One of the things that I have written about from time to time on this blog is the the way in which the combination of rules based approaches with concerns about legal liability and the avoidance of risk have led to increasingly crazy outcomes. I wrote about this a lot while the girls were at school, for then I saw it all the time.
On Friday my colleague got a call from his son's school nurse saying the boy had an injury and that he should come to school to take the 10 year old to a doctor. The child's mother had been called too but was not available as she was in a business's meeting.
Very concerned my colleague got into a cab to home, then drove to the school to pick up his son. The child had a heavily bandaged knee, but could walk just fine, had next to no pain, and only a mild stinging feeling near the injured knee.
Upon arrival at the family doctor's clinic, the doctor unbandaged the knee; there was now no bleeding (child said there had been "A lot before"). After checking the date of the last tetanus shot, the doctor passed the child to support staff, a nurse. With professionalism, nurse stuck on a bandage after a bit of wound cleaning.
A little more than $50 was paid by the father, about $30 will be reimbursed by Medicare. In addition, and this is my comment not the father's, my colleague lost four or five hours charge time in addition to taxi costs to get home. This brings the total cost to over $900.
My colleague was cranky. To his mind, the case illustrated the deskilling of the school nurse and her disempowerment by concerns about legal liability or unduly concerned parents. "Yet all this", he wrote, " people need professionals and social medicine payments just to put a bandaid on a bruise. Common sense has been lost and we need it back!"
He is right, of course. Now when I talk about these cases, the response I get from some parents and others is simply better to be safe than sorry. I shudder at this.
Nursing is a profession, as is medicine. This involves judgement calls. Sometimes those calls may be wrong. The school nurse did not feel that she had the power to make that call despite the minor nature of the wound. Apart from some minor first aid that could have been done by anyone, she passed the responsibility to the parent and the doctor.
Doctors, too, are disempowered. There were a number of times I took the girls to the doctor after a school incident only to be told look, I think that she is okay. but to be on the safe side, you should take her to casualty for tests. In the end, it was easier just to go to casualty and spend the many hours there waiting to see the first available over-burdened doctor.
Am I wrong in thinking that all this is a bit crazy?