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A little ointment is creating a big rift between hospitals, parentsCook: Throwing the baby out with the ointmentGreeson: Blame the law, not Erlanger, on newborn eye ointment rule
Times Free Press columnist David Cook eloquently described the discomfort when parents lose control over the things about which they care deeply. In Cook’s Wednesday column, Erlanger hospital’s efforts to prevent ophthalmia neonatorum (ON) by mandating eye ointment conflicted with a family’s birth plan.
ON is a devastating infection at birth causing permanent eye damage and/or blindness. Current prevention of ON is dependent on a multi-modal approach: test every mother during pregnancy; treat infected mothers; provide eye prevention for every child at birth; diagnose the symptoms of infected infants rapidly; and administer appropriate infection treatment.
This approach is working well, but do we need ointment for every child? First, the size, the cost and the fact that a few babies would develop devastating ON complications in such a trial prohibit this specific experiment. Second, Tennessee is ranked 14th and 15th for gonorrhea and chlamydia (diseases that often have no detectable symptoms and cause the most serious ON). Third, the current eye ointment is known to effectively kill causative agents, has limited side effects, does not impact bonding and is inexpensive.
Health delivery is valuable, complicated and has inherent risks. One way to perform effectively is to have repeatable processes so that the best opportunity for success is achieved. The current trend of individualized birth plans around limited medical evidence or experience-based preference can be dangerous. In all industry, variation creates error — error that parents and providers do not want and should not tolerate. Also, a system dependent on parents to volunteer their sexual risk factors, even to protect babies, will never be successful.
Finally, I am very disturbed that health care providers are so easily cast as the evil strawman. We see this with vaccines, guns, abuse prevention and now eye ointment. Most health providers are individuals serving the community by professionally performing nuanced, important and emotionally charged duties.
The column effectively communicated the parent’s horror of discussing eye prophylaxis during an actual contraction. Well, contractions frequently happen during delivery … a lot. I participated in an identical experience last week. The nurses talked with the family. I talked with the family. Finally, after a lot of time spent by empathetic professionals, the family felt comfortable proceeding.
Sometimes the conversation becomes intense. Individuals usually respond to a strong authoritarian statement from an expert. If a provider says “we feel strongly enough about this to call security,” folks usually reconsider their view. Health care providers do not take such a dramatic action lightly or because they want to bully people. Sometimes, it is the only way to communicate a dangerous position. If someone is running toward a cliff, it is acceptable to tackle that person safely to the ground. If you find yourself regularly lashing out at authority, the conflict isn’t eye ointment.
To be alive is to experience things beyond our control. A healthy and responsible community works together to support and grow from such events. It is important that those of us who desire an effective societal infrastructure seek the best for our community even when it’s gooey.
Dr. Allen Coffman, a Chattanooga pediatrician, is medical director of the Pediatirc Healthcare Improvement Initiative for Tennessee.