The University of California has ten campuses. Each has a risk manager. The University of California also has five medical centers, each with a risk manager. You would think the campus and med center risk managers have a lot in common. But I never saw it.
From my perspective, the campus risk managers were Labrador Retrievers: friendly, sociable, and adaptable. When a bad thing happened, our first impulse was to crack jokes and create emotional distance before engaging the problem, which we treated in proportion to its impact and likelihood to recur.
Not so med center risk managers. They were Pit Bulls, charging straight at any perceived threat, big or small, and clamping down full force, not letting go until they were sure the threat was twice-over dead. In all my years working with them, I counted just one for whom humor and distance were innate; the rest regarded those traits as annoying concessions to the rest of humanity.
Until I spent a week in a (non-UC) hospital, though, I didn’t realize how strong a grip medical center risk managers have gained over their domains. I can understand why. Every time a hospital amputates the wrong limb or leaves a forceps in someone’s torso or suffers a cluster of MRSA infections, it makes the news, and the public’s confidence in the hospital plummets. Then, of course, there are the myriad but less spectacular liabilities, like patient slip-and-falls. Year in, year out while I was at the University of California, Workers’ Compensation was the costliest line of self-insurance across the system — but Medical/Hospital liability was a strong second.
So I understood why my feet were bound in non-slip booties once I was admitted to the hospital. And I understood how every couple of hours, even through the night, someone took my vital signs and made sure I wasn’t in distress. And I understood why I was asked to confirm my birth date every time I was handed a pill. And I understood why I was shot in the stomach with Heparin twice daily. And I understood when the surgeon stopped by the morning of my operation, asked me to confirm which side he’d be operating on, then whipped out a purple Sharpie and scribbled what might have been his signature on the spot I named.
But at a certain point it became too much. I was put on the cardiac floor, where every patient has to wear a heart monitor. As the nurses struggled to make numerous electrodes stick to my un-manscaped chest, then wired those electrodes to a heavy, cell phone-sized transmitter in the chest pocket of my gown, I explained that I wasn’t a cardiac patient, had never suffered a hint of cardiac trouble, and had no history of cardiac problems on either side of my family. Doesn’t matter, the nurse said, every patient on this floor must wear a monitor. And, she forgot to mention, get awakened at all hours when an electrode comes loose and the monitoring station registers the interrupted signal.
How Catch-22. I half-expected to be dabbed with mercurochrome next.
The result of all this risk-managed care? I never got to sleep, nap, or even relax for long. I was always having my IV changed, having a thermometer stuck under my tongue, feeling someone fumbling under my gown (in a chaste way) to reconnect an electrode, etc. Yet when I needed something, often no one was there, usually because the good nurses (the great majority) were abusively overworked and the bad nurses were too burned out to care.
I came to envy the control hospital risk managers have gained over their institutional operations. And I had to concede their success: the hospital fixed me without any mistakes (that I know of). But the hospital also left me unhealed, utterly emptied of energy, acuity, and spirit. And I can’t help but think that’s partly a consequence of risk-managed medicine’s beat-the-small-stuff-to-a-pulp, emotionally stunted character. I continue to admire what med center risk managers do, but not how they do it.