[dawngloves]

After his second refusal I would have gone over his head. Sounds like you're more patient than I.

[janfrn]

If it would have been serious enough, we would have just done that. This guy is an anaesthesia resident, an R5... thinks he's all that and a bag of chips. Had another little run in with him the other day... neonate post-op arterial switch, open sternum, being paced, has a rising K+ of 5.8 on D25 and insulin and has a falling BG of 86. He tells me to increase the insulin from 0.025 units/kg/hr to 0.03 units/kg/hour and turns away to resume his conversation with someone else. I reminded him of the BG and how fast it was falling. "Oh, yeah. Maybe we should increase the D25..." It's like he can only think about one thing at a time... how does he ever manage in the OR?

[fergus51]

Originally Posted by AliRae

I've been caring for an infant on PD recently. He's deteriorated to the point of intubation. Has been intubated since Sunday, hadn't required any sedation until yesterday, when he was coughing gagging, head-thrashing. I sent someone to ask the resident to come over and see the kid. 10 minutes later he showed up, took one glance at the kid and said he wouldn't order anything. I explained that the kid was intubated, lined within an inch of his life, getting PD cycles every hour and BOUND to be uncomfortable. He walked away from me.

Next time the kid woke up, I called him in again. He told me he'd order something the NEXT time it happened. Fine. I explained that the kid had gotten really hypotensive with morphine, suggested a benzo and asked for a very small dose. He again walked away.

I finally just called him over and asked him to write the order so we didn't have to risk our tube by finding him the next time the kid woke up. He looked at me and said "NO!" in a tone I wouldn't even use with a dog, and turned to walk away again. Honestly, my head nurse was sitting with her back to him, and I thought her jaw was going to hit the floor.

I said to him (quite firmly, I must say) "Excuse me, but that was extremely rude and you can NOT talk to me or any other human like that. Don't just say no to me without giving me some kind of rationale behind your answer." He hemmed and hawed and finally wrote the order.

Sorry that was long, but here's my question- my extern was sitting there and heard the whole thing. She thought I was rude to the resident and shouldn't have reacted so strongly. Was I out of line? Maybe it's just me, but it felt more like advocating for my patient than being rude to a doc. Was it crazy to push for some sedation/analgesia for such a sick baby? And should I have let his rudeness slide and taken it as "just a part of the job"? How could I have handled this better?! I'm finally becoming secure enough in myself to be assertive, but I keep thinking I somehow missed the mark on this one.

You were right and if I were a parent, I'd rather have you looking after my child than some nurse who would have just "taken it as part of the job". You should be proud of what you did for that child.

[KJAVRN]

No..absolutely not! The only thing I think I would have done differently is go up the chain of command and called the fellow or attending. Residents may not speak to you in such a way, it is ALWAYS unacceptable. As for your extern, I would have explained that it is our jobs to advocate for patient comfort and safety, and clearly the child you are speaking about was neither safe nor comfortable.