We Are All at the Mercy of Idiots
by E. Noel Preston, M.D. 
email: whuffodat@hotmail.com

   One of the things I tell a new employee is not to worry about doing everything perfectly the first day or week or month on the job. The other staff members and I will be there to keep anything truly horrible from happening, and no matter how careful any of us are to do things exactly right, someone beyond our control is going to do something really stupid and make a mess of things. We are all at the mercy of idiots. The good news is sometimes we get to be somebody else's idiot, and eventually it might all even itself out.

   After Susan had her heart attack her doctor gave her a certificate to get a handicapped parking permit. The certificate had a yes or no question: "Applicant is permanently disabled" and the doctor checked the "yes" box. At the Fulton County Department of Motor Vehicles the clerk gave Susan a red and white temporary handicapped parking permit instead of a blue and white permanent one. When I told the clerk Susan should have a permanent instead of a temporary parking permit, the clerk said the doctor had not answered the question "expected date of end of disability." I pointed out the doctor had checked the "yes" box for "Applicant is permanently disabled" and that there wasn't any expected date of end of disability. It didn't make any difference: Susan was going to have a temporary permit instead of a permanent one. Fortunately, it was almost 4:30 on a Friday afternoon and everyone at the DMV was ready to get out of there and go home. I insisted on speaking with a supervisor and said since I was a doctor too I could fill out a new application to get a permanent permit. They said "You can't do that! Just because you're a doctor doesn't mean you can fill out a new application," and I said "why not?" It was now 4:50 PM and the DMV people were getting restless. Finally they relented and gave us a blue permit. Who was the idiot? The clerk for not knowing a permanent disability had no expected ending date, or the doctor for not writing "indefinite" or "unknown" in the space for the expected ending date? Or was it me, for thinking I could reason with anybody at the DMV?

   I wanted to get Susan's son Robert a pair of brown Carhart jeans for Christmas. He wears a size 32-32 and I couldn't find that size and color at several stores. I called the Galyan's at Lenox and asked the clerk if he had any. He said he didn't know. I asked if he could check for me. and incredulously, he asked, "Do you mean you want me to go look for you?" Amazingly, I said yes, and he put me on hold and went away. I stayed on hold over ten minutes before hanging up. Now who's the idiot? The clerk, or the manager who hired him, or me, for thinking this dunce might actually try to be of service to his employer and his customer?

   The Medicaid refusal envelope came this afternoon and contained three claims refused for not having my provider number, but they did, and so the idiot wasn't in my office. But last week I was seeing a patient named Jason and had written over half my clinical notes into the record before I noticed an assistant had brought me his brother James' chart instead. OOPS! I'm glad I wasn't doing a spinal tap. Now who's the idiot? The assistant for bringing me the wrong chart, or me for not noticing it before I started writing?

   Now and then we hear of anesthesiologists killing patients because their technicians hooked up the oxygen hose to the nitrogen tank instead of the one for oxygen or surgeons operating on the wrong patient, or taking out the wrong kidney. The original good news-bad news joke was the surgeon telling the patient, "The bad news is we took off the wrong leg. The good news is the leg we were going to amputate doesn't need to come off after all."

   Most firearms accidents at home are from a gun everyone thought wasn't loaded. Dogs and little children fall out of the backs of pick up trucks because some inattentive dumbass didn't close the tailgate. A man can't put out a runaway fire in his barbecue grill because his garden hose is tangled and snarled in the shrubbery. The most common reason for serious transfusion reactions is not because of outdated or contaminated reagents or procedure failure, but because of clerical error. Someone misreads a blood type or a patient's name or room number, and a clerical error results in a tragedy.

   Sometimes people think making repeated fruitless effort makes up for incompetence. I had a medical student who stayed up until 4 AM looking through a microscope at nasty, foul-smelling sputum for tuberculosis germs, and he never found any. He wasn't lazy or dishonest or uncaring to his patients, but he couldn't name the five signs of an inflamed appendix. He was a wretched student and became a mediocre doctor. Stubbornly looking for tuberculosis germs that weren't there was a silly, stupid waste of time, effort, and material. His time would have been better spent talking with and examining his patient.

   So where does all this incompetence come from? Lord only knows, but I suspect it's because we've become overly concerned about building our children's "self esteem." If a student can't read or do his math assignment or remember to feed the dog or take out the garbage, we still tell him or her how "special" they are and how happy they make us. But is this doing our kids a favor? When they grow up and have to catch a plane to Miami, that plane is going to leave without them if they can't get to the airport on time -- and then who's the idiot? The likable, happy, incompetent goofball, or the incompetent's parents, who let their wonderful child turn into such a boob?

   Sometime ago I saw a needlework sampler someone crafted that said, "Pray to God, but row for shore." What an idiot!

E. Noel Preston, M.D. is a pediatrician in solo practice in Peachtree Corners. 6063 Peachtree Parkway, Suite 202-A, Norcross. (770) 448-1553.

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