Living Columns & Blogs

Our Lives: Why I am a policy connoisseur

I have a confession to make. I’m a connoisseur. Sadly, perhaps, I’m not a connoisseur of artisanal cheese or art from precolonial East Africa. Instead, I’m a connoisseur of policies, which isn’t a claim made by many of my physician colleagues.

Whether they like policies or not, though, my colleagues would certainly agree that there’s no shortage of policies for a policy connoisseur to savor. Medicare, our Old North State, the N.C. Medical Board and my own hospital are all policy-producing machines. Each has a list of policies as long Rapunzel’s hair, governing everything from managing chemotherapy spills to handling doctors who show up to work drunk.

Honestly, it’s not hard to be a policy connoisseur. Work in medicine for a while. Encounter problems, dilemmas, ethical and legal issues. Then find the policies that address them. Suddenly, you’re a connoisseur.

And what policies does a connoisseur favor? Often, they’re the ones that help us in the middle of the night.

High on my top 10 list of useful policies is the policy on surrogate decision-makers. It tells us who makes decisions for patients when they’re knocked out after a moped accident or delirious from a gangrenous gall bladder.

When the estranged-but-not-divorced wife is standing by the right side of a patient’s bed and the baby-mama is on the left, and the patient’s 21-year-old daughter is on the phone from her deployment in Afghanistan, who gives permission for treatment? Who agrees to an operation?

Off the top of your head, you might not know the rank order of surrogate decision-makers. It’s in the policy corner of the hospital website, though, and when you need it at 2 a.m., you don’t have to be a policy connoisseur to be grateful to the person who wrote it.

Another sad but handy policy is the one on who can declare someone dead. Does it have to be a doctor? Can the nurse do it, or the nurse practitioner? Can it be a resident physician? Sure, it doesn’t come up every 10 minutes, but it’s nice to know it when you need to, so you can send the right person to the bedside.

And since we’re talking about it, the policy for filling out death certificates is also helpful. Black pen only and no erasures, abbreviations or strikeouts. Plus, only some causes of death are “acceptable causes” on a death certificate. Since nobody, thankfully, fills out death certificates every day, the policy connoisseur recommends a quick visit to the written policy when you find yourself having to do one.

Good policies are often more than just practical. One of my favorites is the Service Animal Policy. For years, it was how we should interact with patients and their seeing-eye dogs. Then the role of service dogs expanded. The policy morphed to include dogs for the hearing impaired and therapy dogs for patients with post traumatic stress disorder. I liked the policy because I like dogs, and I felt that it accorded them the respect that they deserve.

Then some time within the past decade, the “miniature horse” surfaced as a service animal, and the policy expanded to include them too, including a definition of the “miniature horse” (24 to 34 inches at the shoulder).

When I encounter this incarnation of the policy, I always imagine a post-op appendectomy patient showing up with a Shetland pony. That, of course, makes me laugh, which can’t be said of too many policies. So I give this policy a thumbs-up.

We can definitely use a couple of funny policies in the world of organized medicine.

I could babble on about policies – the smoking policy (not on hospital property), the policy on drug-company pens (don’t accept them), the policy on naming the unidentified patient (they’re not numbers). I won’t go on, though, except to say this:

Hospital policies are more than rules. They’re artifacts of hospital culture, which is why I like them. Individual caregivers and patients may tell you their own stories, but if you want to know the breadth and depth of what we see and do in the hospital, you can’t do better than to simply to read our policies.