doctor disregarding triage decisions

  1. Department full. 2 new patients arrive with families in tow.

    #1 SOB with cold symptoms X 1 wk, fed up with being sick. History of Asthma. No Acute Resp. distress. No coughing. Lungs clear per auscultation. Vitals Normal with respers 16/min, P 60, skin W/D. Sats 96% Triage decision Urgent because protocol says all patients with c/o SOB should be urgent. She could have been nonurgent. pt waited 20minutes in the waiting room.

    Doctor couldn't wait 5 more minutes for me to DC my other patient and clean the room quick. Instead of waiting 5 min for me to place the pt in a room, He goes back to the waiting room, proceded to examine and interview patient #1 in front of everyone in the waiting room. I feel this was totally inappropriate. A TOTAL violation of privacy for the patient. And made our department look sloppy and unprofessional. A doctor should never ever do that unless a patient is going down the tubes in the waiting room. This is not the first time he's done this. And we are all complaining to our manager.
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  2. 14 Comments

  3. by   kaycee
    If I were the patient I would have been furious and refused to answer questions until I was in the privacy of a treatment room. How did the patient and family respond to this?
    I would also complain to my manager and the medical director of the ER.
    Would love to see what JCAHO would think of this.
    Very inapproriate in my eyes.
  4. by   massEDgirl
    If you have to work with this docter again then he needs a REALITY CHECK...and he needs it from you.

    One thing I can say about the docters and nurses in the ED I work in is we are a TEAM. If someone does something totally STUPID...like the docter you worked with....we do not hesitate to tell each other. We are a teaching hospital so sometimes we will get a resident who might start off STUPID....we fix that REAL quick!

    If the problem kept happening after talking...only then would it be considered to go to someone higher up.

    You have to trust the people you work with in the ED...things happen to fast...you also have to be able to communicate about everything.
  5. by   CEN35
    well mass,

    while i am not here to argue with you, because i do agree with you on the doc going out there.......the privacy issue doesn't hold water.

    does being in a hallway on a gurney allow privacy? nope...but it happens everywhere. why? er's in this country have become overinundated with the demand for healthcare. the sick, the lame and the people using it in place of the pmds office.

    as far as the joint commision goes? there is not an er i haven't been in or seen, that does not list all the patients last names, and complaint on a big ole dry erase board. this board is usually visible to every person with eyesight also. i know as a fact that breaches the joint commision's policies, regarding patient confidentiality.
    on the other hand i have delt with many people, that would have accepted an evaluation in the wr, just to avoid a 3-6 hour wait.

    i'm not bashing, but confidentiality is busted up in every er across this country. so the privacy issue wouldn't carry any weight, unless it was something detremental to the patients jobor community status (i.e. hiv, hepatitis etc etc).

    if it is a matter of, whether or not the physician beleived your assesment is another story. possibly he did go about it the wrong way, for whatever reason...and that should be delt with somehow. i just don't buy the confidentiality statement, the way ers are across this country.

    just my 2 cents.....i am definately not trying to stir the pot or put you down in any way, so please don't take it that way.


    me

  6. by   Nittlebug
    CEN - I agree with you to the extent that providing patients privacy isn't always possible or practicle. Especially in big urban ERs across the nation.

    However. We are in a smaller town ER. We have 11 medical/trauma beds, 2 psyche beds and we see usually less than 30-40 people per 24 hours.

    It is very rare that we have anyone on a gurney in the hallway. We don't allow family to hang around in the halls or anywhere near the nurses station. And we don't have a visible greese board. The pt info is on a computer at the nurses station.

    So pt confidentiality is a big issue for us. But anyway that's not the real reason I'm griping about that Doctor. I just plain can't stand him! He's a total slob, and he disrespects all the nurses.

    That was the second time he examined one of my patients in the waiting room and I just flat out told him he needed to wait until the patients got roomed. The main reason he did it was because he was caught up with his other patients and wanted to get ahead. I can understand why he wanted to do this. But I say, if he's so caught up then why doesn't he discharge someone so we have a bed for the new ones?
  7. by   CEN35
    gotcha nittle! hopefully today will be a better day! i hope so! so far today has went exceptionally well for me! one more shift before the weekend!

    in the meantime, after tonight it will probably be a few days before i can post again. i have a lot of stuff to get done this weekend! hope everybody has a good weekend, and i will be thinking of you all!

    me






  8. by   eldernurse
    Our ED is even being redone so that when people are being interviewed for their insurance info it is in a private cubby hole.
    Except in the situation of arrest that physician was way way out of line, and I don't normally judge physicians.
  9. by   teeituptom
    Howdy yall
    from deep in the heart of texas

    Well Nittlebug, I sympathize with you, and this doctor you are having problems with. Now the trick to the situation is to understand the game the doctor is playing. Does he have a passive aggressive personality that he is trying to get under your skin and thus control the situation in his favor. Is he frustrated with system and is venting his frustration. Does he suffer from the short man short ---- syndrome, and is in a power struggle with whomever. Or is he under pressures and guidlines from the emergency director to cut his length of stays in the ER. Figure out his game and you will be able to control him or her much easier.
    As long as you continue to work in the best interests of the patients, then he cant beat you under any circumstance. But the trick is to understand what is motivating him, then you have the upper hand in controlling, its just a game of maneuvering.

    By the way what is a nittlebug



    keep it in the short grass yall
    teeituptom
  10. by   jmcclellanprofrn
    I work in a city ER, there is no privacy for those being triaged or registered. A glass window was put up to protect confidentiallity, please, those ignorant people will stand in the doorway waiting for me to acknowledge them, even though I am currently triaging someone, listening to our discussion. Pt's in the hallway, I hate more than anything, but we are not allowed to divert! Please, half of my patients have family reunions in my waiting room, being loud and obnoxious, and taking up needed seats for those who are really sick. Nurses need to be in the community, treating and educating are patients, and help in the prevention of ER/PCP use. I actually had one lazy, no-good patient tell me (cough for 2 weeks) that he came to my ED rather than his PCP's office because we have TV's in the waitingroom!! I immediately had the TV's turned off! Forget my manager, I would have went to her boss, our administrator. I would have not allowed to patient to be questioned in the waitingroom. The charge nurse sees the charts first, she should have prevented this. Besides, he was in No Acute Distress! The doctor was perhaps representing his male genitalia?eh?
  11. by   Hopingtobecome
    A teaching hospital in our area does alot of the same things... My Ex boyfriend had a propensity to injure himself... and we'd end up there often enough... but most of the time these two doc's would check patients in the waiting room... when the patient did refuse... the doctors would take them into the room.... but more often then not the patients would just let the docs check em out in front of whoever....

    Personally not my thing.... I would refuse and write to the director about it.
  12. by   NurseyK
    We had a Doc that liked to paw through the waiting room charts also. Anything with, "c/o CP" or "c/o SOB" got raced back and received an EKG before any of the staff knew what was happening. Her reasoning, "Well, it says the pt c/o is ____, which is an Emergent/Urgent classification" (never mind her checking the V/S or Sats, ie: the REST of the story...). When I thought about it, she was right.....if any chart review was done for legal purposes and "pt c/o CP (or SOB or chest tightness)" is on there and the pt sat in the waiting room for 4 or more hours....getting the picture? Never mind the rest of the chart that says that the pt was in NAD eating a bag of chips, sipping on a soda; the CC is "SOB (CP)" and that is all that "Buffy the former Cheerleader" is reading when she does the chart review (just a little joke there about that old HMO TV commercial...). Also, a pt c/o CP, SOB, chest tightness, or any of those other great buzz-words, can mandate the Physician to order full Cardiac/Resp work-ups (read: litigation fear). As one of our Docs put it, "You write a high-powered pt c/o on there and I have to order a high-powered work-up -- whether they need it or not -- based on any possible future chart review. Or, I have to cover my butt in a thick wooley blanket and explain in the chart why I didn't order it all." Medical and Nursing Admin agreed. The rest of us went..ooohhhh....

    What we decided to do was improve our Triage skills. Ask more questions before writing down the "pt c/o..." Even perform a mini-PE out there. EX: So they are running in the Traige room c/o CP? When you get down to the nitty-gritty questions, they are really talking about some gas cramps in their mid-abd because they haven't had a BM in 3 days OR they like to use the c/o SOB or CP to "get in quicker" (we had a ton of pts that liked to use that line -- saw in on TV)......Soooo, your person witht the "cold": they may have come in c/o "SOB", but upon further questioning, their CC sounded like "c/o cold sx: cough, runny nose, blah, blah"....you get the picture.

    This was just our soln and it turned out well (for the most part). Ms. Nosey Doc still pawed through the charts, but with better Triage and appropriate catigorization and description of pt c/o, she didn't race people back anymore (well, OK, maybe the occas S/T or OM that she could handle on her own w/o nursing). The hard part is with inexperienced/new nurses out there in Traige w/o the "eye" yet.....but I guess that's probably another subject

    In our Level II center (approx 40-50,000 visits/yr), our Doc's and PA's also went out to the WR to "check" on the pt's on nites when Nsg was really bogged down. Many of them were D/C'd right from the WR (well, actually the Doc would take them into a little alcove off of the WR for some small sense of privacy and confidentiality). We never had a pt c/o generated from those nites when Doc did that. We knew he was trying to get out from under, and decrease Nsg's work as much as he could. We would get mad initially, but at the end of the shift we always realized it was a good thing and told him thanks.

    JMHO

    Kat
    Last edit by NurseyK on Jul 3, '02
  13. by   oramar
    The trouble with treatment rooms is that some of them are not very private. I can't even repeat some of the stuff I have heard sitting in a treatment room with the door closed. It happens because those walls are paper thin.
  14. by   fab4fan
    Oooohhhh!!! It chaps my butt when people c/o CP or SOB because they know it will get them back more quickly; another one is the women who c/o abd. pain/pelvic pain and all they really want is a pregnancy test...they know if they c/o pain they won't have to wait as long.

    Some of our ED docs get antsy and bring people back before we're ready for them; thenthey get mad because there's no nurse assigned to the pt. Hellooooo...if you'd give the charge nurse 5 mins maybe this wouldn't be a problem!!

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