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An Open Letter To My Esteemed Doctor Colleagues

Dear Doctors,

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.

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Yay! for this suggestion. The docs I work(ed) with for the most part did a pretty good job explaining meds/treatments to be administered to the patients. But sometimes they forget, or don’t see the explanation part as a necessary step in their busy shift. I SO know the look of distrust/confusion/bewilderment on the face of a patient when I walk in with an IM injection or IV supplies and the doctor hasn’t told them what’s what. And as for diet, activity, etc… orders, they often leave those little ‘details’ out when explaining to a patient that she is going to be admitted. And yet those ‘details’ are often the most important things to a patient.

I posted on this subject last week at hospice blog. I don’t know the look of weirdness that you are talking about, because in the hospice field it’s more a look of horror when you explain to them for the first time that they are talking to hospice because the doctor thinks they are terminally ill. I’m all for doctors spending more time explaining what happens next to patients. It’s good for me, good for the nurse, and (most importatnly) good for the patient!

Boy do I ever want to print this out and take it to work with me! The only thing I’d add is this: in a teaching institution, attendings, please make sure that all your residents are on the same page. Please. That way, you won’t have Resident A saying “You *so* need surgery!” and Resident B saying, “Um, no you don’t.” Talk about a look of confusion on the patient’s face!

Re: starting a second IV line for the PPI or H2 blocker – Perhaps why many docs don’t explain some of the finer points is that they have *NO IDEA* how things are really carried out. A favorite was when the housestaff would order lactulose enemas! Never let that order get by me – if the gut worked, then that stuff was going in the stomach first!

I was interested to see a doctor’s eye-view of patient avoidance, here
linked on grand-rounds via instapundit.

Doctors didn’t like explaining things to this patient, because she had a bossy manner, and expected to have a say in her own care.
Nurses and other caregivers didn’t like her trying to be in control, being second guessed by her, either.

These traits caught a mistake, however.

Patients OUGHT to distrust meds and that haven’t been explained by the treating physician.

Patients not only have a right, they have an obligation to know what treatments have been prescribed and why, and to ask questions to make sure something is necessary.

I know this is old but heres my 2 cents

I remember when I had just been transferred from icu to orthopedics after coming off a motorbike. I had a surgoen come in and tell me he was going to sick a large metal bar through my leg as way of traction. Given everything I had just been through (almost lost my dad) adn teh amount of morphine etc I had pumping through my system I panicked. Apparently whilst under sedation I screamed some rather charming endearments and threw absolutely anything not bolted down at this man. It pays to maybe give a spot of warning as well for any procedure which may be required

So, what brought you to the hospital today?

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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