insurance company...it costs me valueable time. This covers the red tape section as well, as these are documented hospital policies. This bothers me, but not near as much as the politics. Often I feel as if I'm only there to suck the doctor's dicks. Our business hinges on referral sources. So, a main part of our job is to be at the doctor's need. It doesn't sound so bad, until you realize that it basically makes us slaves to doctors. When they call us, they want us right then and there...regardless of what we may already may be involved in. Most of the time it isn't anything major, and the doctors could send the patient to our office with a prescription instead of us having to drop everything and go see them. It's a major disservice to the patients that have a valid appointment. I honestly think it's just another way for doctors to assert control and feel more important that they actually are. There's a huge difference between an emergency surgeon and a doctor that see's people for foot pain or a sprained knee. More importantly, since the doctors are our livelihood, what they say goes..even if they are wrong. Most doctors have only limited training in orthotics and I often see prescriptions for patients that are overprescribing, underprescribing, or just plain contrainicated. Yet we are expected to fill that prescription and not ask questions....just in the rare event that we may offend the doctor and lose them as a referral source. IT IS FUCKING SICK. Of course, not all doctors are complete assholes....some will listen to other ideas, especially residents. However, there are some doctors that are so adamant that they are right that they won't listen to reason. It truly is digusting. Imagine making a phone call to doctor to debate a prescription, knowing that what they are asking for is completly unecessary or even wrong, just to have them completely ignore rationality and open discourse. This has happened to me on more than one occaision. So, what do you do? You fill the prescription like a fucking monkey knowing that it is wrong just so you won't piss off the doctor. And, wouldn't you know, the patient comes back to you having more pain than they did at the onset. I have had some vindication by trying my idea after a doctor's prescription failed, and lo and behold......my idea was succesfull. It's this concept of bowing to the politics of a doctor that truly makes my job frustrating and disheartening. I feel helpless to do what is right...which is why I got into this business in the first place. So, this brings us full circle to the topic of what is good. Is following orders good? Is doing something you know isn't the best course of action good? It's good for the company....they profit. Is providing a service that isn't needed in the name of safety and red tape good? It does cover people's asses. Is good following your education and experience to do what you believe is appropriate. Not if you want to remain in good standing. It doesn't take crayons and a big chief tablet to show you the dichotomy that I face in my career. So why do I do it? I do it for the rare instances when a doctor is either generic in their prescriptions or genuinely open to suggestion so that I can do what's right. I do it for when I see a child that could honestly benefit from my help......not just to appease a parent's skewed point of view of what their child can accomplish. I do it for adults that have limitations on how they want to live their life, but can't due to pain or injury or disease. I do it to prevent further injury in ingnorant patients that have been mislead by inexperienced profiteers. I do it because sometimes I am the last option besides permanent surgery for people who don't want that. I do it for people that can't afford my services but need it anyway. So, is that what is good? I would like to think so. Hopefully with experience, knowledge, and growing trust from the doctor's that run my life I can make a difference in people's lives eventually. But, for now, I'm in living hell.....at odds with what is right and what I have to do to survive.

Fear and loathing in Columbia,
-J