Here Come the Interns

When I started nursing back in the 70's, I witnessed first hand the truth of the old saying that the most dangerous time to be a hospital patient was the month of July, when the shiny new interns arrived. In those first thrilling, scary weeks of responsibility, we all worked to make sure those physicians lived up to their pledge to "first, do no harm." Well, America, our economy is in the intensive care unit and look out---here come the interns! Observing the brand spanking new Obama administration, I see quite a few parallels to medical centers in July.

Interns run the gamut of attitudes and abilities. Many of these brand new doctors are very well educated but somewhat inexperienced in actual interactions with patients. Obama is very well educated (so we're told, we've yet to see a college transcript) but he has very little experience with governing. The best interns I worked with were intelligent and aware of their shortcomings in the real world. They did not hesitate to ask for advice and help. The worst interns managed to squeak through medical school but had a chip on their shoulder the size of the Rock of Gibraltar. This type of physician wouldn't admit he was hopelessly out of his depth if his life (or the patient's) depended on it. From where I sit, President Obama is squarely in the Amateurish yet Arrogant camp.  Exhibit number one: Telling the Republicans
"I won." That reminds me of an green intern telling an experienced nurse, "Because I'M the doctor, that's why!"

What characterizes the Arrogant Intern? Here are some symptoms:

Eager to prescribe the "new" treatment, they toss out the tried and true. Cutting taxes worked for Reagan and JFK, but Obama is chomping at the bit to launch the New New Deal, even though the Old New Deal didn't work. (See
The Forgotten Man by Amity Shlaes). Closing Guantanomo Bay was all the rage in med school; unfortunately, the research isn't optimistic as to the consequences. Arrogant Interns may find the standards of care boring, but they didn't become standards by killing the patient.

Ordering another intervention when the first one hasn't had time to work. This is classic new practitioner behavior. The intern is told of a problem. He orders a medication. When no improvement is seen in five minutes, he orders another medication. Just days ago President Obama encouraged Congress to release the second half of the TARP funding. Now he's ordering close to a trillion more in spending (Stat!) telling the country that "We're in a crisis and we have to do something!" But Dr. Obama, you all did just do something. You spent 700 billion dollars. Let's all wait a bit and see if the last thing you ordered works before we overdose the patient and cause irreparable harm.

Focusing completely on the "numbers", they never really look at the patient. It's very easy to fall into the trap of picking up the chart, seeing a normal blood pressure and pulse and conclude the patient is doing just dandy. But experienced doctors and nurses see beyond the numbers. There have been times I have told an attending physician, "I can't give you any hard evidence, I just know something's wrong." Smart interns always pay attention to an experienced health care worker's instincts.

Arrogant Interns, however, dismiss warnings from underlings. One sees this behavior in the way the politicians dealt with the mortgage industry.  The numbers were great: home ownership up, stocks and profits through the roof. But people in the real world knew something was wrong. Ask yourselves a question: How many of you a year ago heard of a co-worker, or your wife's nephew, or some other person among your acquaintances getting a huge mortgage, and your first thought was, "What idiot gave that bozo a mortgage?" It didn't matter how great the numbers on the mortgage application were, you knew loaning that guy money was a colossal mistake. Now we're all paying for it.

Dr. Obama also seems to be ignoring the experienced realists with his stimulus package. Those in favor of massive spending can come up with all sorts of numbers as to why it should be passed. The realists look at it and conclude that not only won't it work; the patient might well be killed.

So what can conservatives do? Yes, it's true that Obama "won." It's true that on July 1st brand new interns all over America can write orders. But nurses and health care workers have a few weapons in their arsenal in defense of the patient. Conservatives need to keep in mind that their job is to be America's advocate. With that in mind, conservatives can try these tactics when Dr. Obama and his fellow interns are heading toward governing malpractice:

1. Always begin by politely stating why you disagree with his intervention and give him an opportunity to explain his reasoning. This step usually has no effect on an Arrogant Intern, but a cordial discussion is always a good place to start. And it's possible that the intern might actually listen to you.

2. As you try to guide the intern in what he should be doing for the patient, always interact in such a way that he is allowed to "save face."  I know how tempting it is be to be confrontational and announce to the world how dumb this new doctor is. But nurses---and conservatives---need to remember that in the middle of the crisis someone needs to be on the patient's side. The goal is to save the patient, not score points. I'm all for blowing your own horn later (maybe in the next campaign). But right now conservatives are the only ones standing between Obama, the Democrats and the death of the American economy.

3. If Dr. Obama insists on ordering flaky, dangerous interventions, delay, delay, delay! This is a great weapon that needs to be used more. I have heard of procedural tactics that can be employed to bottle up legislation for weeks. By the time legislators have exhausted all these tricks, who knows? Maybe the economy could start recovering on its own.

4. Enlist like-minded Democrats to your side. As much as I believe in the wisdom of nurses, Arrogant Interns loathe taking their advice. Frequently nurses have to request the assistance of others, such as the resident physician. Dr. Obama has spent so many years fighting conservatives that it is probably anathema to him to listen to them now. So sign up some Democrats to help you make your point. There are at least eleven of them in the House of Representatives.

Conservatives are showing signs of being America's advocates. The 100% opposition to the stimulus bill in the House is a great start. In the same way a patient sometimes needs a street-smart nurse to stand between him and the Arrogant Intern, America needs conservatives to stand between capitalism and the new administration. I can guarantee you won't be invited to a lot of White House cocktail parties, but you can be proud that because of you, the patient lives on.

Carol Peracchio is a Registered Nurse.
When I started nursing back in the 70's, I witnessed first hand the truth of the old saying that the most dangerous time to be a hospital patient was the month of July, when the shiny new interns arrived. In those first thrilling, scary weeks of responsibility, we all worked to make sure those physicians lived up to their pledge to "first, do no harm." Well, America, our economy is in the intensive care unit and look out---here come the interns! Observing the brand spanking new Obama administration, I see quite a few parallels to medical centers in July.

Interns run the gamut of attitudes and abilities. Many of these brand new doctors are very well educated but somewhat inexperienced in actual interactions with patients. Obama is very well educated (so we're told, we've yet to see a college transcript) but he has very little experience with governing. The best interns I worked with were intelligent and aware of their shortcomings in the real world. They did not hesitate to ask for advice and help. The worst interns managed to squeak through medical school but had a chip on their shoulder the size of the Rock of Gibraltar. This type of physician wouldn't admit he was hopelessly out of his depth if his life (or the patient's) depended on it. From where I sit, President Obama is squarely in the Amateurish yet Arrogant camp.  Exhibit number one: Telling the Republicans
"I won." That reminds me of an green intern telling an experienced nurse, "Because I'M the doctor, that's why!"

What characterizes the Arrogant Intern? Here are some symptoms:

Eager to prescribe the "new" treatment, they toss out the tried and true. Cutting taxes worked for Reagan and JFK, but Obama is chomping at the bit to launch the New New Deal, even though the Old New Deal didn't work. (See
The Forgotten Man by Amity Shlaes). Closing Guantanomo Bay was all the rage in med school; unfortunately, the research isn't optimistic as to the consequences. Arrogant Interns may find the standards of care boring, but they didn't become standards by killing the patient.

Ordering another intervention when the first one hasn't had time to work. This is classic new practitioner behavior. The intern is told of a problem. He orders a medication. When no improvement is seen in five minutes, he orders another medication. Just days ago President Obama encouraged Congress to release the second half of the TARP funding. Now he's ordering close to a trillion more in spending (Stat!) telling the country that "We're in a crisis and we have to do something!" But Dr. Obama, you all did just do something. You spent 700 billion dollars. Let's all wait a bit and see if the last thing you ordered works before we overdose the patient and cause irreparable harm.

Focusing completely on the "numbers", they never really look at the patient. It's very easy to fall into the trap of picking up the chart, seeing a normal blood pressure and pulse and conclude the patient is doing just dandy. But experienced doctors and nurses see beyond the numbers. There have been times I have told an attending physician, "I can't give you any hard evidence, I just know something's wrong." Smart interns always pay attention to an experienced health care worker's instincts.

Arrogant Interns, however, dismiss warnings from underlings. One sees this behavior in the way the politicians dealt with the mortgage industry.  The numbers were great: home ownership up, stocks and profits through the roof. But people in the real world knew something was wrong. Ask yourselves a question: How many of you a year ago heard of a co-worker, or your wife's nephew, or some other person among your acquaintances getting a huge mortgage, and your first thought was, "What idiot gave that bozo a mortgage?" It didn't matter how great the numbers on the mortgage application were, you knew loaning that guy money was a colossal mistake. Now we're all paying for it.

Dr. Obama also seems to be ignoring the experienced realists with his stimulus package. Those in favor of massive spending can come up with all sorts of numbers as to why it should be passed. The realists look at it and conclude that not only won't it work; the patient might well be killed.

So what can conservatives do? Yes, it's true that Obama "won." It's true that on July 1st brand new interns all over America can write orders. But nurses and health care workers have a few weapons in their arsenal in defense of the patient. Conservatives need to keep in mind that their job is to be America's advocate. With that in mind, conservatives can try these tactics when Dr. Obama and his fellow interns are heading toward governing malpractice:

1. Always begin by politely stating why you disagree with his intervention and give him an opportunity to explain his reasoning. This step usually has no effect on an Arrogant Intern, but a cordial discussion is always a good place to start. And it's possible that the intern might actually listen to you.

2. As you try to guide the intern in what he should be doing for the patient, always interact in such a way that he is allowed to "save face."  I know how tempting it is be to be confrontational and announce to the world how dumb this new doctor is. But nurses---and conservatives---need to remember that in the middle of the crisis someone needs to be on the patient's side. The goal is to save the patient, not score points. I'm all for blowing your own horn later (maybe in the next campaign). But right now conservatives are the only ones standing between Obama, the Democrats and the death of the American economy.

3. If Dr. Obama insists on ordering flaky, dangerous interventions, delay, delay, delay! This is a great weapon that needs to be used more. I have heard of procedural tactics that can be employed to bottle up legislation for weeks. By the time legislators have exhausted all these tricks, who knows? Maybe the economy could start recovering on its own.

4. Enlist like-minded Democrats to your side. As much as I believe in the wisdom of nurses, Arrogant Interns loathe taking their advice. Frequently nurses have to request the assistance of others, such as the resident physician. Dr. Obama has spent so many years fighting conservatives that it is probably anathema to him to listen to them now. So sign up some Democrats to help you make your point. There are at least eleven of them in the House of Representatives.

Conservatives are showing signs of being America's advocates. The 100% opposition to the stimulus bill in the House is a great start. In the same way a patient sometimes needs a street-smart nurse to stand between him and the Arrogant Intern, America needs conservatives to stand between capitalism and the new administration. I can guarantee you won't be invited to a lot of White House cocktail parties, but you can be proud that because of you, the patient lives on.

Carol Peracchio is a Registered Nurse.