VR.org SupporterSupporting Member
- Mar 17, 2015
- SOUTH FLORIDA
well here's the thing, there is resistance to being up with best practice for so many reasons, not least the time involved for the clinician. Then there is the psychology of clinicians involved in INR, they really are at the bottom of the Hospital Pecking Order. You'll probably notice that even orderlies at the hospital are more powerful.
Basically surgeons shrug off INR to someone else, and nurses too are only involved gathering the information and plugging it into a system which tells them what to do. They literally have no clue. I learned recently in the UK that one such system (called Dawn) has a claimed efficacy of <55% in range. Wow ... I can do about that with my magic 8 ball INR method for dosing management:
Given that nobody in the structure takes accountability for your INR swings, and worse how many people just don't do what they're told we have the situation we are in now.
Another way to look at it is this: the data shows that the biggest problem is patient compliance (taking their drug) and so from the perspective of a bureaucratic and authoritarian institution like a hospital taking control out of your hands and investing it in their hands is the "safest way" (as they see it).
informed is really a vexed question for so many reasons, not least of which is you are in a position of confusion and from what I've read here utter irrational panic in some cases.
I'd say that this persists well after surgery with the stories we tell ourselves to firm up the confidence we've mad in our decision of who to believe.
Ultimately that is what this place really does. Gives a place where you can rub shoulders with actual people, see and observe what they did and why and then make up your own mind about what you learn here.
Thank you again my friend, I edited that post you just answered to, and added something that I believe needed to be added, read again, if and when you have a moment, HHO [and also, agreed with everything you now just said! what did ya say doc? the bill is in the mail! NP]