I’LL Give You A Comment

Was reading through several of the journals that have piled up on my desk over the past couple of week. One short article that caught my eye in ACEP News (page 13) was the latest “standard” the Joint Commission (aka the “Medical Marijuana Advocates“) is exploring.

Because “nearly one-third of all persons using hospital emergency services use alcohol in hazardous or unhealthy ways,” the Medical Marijuana Advocates are now suggesting that we should begin screening and counseling every patient in the ED for alcohol use/abuse.

In other words …

While we’re seeing more patients with less ED facilities
While we’re providing more complex care with less availability of specialists
While our emergency departments are overcrowded with patients and we have little if any reserve for emergencies
While the 2006 IOM Report says that the root cause of many of these problems is underfunding

and …

While intoxicated trauma patients come in with no blood pressure and their guts hanging out of the side of their chest …
-or-
While intoxicated patients do not cooperate with your attempts to try to stabilize them, blurting out slurred strings of obscenities while spitting at you, threatening to sue you, and getting various forms of dirt and assorted excrement all over your clothes …

-and-

While we are already forced to screen ED patients for domestic violence, TB, depression, drug interactions and who knows what else in addition to the patient’s chief complaint of “belly button lint won’t come out” …

-NOW-

We’re supposed to take a “brief” 15 minute intervention to determine whether each and every patient drinks and to provide counseling to those that do drink to make sure that they drink responsibly and that no one is abusing alcohol.

Great idea.

I can see it now.

OK, Mrs. Peel, I know that your life is hanging on the line and that every minute counts, but while I’m intubating you, putting in a chest tube, setting your broken femur, trying to figure out why your blood pressure is 83/palp, discussing your case with five different consultants, and begging them to come in to help me …. umm … do you think that your drinking may be contributing to an overall decline in your health? How’s that working for ya?

So, oh Purveyors of Medical Marijuana … what’s next?
Mandatory colonoscopies in the ED to screen for polyps?
How about mandatory dental services so we can randomly use a pair of ViseGrips to pull any teeth we deem rotten?
Maybe we should also have a mandatory home checks on all of the patients that come to the ED. After work, the ED staff can split up and go to all of the homes of patients to make sure that there is no dirt on the floor and that there is no risk for a fall (wouldn’t want a “never event” happening at home, now would we?).

Joint Commission “standards” are part of the problem and not part of the solution. When you frustrate the remaining medical providers to the point that they want to leave medicine and you discourage young doctors from going into medicine, you create danger, not avert it.

But alcohol screening does save lives. So …

I propose that the Joint Commission contact every household in the US by telephone to do the alcohol screening itself. Don’t forget to document whom you talked to, their age, exactly what you said, and the follow up care that you arranged for them. Then E-mail it to me once you’re done so I can cite you for not doing it right.

The Joint Commission has set up a web site where interested parties can leave comments here.

Go for it.