We have a few fetal heart rate monitors. We unfortunately have problems related to their use which outnumber them in a ratio of 2:1 to 3:1. The problems are not related to the hardware. They are related to the end users.
We were seeing our patients in the labor ward. On my way out, I saw a resident doctor who saw me at the same time, stopped in her tracks and ran back to the labor room. My sixth sense me go to the labor room, while I was wondering what I expected to see there. I found that there was a single patient in labor. Her fetal heart sounds were being monitored by this resident using a monitor. The transducer for fetal heart rate was held manually on her tummy by the resident, instead of being strapped with a nylon belt. I realized what the sixth sense had sensed. I had reason to worry about the transducer, because the quartz crystal inside breaks when the transducer falls down. It cannot be glued back. Replacing it takes a few thousand rupees, and a lot more number of months (not in thousands) going by the speed of work of the civic body workers.
"Who was holding the transducer in place?" I asked the resident. There was no answer.
"Was the patient holding it herself, was God's hand holding it, or the conducting jelly holding it?" I asked.
She did quick mental calculations, decided not to drag God into it, not lie since I was known to verify such answers by asking the patient about it, and said "The jelly was holding it".
"You have worked in my unit for 6 months. I think we both have failed in getting proper education for you. Or you would not do such a thing, knowing full well how to do it, how not to do it, and the financial and management reasons behind the method of using the monitor." I did not wait for the conventional 'Sorry, Sir' and went away, because there was more work to be done, and no degree of training seemed to work on her.
The next day found me taking a round of the same ward. There was another patient there, and another resident doctor. The fetal monitor was next to the patient, not in use at that moment. I picked up the transducer out of habit, and inspected it. It was covered by the conducting jelly, instead of being wiped clean as was the requirement.
"Did the doctor check you with this machine just now?" I asked the patient.
"Yes" she said and indicated the doctor concerned.
"Doctor, why have you not wiped the jelly off the transducer after using it?" I asked, though I knew the answer. The answer was she did not care or she was too lazy to do it. She knew I knew the answer. She just picked up a piece of gauze and proceeded to wipe the jelly.
"If the jelly dries on the transducer, it does not work well" I told her. "The manufacturer says that it must be wiped away after use. Which post are you doing?"
"Third" she answered briefly. She did not enjoy conversing with me, I thought.
"If you have not picked this up after one year and three months, the chances seem small that you ever will" I said and turned away because there seemed no point in stressing myself over an impossible situation. On my way out, I saw the resident doctor who had let the jelly do her job the previous day. My right brain had an idea and I called her to accompany me back to the labor ward. We reached the resident doctor who had left the jelly behind.
"Please put you mask down so that she can see your face" I requested the resident doctor in the ward. She did so, confused. "Dxxxxa, meet Nxxa" I said to the yesterday's resident doctor. "Nxxa, this is Dxxxxa" I said conversationally. Nxxa looked as if I was off my rocker. If both of them were from the same batch, obviously they knew each other. I should have known that. If she had known me, she would not have been so confused, I thought.
"I know you must have met before" I said. "I am introducing you to each other for a new quality that connects you together. Dxxxxa left the transducer on a patient's tummy yesterday, held there by jelly alone. You left jelly on a transducer today to let it become a sticky stuff, so that for Dxxxxa, some other doctor, or you yourself can leave the transducer on the next patient's tummy without anything like a belt or anyone holding it safely."
If they cannot remember the procedure of fetal heart rate monitoring despite clear and repeated instructions, perhaps a dose of sarcasm will make them remember it. Even as I thought so, I knew I was hoping against hope.
We were seeing our patients in the labor ward. On my way out, I saw a resident doctor who saw me at the same time, stopped in her tracks and ran back to the labor room. My sixth sense me go to the labor room, while I was wondering what I expected to see there. I found that there was a single patient in labor. Her fetal heart sounds were being monitored by this resident using a monitor. The transducer for fetal heart rate was held manually on her tummy by the resident, instead of being strapped with a nylon belt. I realized what the sixth sense had sensed. I had reason to worry about the transducer, because the quartz crystal inside breaks when the transducer falls down. It cannot be glued back. Replacing it takes a few thousand rupees, and a lot more number of months (not in thousands) going by the speed of work of the civic body workers.
"Who was holding the transducer in place?" I asked the resident. There was no answer.
"Was the patient holding it herself, was God's hand holding it, or the conducting jelly holding it?" I asked.
She did quick mental calculations, decided not to drag God into it, not lie since I was known to verify such answers by asking the patient about it, and said "The jelly was holding it".
"You have worked in my unit for 6 months. I think we both have failed in getting proper education for you. Or you would not do such a thing, knowing full well how to do it, how not to do it, and the financial and management reasons behind the method of using the monitor." I did not wait for the conventional 'Sorry, Sir' and went away, because there was more work to be done, and no degree of training seemed to work on her.
The next day found me taking a round of the same ward. There was another patient there, and another resident doctor. The fetal monitor was next to the patient, not in use at that moment. I picked up the transducer out of habit, and inspected it. It was covered by the conducting jelly, instead of being wiped clean as was the requirement.
"Did the doctor check you with this machine just now?" I asked the patient.
"Yes" she said and indicated the doctor concerned.
"Doctor, why have you not wiped the jelly off the transducer after using it?" I asked, though I knew the answer. The answer was she did not care or she was too lazy to do it. She knew I knew the answer. She just picked up a piece of gauze and proceeded to wipe the jelly.
"If the jelly dries on the transducer, it does not work well" I told her. "The manufacturer says that it must be wiped away after use. Which post are you doing?"
"Third" she answered briefly. She did not enjoy conversing with me, I thought.
"If you have not picked this up after one year and three months, the chances seem small that you ever will" I said and turned away because there seemed no point in stressing myself over an impossible situation. On my way out, I saw the resident doctor who had let the jelly do her job the previous day. My right brain had an idea and I called her to accompany me back to the labor ward. We reached the resident doctor who had left the jelly behind.
"Please put you mask down so that she can see your face" I requested the resident doctor in the ward. She did so, confused. "Dxxxxa, meet Nxxa" I said to the yesterday's resident doctor. "Nxxa, this is Dxxxxa" I said conversationally. Nxxa looked as if I was off my rocker. If both of them were from the same batch, obviously they knew each other. I should have known that. If she had known me, she would not have been so confused, I thought.
"I know you must have met before" I said. "I am introducing you to each other for a new quality that connects you together. Dxxxxa left the transducer on a patient's tummy yesterday, held there by jelly alone. You left jelly on a transducer today to let it become a sticky stuff, so that for Dxxxxa, some other doctor, or you yourself can leave the transducer on the next patient's tummy without anything like a belt or anyone holding it safely."
If they cannot remember the procedure of fetal heart rate monitoring despite clear and repeated instructions, perhaps a dose of sarcasm will make them remember it. Even as I thought so, I knew I was hoping against hope.
