Neither science nor sense can explain these idiotic and damaging rules, says ZDoggMD.
Following is a rough transcript of his remarks (Note: errors are possible):
Hey everyone, so recently a resident physician from a large academic center back East emailed me and mentioned, OK look, they're a second-year resident or something like that and I'm not gonna give away too many details to keep it anonymous, and they felt actually very supported by their institution in terms of their well-being and so on, but they had concerns about the policies for COVID within the hospital, and as our science improves, as we get vaccinated, as things are changing, it doesn't look like hospital policy is changing. Now I have heard this from multiple people around the country, which makes me think it's worth talking about.
I wanna go through some of the things this person mentioned and talk about it a little bit. So they say residents are not allowed to eat together despite being vaccinated. So you can't eat together in the cafeteria in the hospital even though you've been vaccinated. And this to me makes absolutely no sense. The vaccines are highly effective. We talked about how safe they are, they're highly effective and multiple vaccinated people in the same location should be able to interact together, and in fact, the CDC has said this.
So why would hospitals prohibit this activity? Now why does it matter? I don't know how many of y'all have been in these situations, but those meals are not just fun-time hangout with your colleagues, they are where we actually get some discussion done, where we brainstorm ideas for complicated patients, where we blow off steam, where we talk about what happened at noon conference, where we gossip, which is actually crucially important to human functioning.
These are key things, so what happens when you prohibit residents from coming together to have a meal, which was key -- did I mention it was key? Especially when you're working really hard and you're sleep-deprived, hanging out with your colleagues over a meal is the only thing you can look forward to. What's gonna happen when you prohibit it? You're gonna push it into restaurants and homes anyway, which is, again, where would you rather eat with another person? Two vaccinated people in a hospital or take those same people and put them in a restaurant somewhere? I mean, this makes no sense at all. So that's a policy that hospitals need to change.
Let's see what else they're saying. We have to wear masks still in our workrooms despite being vaccinated. So for people that don't know, these workrooms are often closed spaces with a bunch of computers where physicians and nurses work on stuff. Having to wear masks in those spaces, OK, I understand why people would wanna do that in general, but if everybody is vaccinated, which you assume they are, right, 'cause they're in healthcare at this point.
Again, CDC themselves have said there's no reason that vaccinated people can't hang out together without masks. So you gotta understand these workrooms, taking off a mask, you've been wearing a mask all day, taking off a mask, working with your colleagues, working at the computer, not fogging up your glasses, seeing each other's facial expressions, feeling like normal human beings. That's key, that's important. I don't see a good reason why they should mandate masks in those situations.
All right, patients are still allowed only one visitor from 9:00 a.m. to 9:00 p.m. unless they're on hospice. Now, this is something that ... Vinay Prasad and I have ranted about. Assuming that there's enough PPE, you should allow visitors. Not allowing visitors is a human rights violation. Now, how many visitors to allow is gonna depend because visitors do tax the nursing staff in terms of staffing because they do present demands and we all know that when they're demanding visitors, it can be difficult. But still, one single visitor, I mean, that creates a dynamic that's very difficult.
It's also difficult for the care team because a lot of times we need to have meetings with the patient and family members together and it's more than one family member to discuss care plans or to update the family, because otherwise it just becomes a mess. So I think it's time we started looking at that very very seriously. Now the hospice thing, I'm glad that they've relaxed it during hospice, but it really needs to be looked at throughout the continuum of care. And again, I'm sensitive to staffing issues and PPE issues, if those are still problems, right?
Now, the other thing that he or she says is if a patient comes in from a SNF, a skilled nursing facility, despite testing negative for COVID, they must be on full-contact precautions even if vaccinated. So that again, if you're talking about wasting PPE, there's a great way to waste PPE. You have a vaccinated nursing home patient who's been tested. Well, I don't think they need ... the full everything every time. It doesn't make a lot of sense, I'm not sure there's data showing that that is useful. You could invoke the precautionary principle and say there's a small chance that the test is false-negative and they're a vaccine failure. But that's so tiny. I think the sort of standard precautions of masking, etc, which we use with every patient now, [is] probably enough in that case. But again, if you're an epidemiologist, an infection control nurse, and you disagree, come at us in the comments with good wisdom and some data and you can change my mind on that.
Let's see, we're not allowed to have meals, food sitting out for conferences. All food has to be individually packaged. So I would love to see data on that. Like, that individually packaged food is somehow safer than covering the food that's sitting out when everybody in the facility there that's eating the food has been vaccinated, presumably. It would seem to me you're more likely to spread disease on the wrapping and the packaging and touching that and then eating the food than via the food themselves.
But again, do we have data on this? No. Are we making edicts that make it very hard to live a life and stay sane while being a resident or a nurse or a facility worker? No, I mean, it's kinda onerous and it just, again, this is, we've entered this culture where just doing stuff to do stuff just seems to be okay and I just don't see it there. Now again, I don't have data on this. I don't know if anyone does. I'd love to see it if they do.
Now, here's a good one. Noon conferences are mostly via Zoom and attendance has been much poorer compared to prior due to less food options and the lack of interest in Zoom lectures. So you guys have to understand, noon conference when we were residents, that was about getting fed a lunch and getting our learn on. So we could eat, hang out with our colleagues, and get our learn on. Now when you suck away the food, and you suck away the learning, what's the point of noon conference?
Now, why is Zoom not a learning environment? Because it sucks. Let's be completely clear. If you can't interact with the teacher in a real-time way with both body language that's subtle and not transmitted via video and auditory visual cues, and I'm gonna do a whole show on why Zoom sucks for group collaboration 'cause the data shows that it does. There's actually data on that. You know, Zoom is not a good way to teach. Now, why when we are starting to get ... fully vaccinated in healthcare facilities can't you go back to in-person lecturing? I think we should, I really think we should. So again, I mean, this to me is, people think it's not important.
It's absolutely important to how we learn and interact and also get back to a vestige of normal. We cannot accept this way of being in the world, meaning the restrictions that haven't been improvements. Like, hey the decrease in traffic, the decrease in having to go into the office, all that stuff, that's great. The idea that you can spend more time with your family, that's actually great. But the downside of always masking and distance stuff when distance stuff is inferior, we gotta start getting away from that as we begin opening up with mass vaccination.
Let's see what else is good to comment on here. Our program is not allowed to fund or sponsor any event with residents, including going out to eat, or a graduation party for the chiefs who are graduating, etc.
Why? Would you rather force those events to happen without the residency approval or guidance? 'Cause they're gonna happen anyways in groups of people. Why would you change that? If the funding was there anyways to do those events and people are vaccinated and they're gonna do them relatively safely, it seems to me that's a cover-your-ass thing that just doesn't hold water.
So again, it's time we start marching towards the new normal that's better than the old normal, which means bringing back the things that don't suck. And residency-sponsored events don't suck. In-person lectures don't suck. Noon conference with food doesn't suck. Not wearing masks in a workroom, that doesn't suck. Being able to eat with your colleagues in the hospital cafeteria when you're vaccinated, that doesn't suck. So let's suck less. That's basically the punchline of this video.
All right guys, share the video, tell me what you think in the comments: what's your program doing, what's going on? Nurses weigh in -- 'cause we know JCAHO won't even let you have a drink at the nurses' station but they were completely AWOL during the beginning of the pandemic when no one had PPE. It's like, why do you even exist? What's even the point of you? Except to yell at us about, nanny us about drinks at the nurses' station. Now they're gonna want pre-packaged drinks. We're all gonna have to have Capri Sun and somehow just absorb it by osmosis. We can't open them, you just have to. Anyways, I love you guys, we out.
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