Superfluous (Tales from the CCU)
added by geena on January 14, 2004 at 8:59 PM
Man, I really don't post much, do I? I acquired some new and improved (and expanded!) hours at work, so I'm there more. Thus I am much more protective of my free time :-)
Even though I'm there more, nothing interesting has been happening. Nothing overly controversial. Nothing all that funny. So I'll have to dig down and come up with something that happened sometime last year...
There's a specialist that is occassionally consulted who is becoming more and more difficult to work with. For example, if our patient has dry eyes, and it's like 10:30pm, we'll just take it upon ourselves to put in an order for saline drops. The next day, when this doctor logs in, she'll see this order she needs to sign off on, but will instead write, "Order #133 not given by me." Nice. Same with restraints... A restraint order needs to be updated every 24 hours in order to keep in compliance with Joint Commission. We nurses take it upon ourselves to renew the restraint orders ourselves. We're all smart, we all know the indications for restraining patients. If the order is not renewed, JC gets their knickers in a knot. So if we do this under that particular doctor's name, she'll do the "Order #444 not given by me." And then will proceed to try to put the order in herself, occassionally getting it right. But what if she forgets to put the order in one day? We'd just rather do it ourselves; that way we know it was done.
Anyway, she was consulted on a patient of mine and came into CCU, read the chart, and proceeded to go into the room to examine the patient. If I have the time, it is my personal practice to go into the room with the doctor. It's helpful to see the doctor's assessment, and I can get a lot of background and history from a doctor's conversation with the patient/family. Most of all, I like to be around when the doctor is explaining things to the patient and family. It's easy to become intimidated by the most benign doctor, and a lot of things go over patient/family's heads because it is a stressful situation altogether. If I can listen myself to what the doctor is saying, I'm in a much better position to answer questions or re-explain what has been said after the doctor is long gone and the words have had a chance to sink in.
No doctor has ever objected to this and I am always unobtrusive. So I went in behind this doctor, found a corner and watched/listened. She was talking to the family just fine, but then suddenly simply stopped speaking mid-sentence and turned around to look at me. She said, "Did you need something?" I replied that I just wanted to participate in my patient's care and listen to what she had to say. She said that my presence was not necessary, and that she would "call me if she needed anything." I was dismissed from my own patient's room.
Mind you, this wasn't exactly a sensitive situation or anything. I don't want to give any details, but suffice it to say that it was a pretty run-of-the-mill diagnosis that this patient had, and I had already been talking to the family about assorted topics concerning the patient's history.
I was beyond irritated with this doctor. I felt like a handmaiden. Never mind that I'm the person MOST involved in the patient's care. Her whole attitude screamed condescension (it pretty much screams it all the time) and I felt like I was belittled in front of the patient and family. After she was done with the patient and done writing her notes, I approached her and asked why she was opposed to having me in the room. She said something about patients/families tending to be more open when there are fewer strangers in the room. I'd been with the patient for 6 hours already; who was stranger, she or I? :-) I explained to her my reasons for being there and she said she hadn't thought of it that way, but that she still preferred to interview and examine her patients in private. Whatever. If this had been an especially sensitive situation (of which I have been in with other doctors and have not been asked to leave) I could understand... but I don't really understand why she needed such privacy. I am a part of the patient's "health care team" and am certainly allowed to participate in conversations regarding the plan of care.
| Progress Notes (8) |
Progress Notes
Man, that even ticks **me** off. I don't suppose you have any way of trueing up this persons perceptions? Like, say, calling her at 2AM to verify an order?
added by bill reith on January 15, 2004 7:10 AM
For what it's worth, this family doctor appreciates your way.
The consultant has the prerogative but I think it's bad business.
added by FP on January 15, 2004 11:11 AM
What a witch! Sounds like she is on a power trip, or she's insecure. I like Bill's idea - call her at 2 AM to get the restraint orders :)
added by suzi on January 15, 2004 10:08 PM
I find it odd that the decision about who is going to be in the room is considered a "turf war" issue between the various health care providers. Why not let the client decide? He or she is the one who is going to be embarrassed, or not.
added by Shamhat on January 16, 2004 3:50 PM
Wow, what a bitch. I prefer that the nurses are in the room with me when I examine a patient. That way we are all on the same page. Sounds like this “doctor” is on a power trip and needs her pee pee knocked in the dirt. Personally, I would call her repeatedly in the middle of the night. After a few nights of getting no sleep she will get the drift. Good luck
Azygos
added by Azygos on January 19, 2004 12:31 AM
when my sister was in CCU, we preferred to talk with the nurse assigned to her bedside. they always knew more, helped more, and were more hyper-vigilant it seemed. nothing against doctors, but they scare the hell out of me because they're rarely around and when they are, always in a hurry and seem to get irritated with questions.
you sound like a fabulous nurse to me. i agree with the others, that doctor is insecure and/or a bitch. you stick to your guns if you can. families appreciate it.
added by Carrie on January 25, 2004 8:37 AM
Ummm...are you actually the nurse from the book NURSE or are you just paraphrasing from the book. Get a life of your own.
added by Carol on March 7, 2004 10:23 PM
Reading about the routine orders that we just write...Early this morning I was working in ICU and found that a patient had been on dig for 5 days but had no level, had a hx of low K and had been diuresed for 1400 that day (with no chem 7 for 4 days), admitted as GI bleed who was started on lovenox with last PT INR having been done 14 days ago and last CBC 4 days ago. I asked a superior if it was okay just to write the lab orders and she said just leave a note on the chart. The Dr. came in, mad about something else with the patient, and proceeded to start reaming me out. He had been negligent and I was only trying to make sure this pt got the necessary blood work but I did write the order without calling him at 4 am so now I think I've lost my job. I could just kick myself.
added by screwed on June 14, 2006 12:47 PM
So, what brought you to the hospital today?