Surgery, Regulations, and the Rainbow Connection

 

Actually, the latter topic is much more pleasant than the former two, so let’s start with the Muppets. The Rainbow Connection was the theme song for The Muppet Movie, back when there was only one Muppet movie and the title could afford to be general. Kermit the Frog is sitting in a swamp playing a banjo singing that song. A hopelessly lost talent scout wanders by; Kermit corrects his path. In return, the talent scout tells this frog he may have a chance in Hollywood. And so Kermit sets out on a journey.

Why are there so many songs about rainbows? What’s on the other side?
Rainbows are visions but only illusions; rainbows have nothing to hide.

When I was nine or ten I had an adverse reaction to some kind of cough syrup. Ambroxol or something like that. You haven’t heard of it? Neither has anyone else. I got it in a clinic in Bolivia of all places and I don’t think the stuff is even sold in these United States. But I had a reaction to it once and it’s in my medical records now.

So we’ve been told and some choose to believe it;
I know they’re wrong; wait and see

I went in for surgery the other day; without getting into the gruesome details I’ll say I’m down one gallbladder, that I wasn’t faking it, and that I’m doing much better now, thanks for asking. Here, let me show you my fancy bracelet. I kept it on for a couple of days so I could get back in without paying again.

This tells you either that I have an Allergy or am Clergy; it’s hard to tell thanks to the poor design. We can be reasonably sure I haven’t been dabbling in Metallurgy. 

Someday we’ll find it; the Rainbow Connection
The lovers and dreamers and me!

You can see I’ve got a ‘lergy. They gave me this bright red bracelet to let one and all in the surgery know that I have a potential reaction to a drug that’s completely irrelevant to the complaint. A drug of which I’d wager there’s not a dose within a thousand miles of me anyhow.

Who said that every wish would be heard and answered
Wished on the morning star?

This is bringing me around to the third topic here, which is regulation. The usual ways this goes I’d be complaining about FDA approvals because that drug isn’t around, or the legalities that require that bracelet where the fail condition is such an unlikely scenario, but the truth is I’m just waiting for the bit to come around in the song.

Somebody thought of that; someone believed it
Look what it’s done so far.

There we go. That’s the point of it all; a piece of information isn’t just a piece of information. Its weight is multiplied by the number of people who know it. Both the someone who thought of it and the someone who believed it. Every time I go over my medical records these days I have to talk about this stupid drug and why they’ve never heard of it. In theory, drug reactions are important information. In this case, it’s just a time-waster. My time, the nurse’s time, and the surgeon’s time.

What’s so amazing that keeps us stargazing?
What do we think we might see?

When you lay down a regulation — any regulation, however salubrious — just having the regulation doesn’t fix the problem. Let’s say you’re putting an upper limit on how much copper sludge a company can dump into the river. Somebody thought of it, but someone also has to believe it. The regulator has to think up the regulation. The company has to know the regulation is there. If they don’t know about the regulation it can’t have any effect. And then you also have to check. Someone has to keep an eye on them to make sure they’re following it.

Someday we’ll find it; the Rainbow Connection
The lovers and dreamers and me

The trouble here is that little costs add up. Think of it like packing a backpack. Do you want that extra pair of socks? They weigh nothing at all in your hand, but three hours on the trail and you’ll be able to measure their every microgram. Okay, but having clean socks after a long hike is probably worth it. The point of it is that those hours on the trail force you to think about your weight budget in a way that your dresser never does. Little costs add up.

All of us under its spell
We know that its probably magic

The cough medicine allergy is in my charts; the surgeon had to read it and understand it long enough to dismiss the concern. The surgeon with the knife sees the bracelet, and he has to stop and remember about that drug that doesn’t matter. It takes him an instant and he’s back on the job, but I don’t want my surgeon having to hesitate that instant.

Have you been half asleep? Have you heard voices?
I hear them calling my name

None of this is a criticism of the surgeon (who did an excellent job), or the hospital procedure, or even the anesthesiologist. (Despite where the song is lining up I was completely out of it for the entirety of the knifing.) I want the surgeon aware of potential allergic reactions, even ones that are pretty darn unlikely to come up. Maybe it’s never gonna happen with me. Maybe it will make a difference on the next patient. The point isn’t that these costs are never worth paying, it’s that we ought to remember that they exist at all.

Is this the sweet sound that calls to young sailors?
Can they be one and the same?

Really we’ve seen the whole story. Even when they solve real problems every regulation we add to the books causes problems, the minimum being that we now have more regulations to remember and abide by. Let too many of these problems creep up, bind together, and agglomerate and you end up with a tax code that’s too large and complicated for any man to actually understand. And even then it isn’t just one person’s problem; it’s multiplied by the regulator, yourself, your accountant, and your auditor.

I’ve heard it too many times to ignore it
It’s something I’m s’posed to be
Someday we’ll find it; the Rainbow Connection
The lovers and dreamers and me!

Published in Healthcare
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  1. HankRhody Freelance Philosopher Contributor
    HankRhody Freelance Philosopher
    @HankRhody

    I was having some difficulty getting the song to embed in the post, so let me just drop it in the comments:

    • #1
  2. HankRhody Freelance Philosopher Contributor
    HankRhody Freelance Philosopher
    @HankRhody

    And here’s the punk cover of the song if that one was too slow for you:

    • #2
  3. Doctor Robert Member
    Doctor Robert
    @DoctorRobert

    Hank, I understand your concern about the allergy to a nonentity.  Was it truly an allergy?  And do you truly know that the drug was a non-entity?   Ambroxol is in fact an actual cough drug, which Wikipedia tells me is used nowadays in Australia and Lithuania and a few other places.

    Perhaps you should have the allergy removed.  If not, have it clarified.

    • #3
  4. Blondie Thatcher
    Blondie
    @Blondie

    You’ve got a lot in there to jump off from. I’ll stick with what I know, the healthcare part. First, I’ve had people with allergies listed that weren’t allergies, per the patient. They didn’t know how they got in the chart. I can take it out of the EMR, but it is “still there” to see for those “cover every single thing listed” types will still ask about it to the dismay of many patients. 

    Next about the regulation on top of regulation. Thanks to an EMR, alerts pop up all the time for things that get added every time something new comes down the pike and nothing gets taken away. This causes is people to not read the alerts and click through them to get on to the task at hand. Most of these alerts get generated from CMS (aka government) regulations. 

    You guys keep reminding me why I’m glad I retired. I do miss my patients and some coworkers, but not the crap that went with the job. 

    • #4
  5. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    Doctor Robert (View Comment):

    Hank, I understand your concern about the allergy to a nonentity. Was it truly an allergy? And do you truly know that the drug was a non-entity? Ambroxol is in fact an actual cough drug, which Wikipedia tells me is used nowadays in Australia and Lithuania and a few other places.

    Perhaps you should have the allergy removed. If not, have it clarified.

    That’s reasonable.

    On the other hand, if it was a true allergy, you might want to keep it on your record.  Just in case there are similar drugs on the market.  We may not have Ambroxol in the states, but perhaps a cousin of that drug could create problems for you.

    I’ve never heard of the stuff, and I don’t know if there are related drugs on the American market.  Just a thought.

    • #5
  6. Full Size Tabby Member
    Full Size Tabby
    @FullSizeTabby

    HankRhody Freelance Philosopher: Really we’ve seen the whole story. Even when they solve real problems every regulation we add to the books causes problems, the minimum being that we now have more regulations to remember and abide by. Let too many of these problems creep up, bind together, and agglomerate and you end up with a tax code that’s too large and complicated for any man to actually understand.

    This is the accumulated weight of regulation that I keep trying to bring up when a new regulation is proposed, and its supporters say (often correctly) that the cost of the new regulation to existing businesses is so small that no business will close because of the new regulation or no employee will be laid off. But I want people to think of the entrepreneur who is thinking about getting into the business. That new regulation is piled on top of 30 or 50 or 100 preexisting regulations. No one of those 30 or 50 or 100 regulations was burdensome enough as it was added to cause any then-existing business to close. But, the prospective entrepreneur is not looking at one new regulation. He is looking at a pile of 31 or 51 or 101 regulations. Is it not probable that as “minimal” new regulations are added, the cumulative pile of regulations becomes large enough that the prospective new business owner says, “Forget it.” 

    • #6
  7. MarciN Member
    MarciN
    @MarciN

    I agree that regulations will eventually cause our premature demise, :-), but I don’t think I would attribute the allergy-listing problem to regulation. It’s been a standard question and concern in all medical settings throughout my entire life.

    My organization hosted a three-day exchange concert with 40 orchestra members from Canada. I had to prepare a health questionnaire for the kids for the chaperones and hosts to have. At the top of the list was “Does your child have any allergies?” because I knew the ER doctors would want that information first. :-) The ER pediatricians had trained me well. :-)

    • #7
  8. Flicker Coolidge
    Flicker
    @Flicker

    Doctor Robert (View Comment):

    Hank, I understand your concern about the allergy to a nonentity. Was it truly an allergy? And do you truly know that the drug was a non-entity? Ambroxol is in fact an actual cough drug, which Wikipedia tells me is used nowadays in Australia and Lithuania and a few other places.

    Perhaps you should have the allergy removed. If not, have it clarified.

    Or I’d take a sip and see what happens.  Just to know.  Maybe you can get it on Alibaba.

    • #8
  9. Henry Racette Contributor
    Henry Racette
    @HenryRacette

    WARNING: The dye used in this Ambroxol allergy-warning wristband may contain chemicals known to the State of California to cause cancer and/or birth defects or other reproductive harm.

     

    • #9
  10. EJHill Podcaster
    EJHill
    @EJHill

    I like the drug adverts on TV.

    “Here’s a new wonder drug called ‘Xaxzacalimbis…’ It can cure you of your disease but may cause drowsiness, diarrhea, dry eye, bleeding in the lungs, tinnitus, infertility and in severe cases anaphylaxis and death. Tell your doctor if you have been exposed to tuberculosis, AIDS, Covid-19 or Ebola…”

    And then the kicker.

    “Do not take Xaxzacalimbis if you’re allergic to Xaxzacalimbis.”

    Ok. How do I find out if I’m allergic to Xaxzacalimbis? Well, ya gotta take it first…

     

    • #10
  11. kedavis Member
    kedavis
    @kedavis

    I am – or at least was – allergic to St Joseph’s Children’s Aspirin, which also hasn’t been a concern for many years.  It still exists, but there would be no reason to give it to me, and the formulation may have changed many times in the intervening years.

    I’ve had other allergic reactions over the years, mostly to a couple treatments that were tried for my chronic ulcerative colitis:  6MP, and more recently Azathioprine.  I had my own gall bladder surgery almost 2 years ago, and the Azathioprine issue wasn’t discovered until after that, but they wouldn’t have given me Azathioprine for my surgery anyway.  Because of those factors, I don’t get allergy bracelets when I go to a hospital.

    The main problem as I see it is when people don’t know they have an allergy until something comes up when they might receive something in an emergency situation, and the reaction might actually be what kills them.

    • #11
  12. HankRhody Freelance Philosopher Contributor
    HankRhody Freelance Philosopher
    @HankRhody

    Doctor Robert (View Comment):

    Hank, I understand your concern about the allergy to a nonentity. Was it truly an allergy? And do you truly know that the drug was a non-entity? Ambroxol is in fact an actual cough drug, which Wikipedia tells me is used nowadays in Australia and Lithuania and a few other places.

    Perhaps you should have the allergy removed. If not, have it clarified.

    I was a kid at the time, and I don’t recall it all that well, but I got this bright red rash all over me. Seeing as I hadn’t had an allergic reaction before then and not another for a couple decades I figure that it being the drug in question is a reasonable inference. I haven’t had occasion to test the theory for a good while now.

    • #12
  13. HankRhody Freelance Philosopher Contributor
    HankRhody Freelance Philosopher
    @HankRhody

    Blondie (View Comment):
    Next about the regulation on top of regulation. Thanks to an EMR, alerts pop up all the time for things that get added every time something new comes down the pike and nothing gets taken away. This causes is people to not read the alerts and click through them to get on to the task at hand. Most of these alerts get generated from CMS (aka government) regulations. 

    I had a brief conversation with the nurse in the recovery room. “I hate audible alarms” I said, as the machine next to me was beeping. “I wrote a paper about alarm fatigue” she says. It was part of her continuing education. That’s all the further I got on that topic. You’ll have to forgive me; I was mildly indisposed.

    • #13
  14. HankRhody Freelance Philosopher Contributor
    HankRhody Freelance Philosopher
    @HankRhody

    MarciN (View Comment):
    I agree that regulations will eventually cause our premature demise, :-), but I don’t think I would attribute the allergy-listing problem to regulation. It’s been a standard question and concern in all medical settings throughout my entire life.

    Oh I get that; I wasn’t proposing this as a regulation that needed to be cut, just as an example of how having to know about everything stacks up.

    • #14
  15. HankRhody Freelance Philosopher Contributor
    HankRhody Freelance Philosopher
    @HankRhody

    kedavis (View Comment):

    The main problem as I see it is when people don’t know they have an allergy until something comes up when they might receive something in an emergency situation, and the reaction might actually be what kills them.

    Sure; and there’s no denying that. But it’s also not something you go over with in the questionnaire with the nurse beforehand. “Do you have any allergies unknown to you to that you aren’t telling us about?”

    • #15
  16. HankRhody Freelance Philosopher Contributor
    HankRhody Freelance Philosopher
    @HankRhody

    EJHill (View Comment):

    “Do not take Xaxzacalimbis if you’re allergic to Xaxzacalimbis.”

    Ok. How do I find out if I’m allergic to Xaxzacalimbis? Well, ya gotta take it first…

    First of all, well done on the drug name. I may have to steal it for a mad wizard living alone in a tower in my D&D campaign. (This is a standard game I play with drug names. Where did they steal it from? Zyzax captains his invasion fleet from the planet of Zoloft. Hours of fun.)

    Secondly, this particular problem I attribute to our lawsuit culture, where “The injured party was dumber than a box of rocks” is no defense. How are they going to know not to kill themselves with an allergic reaction if a TV commercial hasn’t told them not to?

    • #16
  17. CarolJoy, Not So Easy To Kill Coolidge
    CarolJoy, Not So Easy To Kill
    @CarolJoy

    HankRhody Freelance Philosopher (View Comment):

    Doctor Robert (View Comment):

    Hank, I understand your concern about the allergy to a nonentity. Was it truly an allergy? And do you truly know that the drug was a non-entity? Ambroxol is in fact an actual cough drug, which Wikipedia tells me is used nowadays in Australia and Lithuania and a few other places.

    Perhaps you should have the allergy removed. If not, have it clarified.

    I was a kid at the time, and I don’t recall it all that well, but I got this bright red rash all over me. Seeing as I hadn’t had an allergic reaction before then and not another for a couple decades I figure that it being the drug in question is a reasonable inference. I haven’t had occasion to test the theory for a good while now.

    I have an allergy to penicillin, and for about 15 years doctors got severely disturbed that I “was insisting on clinging to an allergy you might have grown out of.”

    As a baby, a shot of penicillin had produced an anaphylactic shock event mitigated by Epinephrine.

    Luckily a girlfriend who was a chemist and who had noticed that my fingers broke out in a rash whenever I handled blue cheese, which frequently has penicillin in it, told me to mention this fact to doctors when they pressured me.

    I did and then they shut up about it. (I guess s doctors like to be able to use penicillin for some infection or other, but I had great results with all available penicillin substitutes.)

     

    • #17
  18. CarolJoy, Not So Easy To Kill Coolidge
    CarolJoy, Not So Easy To Kill
    @CarolJoy

    Hope your recovery is going smoothly and you are back in top form soon.

    And glad you are short one gall bladder rather than one liver.

    Also – lucky you. The health personnel actually read yr personal medical history.

    I can’t even remember a single time when a doctor has  referred to my med history. Next time I switch doctors I am tempted to write out how both parents died of ebola, or elephantitis, just to see if the history gets read.

     

    • #18
  19. kedavis Member
    kedavis
    @kedavis

    CarolJoy, Not So Easy To Kill (View Comment):

    Hope your recovery is going smoothly and you are back in top form soon.

    And glad you are short one gall bladder rather than one liver.

    Also – lucky you. The health personnel actually read yr personal medical history.

    I can’t even remember a single time when a doctor has referred to my med history. Next time I switch doctors I am tempted to write out how both parents died of ebola, or elephantitis, just to see if the history gets read.

    Sounds like a good idea.  As the story goes, the reason the band Van Halen put the “no brown M&Ms” thing into their contract was not to be divas, but to find out if the concert venues they dealt with, actually read the contract.  If they showed up for a performance and there were no non-brown M&Ms in their dressing rooms/whatever, they would check to make sure all of the stage equipment was correct, because they knew that the people hadn’t read the contract.

    • #19
  20. MarciN Member
    MarciN
    @MarciN

    HankRhody Freelance Philosopher (View Comment):

    MarciN (View Comment):
    I agree that regulations will eventually cause our premature demise, :-), but I don’t think I would attribute the allergy-listing problem to regulation. It’s been a standard question and concern in all medical settings throughout my entire life.

    Oh I get that; I wasn’t proposing this as a regulation that needed to be cut, just as an example of how having to know about everything stacks up.

     I figured you knew that. So I don’t know why I wrote that. :-) Hot day on Cape Cod. :-) 

    • #20
  21. Randy Weivoda Moderator
    Randy Weivoda
    @RandyWeivoda

    HankRhody Freelance Philosopher:

    This tells you either that I have an Allergy or am Clergy; it’s hard to tell thanks to the poor design. We can be reasonably sure I haven’t been dabbling in Metallurgy. 

    At first glance I thought it said “Leroy.”  You do use an alias when you check into a hospital, right?

    • #21
  22. Judge Mental Member
    Judge Mental
    @JudgeMental

    Randy Weivoda (View Comment):

    HankRhody Freelance Philosopher:

    This tells you either that I have an Allergy or am Clergy; it’s hard to tell thanks to the poor design. We can be reasonably sure I haven’t been dabbling in Metallurgy.

    At first glance I thought it said “Leroy.” You do use an alias when you check into a hospital, right?

    That’s the right way for Hank to go into an OR, like a hero.

    “LEEEEEEEROY JENKINS!”

    • #22
  23. HankRhody Freelance Philosopher Contributor
    HankRhody Freelance Philosopher
    @HankRhody

    Randy Weivoda (View Comment):
    You do use an alias when you check into a hospital, right?

    Depending on the complaint.

    • #23