Incometent Doctor

  1. What do you do when you work with an incompetent doctor? This doctor is truly an idiot and is inhumane. I know how very frowned upon it is for nurses to go after a doctor, but I am scared for MY license and MY patients lives when I work with her. We were getting ready to put a hare traction splint on an 8 year old with a femur fracture who was crying with pain already, we requested pain meds, she refused and said, it's going to hurt anyway!!!!:angryfire Then after we insisted she said to give 1 mg of morphine! Gee, thanks, then when the nurse went to push it she said, hold on, were not ready yet!?! Like we were giving Sux or something!?! This is just one example of MANY as you can imagine. If I write her up then the policy is that I will end up in a room face to face with this physician to discuss the write up, and we all know they will not fire a doctor over one nurses right up. All of the other nurses in the department agree with me. What do we do?
    Last edit by Happy-ER-RN on Apr 1, '07
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  2. 23 Comments

  3. by   psalm
    Do you have incident reports that you can write anonymously? Can you and the other nurses next time have a code white on her when she tried to do something you think is inappropriate?
  4. by   nuangel1
    speak to your manager give specific examples as to what the issues are.speak to the mds boss the same way with specfic ex.you neeedto continue to advocate for your pts. go up the laddder of authority as much as you need to .however be cautious a difference of agrement as far meds and tratment of a pt is different then true incompetence.incompetnce puts the pts safety at risk.
  5. by   Batman24
    Can you all go to your superior together?! That might be best.
  6. by   neneRN
    We have a specific form to "write up" docs, it's only to be used for MD behaviors/actions that are inappropriate. I would think every hospital has these, they're probably just not advertised/put out there where staff is even aware of them. give HR a call-they know all about this type of thing.

    The direct approach is usually best; either speaking directly to the doc or having your sup/manager do it if you're uncomfortable. But a paper trail is useful when these are repeated occurrences.
  7. by   charlies
    incometent doctors abound. just try to CYA. Document well.
    Last edit by charlies on Apr 1, '07 : Reason: lol
  8. by   pickledpepperRN
    We write an incident report and a report to our nursing manager and medical director.
    I have written the Medical Board about a doctor. They sent me a letter stating it would be looked into.
    That doctor asked me in the elevator why I reported him. I told him the facts. He then asked, "Did I really do that?"

    He kept his license but the rude abusive behavior that also risked patient care stopped.
    I'm told the medical board works behind the scene.
  9. by   cccnurse
    Document,Document,Document. I know you have heard all of this before, but it works.

    Do Not put any of this documentation in the patients charts you will be looked down upon. Talk this over with your ER manager then talk to your Risk Management division.

    Keep a copy of everything for yourself just to CYA in case your investigated by nursing for "not doing anything about it". It can be amazing how some paper work comes up missing at times. I work in a small rural ER, this is how we managed to get rid of one, we convinced administration that this doctors actions was out of line and was a lawsuit waiting to happen. It took several months to make it happen but it happened just as well.

    A "code white" also works very well, just be sure that during the "code white" that you do not become the one that puts the patient at risk and that the rest of your department is on board. This works in our ER because there is only 2 nurses and 1 doc a shift anyway.

    Good luck and hang in there, because hanging out of there is more embarrassing.
  10. by   gonzo1
    A while ago enough nurses in our ER complained about a doctor that he was asked to leave. It can happen, but it takes a concerted effort. Just keep harping on patient safety, and throw in a little press ganey if you can.
  11. by   NicoleRN07
    CYA.....I can't tell you how important your documentation is in situations such as this. I work with a MD who is the same way, but I chart, chart, chart! Keep copies of your documentation for the supervisor/medical director, that way, when a problem presents itself, you have it there in front of you as your proof. The particular MD that I work with is aware that I have a problem with him, because i have addressed the issue with him multiple times, and he knows that I'm watching him, and has even seemed to have improved in the last few months. GOOD LUCK!!! Remember: DOCUMENTATION IS YOUR KEY!!
  12. by   RNPamP
    I just want to respectfully disagree that you should "not put anything in the patient's chart". Of course, don't include any personal commentary or opinion, but you should be documenting exactly what this doctor says and does. That's part of "CYA". For instance, in the pain control scenario, document "patient c/o severe 10/10 pain. MD aware, refuses to order pain meds, stating (quote reason)." This way, you have shown that you did what you were supposed to do, and that you followed up on it. BTW, I recently read an article about a malpractice case in which a vascular patient was having pulse check changes; the nurse reported to the attending physician and he chose not to do surgery. The patient ended up losing a leg. Guess who was found liable---the nurse for not reporting up her "chain of command"! They claimed that she should have reported to the nursing supervisor even though the physician was aware. Scary! :uhoh21:
  13. by   neneRN
    I agree with RNPam that you do need to document in the chart that you made the MD aware and the MD's response, but you need to be very careful to objectively chart this. Instead of writing "refuses to order....," I would chart "No orders rec'd;Dr. X states..." And this is because there is always a chain of command to follow; if your notes reflect that you disagree wih a physician's decision, then you better also have documentation of what further steps you took to be a pt advocate. If you have significant concerns about a pt's care and the case ends up in court, you are going to be asked what you did about it, and saying that "well, I charted it" as your only reaction to the incident is not a good thing. This is demonstrated by the case RNPam referred to with the pulse checks. Its a fine line, and if its a situation that I disagree with, but does not put the pt at harm, then I simply chart, "MD aware" and nothing further. Anything else can imply you disagree with the physician and warrants further action by the nurse.
  14. by   RNPamP
    Nene's probably right, "refuses" is kind of a loaded word. But when you are telling a doc over and over again that a patient is awake and c/o 10/10 pain and they say they won't order anything, technically that is a refusal. I've always been taught that you should document exactly what actually happens, not to pick and choose what's going to get a certain person into "trouble". If they say it, they should be held accountable for it. Also, with the above case that I mentioned, the point was that she did notify the attending sugeon and was held accountable for his decision not to do surgery. So these incompetent docs must be reported not only for the patient's sake, but for the fact that we can be held responsible for not reporting their poor care.

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