Doctors orders are held captive by a greater power

While few would admit it, and while you might find it hard to believe, most doctor orders are not necessarily what the doctor ordered.  In fact, most doctor's orders, and even some diagnosis's, are made for some other reason other than that they are needed.

Confused?  Well, if you don't work in the medical field so you can see it for yourelf, you probably are.  And considering we're all about honesty here at the RT Cave, I'm one of the few who will come right out and tell you that probably about 80% of the stuff doctors order is bull.

Now don't start thinking I think doctors are bull.  Doctors are brilliant.  I completely respect doctors.  They simply find that they have to order things just... well, just because.  It's just the way it is.  They don't have a choice. 

For example, here are some of the reasons many doctor's orders are bogus:

1.  Order sets:  the doctor didn't order the procedure, it was simply part of an order set for whatever your diagnosis is.  For example, if you are admitted to the hospital and your diagnisis is pneumonia, then you will get breathing treatments every 4-6 hours whether you need them or not.  I bet most doctors don't even know treatments were even ordered. 

2.  Intensity of Service:  This is part of the reason many hospitals create order sets.  In order for the patient to meet criteria for admission, you have to show that the patient needs to be admitted.  If a patient is admitted with pneumonia and you didn't order a breathing treatment, then some person sitting in a leather chair 3,000 miles away from the patient might think something like:  "If that patient didn't need a breathing treatment, then why did he need to be admitted?  Reimbursement DENIED!!!!!  To prevent this, the doctor better order whatever he thinks the government requires for said diagnosis. A treatment might not be needed, but so what. 

3.  Fake Diagnosis:  So you're scheduled for a pulmonary function test (PFT), yet your diagnosis is diabetes.  The doctor knows most insurance companies only cover PFTs if the diagnosis is COPD, cystic fibrosis, or asthma.  Even though your doctor obviously thinks you need a PFT, your insurance won't cover it unless he lies.  This should explain why on the PFT order form he gave you to take to the hospital it has "asthma" on the line next to diagnosis instead of diabetes.

4.  To cover their asses:  Doctors don't want to be sued, so they order whatever they think is needed so it looks like they did their best.  Much of what we do in the hospital has no medical benefit whatsoever, and the only reason we do it is becasue the doctor wanted to cover his own butt from potential litigation.

5.  Habit:  Doctors have a set list of things they order for each diagnosis.  After a while he simply writes orders based on habit and may not even know what he wrote.  For example, we have one doctor who orders breathing treatments for all his post operative patients.  I asked him why he writes this order once and he said, "What's a breathing treatment?"  Yet he continues to write the order.  It's for this same reason many foley catheters are inserted into patients and other invasive procedures performed.  Since no one questions the doctor, he has no incentive to update his ordering habits.

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