Protocol

Jen and I went to dinner in West End Saturday night before last. From Highgate Hill, we went down Dornoch Terrace to Hardgrave, and the first clump of the West End eateries. We went on down towards the next group, centered on what was the Rialto picture show. We have long been threatening to go to the Tongue and Groove, a name of intricate connotation, on a live music night, but there was no visible means of support for the car, so we turned back towards Dornoch, and found a park not far from the food. We hadn’t thought about booking, of course, but we got a table at Lefkas. We arrived without a bottle of wine, and I set off, thinking I would have to go down to the Rialto, but there was next door a bottle shop we hadn’t noticed. The Oyster Bay sav blanc is mighty popular in these parts, and they had sold out, so we ended up with another Kiwi called The Ned, which was tasty. Waiting for the food, we got to talking about Jen’s leaving Intensive Care.

They’re making it harder. With insulin, for instance. I used to stabilise patients quickly then level of the dosage. Now they have a protocol in place, and you can’t set the pump the way you want to—they have fixed programming. So I have to do it manually. But with all the babies on the staff, they need the protocol. When I started down here, they were trialling an insulin protocol, but it was thrown out. Then a couple of mistakes were made, and it was back on the agenda.

In Britain, there’s a crying need for protocols. You’d go into a unit as an agency nurse, and start doing the things you were used to. “Oh no. That’s Dr So-and-so’s patient. He doesn’t want things done that way.” “Ok, so where’s his protocol?” There wasn’t one—you just got to know what he wanted done.

There’s the argument for protocols. But there’s a difference between the protocol developed in a local environment, and the protocol imposed from a distance, and from a height. The local protocol allows of local override. Those who understand the motives also understand the limitations, and have the confidence to say, No, in this situation we will do it differently. They have a measure of autonomy in its application. The further the protocol moves from the centre of its development, the less autonomy its users retain. The black hole of externally imposed protocols is the demotivation and demoralisation of the most talented of its practitioners.

On top of all of that, the calamari was disappointing. The night was beautiful, though. The diners were mostly dressed for a night out, and were probably heading in to the clubs after the meal. It’s generally a mixed crowd at West End though, and there were plenty of guys in shorts and thongs wending through the diners on the footpath. It’s a measure of the charm of the place, that makes the idea of living there so appealing. We’ll just have to settle for Yerongpilly.

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