How about we strike a deal here? You decide on what treatments to give a patient, and I’ll (usually) gladly administer them – as long as you tell the patient what you’re ordering.
This sounds very obvious, I know, but several doctors that I work with do not prepare their patients for the treatments that are forthcoming. Case in point: I recently admitted a man with a low hematocrit (blood count). It was determined that he was GI bleeding, and in addition to a few units of blood, also needed a dose of anti-ulcer medication.
First off, the doctor did not tell the patient that he was being admitted to Critical Care. This concerned the patient when he found out (“Just how sick am I? How serious is this?”). Secondly, he did not tell the patient that he was to receive multiple units of blood and FFP (Fresh Frozen Plasma – contains some nice clotting factors). (“Just how many units of that am I getting?”)
I don’t mind explaining treatments to patients; in fact, I enjoy that part of the job immensely. However, I do not relish the look of … weirdness that comes on my patient’s face when he finds out that I’m about to administer treatments that he isn’t expecting and hasn’t been prepared for. I can’t quite describe this look – it isn’t distrust per se; I guess I would describe it as slight bewilderment. As if they’re thinking to themselves, “Now why didn’t the doctor mention that I’d be receiving 8 units of blood products??” I thought I would have to start another IV, but rigged his current one IV to allow me to infuse several blood products at once. He was pretty happy that I wouldn’t have to start another IV.
Then another doc comes in and talks with the patient for awhile. This doc states that he wanted to do a procedure the next day and explained that pretty throroughly and obtained informed consent from the patient. Then the doc proceeds to walk out to the desk and enter an order for a continuous infusion of the anti-ulcer medication, definitely necessitating another IV to be started. This just after I’d informed the patient that I wouldn’t have to start another IV. I was pretty annoyed because I knew that the doctor did not mention to the patient that he’d be getting this continuous infusion.
Anticipating that look of bewilderment again, I asked the doctor if he could please go back in and tell the patient that I’d need to start another IV, what medication I’d be infusing, and the reason for it. This time when I went in with my IV supplies, the patient completely expected it and was much more open to the idea.
I believe that it’s up to the physicians to outline the treatment plan. The nurses can explain the finer points of said treatment plan, but shouldn’t have to be the ones to introduce it unless it’s an emergency or the middle of the night. I think this applies most to patients that have just been admitted to the hospital – they’re already shaken up about having to be admitted into this unfamiliar place. After they’ve been there for a day or two, they’re much more receptive to the nurse introducing new treatments.
So please, I beg of you – letting the patient know that they’ll be NPO (nothing by mouth) and the reason for it, what medications they can expect to receive, what treatments that will be ordered – all of that will foster trust in the patient and everyone benefits. Just a brief explanation (no jargon!) should do the trick – and we’ll gladly take it from there.