Utter Rubbish: A Call for a Moratorium on the 4 AM Blood Draw

The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself.  Therefore all progress depends on the unreasonable man.  - George Bernard Shaw

Depending on the week and the driver, I am often awakened around 4 AM when one of several delivery trucks backs into the driveway of the restaurant beside my house, 15 feet from my bedroom.  Rankled, I have been known to open the window and have words with the driver, who, in my opinion, should park on the street, thus creating a distance between our house and his beeping, rattling, diesel-idling, polluting truck with its slamming ramps and gates and whatnot.  Because he mindlessly prioritizes a minute or so of his time over my and my wife's uninterrupted sleep.  Sometimes, we just get back to sleep before the next truck comes and awakens us again.

In relating this story to my father, he told me that the residents of a Northeast Ohio municipality recently passed a city ordinance banning the picking up of garbage before a certain hour, because of complaints of the noise and disturbance that the rubbish trucks cause at earlier hours.  Immediately drawing the analogy of the 4 AM phlebotomy visit in the hospital, my father wonders why, in the era of customer service, we subject the sick of society to this indignity and injustice while they're in the hospital.  And the answer is that I don't know.  A quick Google search is of little help.

There are two likely and possibly related reasons for the 4 AM blood draw.  First, in days of yore, physicians rounded very early in the hospital and then went to their office or to the operating room.  They wanted the lab results by the time they rounded so they could complete the rounding task and move on to others and not worry what Mrs. Jones' creatinine was all morning.  So, in essence, we have historically been awakening patients at 4 AM for physicians' convenience.

Behind Closed Doors Lurk Proxy Wars: Is Visitation Really About Visitation?

I decided to rewrite this today, on January 30th, 2016, after thinking about it for almost two years.

The previous post took on the heretical task of making the case against wide open visitation in the ICU without restrictions.  I took that stance for several reasons.  First, I'm a heretic and an iconoclast, and I believe that free thinking, rationality, and good judgment and decision making require all angles of a debate to receive their due - my goal is to keep the dialogue fire stoked.  Related to this, I sensed (and still sense) an agenda - open visitation is being pushed for ideological or financial reasons (yes, the almighty dollar - patient satisfaction scores are tied to Medicare reimbursement), professional associations such as the AACN are pushing the issue, and substandard data are being touted to support this agenda.  Next, it was and is my belief that because of the agenda, nurses' (and physicians') dissenting voices are being shamed into a collective hush by The Man, as it were, and that this censorship needed redress on this blog (it got redressed in 60,000 views and over 100 comments to the original post, still visible below.)  Furthermore, this institutionalized censorship may cause pervasive Hawthorne effects in any nursing survey that is done on the topic.  Finally, it was and is my view that if open visitation is the stated goal, there may be subgoals that are driving the desire for open visitation, and satisfaction of these subgoals through other means may be superior to open visitation for making everybody happy.  That is, desire for unrestricted visitation may be the symptom of an underlying disease and treating the underlying cause (such as poor communication) may cure both the disease and its symptoms.

Even if these considerations are cogent, reasonable and rational (which does not mean that they lead to the correct conclusions), there was a significant omission from my train of thought, small hints of which were peeking through from the text.  If some physicians and nurses don't want open visitation, maybe that too is the symptom of a deeper underlying disease that likewise could be addressed in other specific ways - and it thus follows that restricted visitation is not necessarily the solution that their symptoms demand either.