I am still seething about an exchange I had with an attending on the pain service at my hospital. I work pediatrics. I had an 11 year old on his 3rd week, transferred 2 days earlier from ICU post several I & D's. He had significant issues of pain, immobility, and stress and despair from a traumatic illness and long hospitalization.
- the first day I had him he was on MSO4 PCA with a continuos infusion of .7cc/hour. He was zonked. I asked the pain service to consider taking the continuos MSO4 off. The attending gave the order, and the patient became less dizzy, more alert, and began eating and drinking.
- On the second day I asked to have his PCA dc'd, and him switched to po pain meds. I had discussed this with the resident from his admitting service. I discussed with him and his mother the benefits of his not being attached to an IV pump, being able to go off unit, and not having to focus on pushing a button. He was also using his PCA much less. Mother and patient agreed, so I contacted the pain team.
-The attending MD came to the floor, I gave him my reasons, he met with the patient's mother, and left the floor without seeing me. I checked the chart and found no orders. He had written a progress note which I did not look for. I thought there had been an oversight, paged the pain team, got the resident, and told them I thought he was going to be switched. The resident came up later that morning, didn't talk with me, and left without writing an order, but left the chart open so I could see the attending's note.
- The note said that he (attending) had discussed with the patient, RN, and mother, and agreed to start po meds the following day. Since he had not discussed this with me, and since this was different from what I was hearing from the parent, I called the pain team back, saying I thought there had been a misunderstanding. The resident who returned my page reffered me to the attending. I paged the attending.
- The attending called me back. I said I thought there had been a misunderstanding on the pt's pain meds, and he immediately began yelling at me. He said I was trying to make him go back on his word to the mother. I immediately told him not to yell at me. He replied that he would yell, because I had gone behind his back and tried to get a resident to write an order he had refused to write. I replied that I had simply paged the pain team each time, not knowing who would answer, repeated that I thought there had been a misunderstanding, and suggested that he talk with the mother again. He snapped that he would but only after he finished rounds. I thanked him and hung up.
- The attending arrived about an hour later, and asked the mother if there had been a misunderstanding. She replied that she thought po pain meds and getting off the IV were a good idea. Without speaking to me, he went to the charting room and wrote for po pain meds.
- I approached him and told him that I had not been trying to go behind his back at any time - that I was simply trying to do my job and help my patient progress. He replied "Don't try to tell me you didn't know what you were doing, my note couldn't have possibly been more clear." He then read his note to me. I asked him if he really minded being called back if I thought his note was based on a misunderstanding, which I added it clearly had been. That was basically the end of the conversation.
- The patient did very well on po meds. His IV was hep locked, he went off the unit with his mother for an hour, had better range of motion to his sore shoulder, and reported his pain as 0/10, instead of the 4-5/10 it had been with the PCA.
- I felt that I had been wrongly accused of lying, and I hate being yelled at. I realize I should have checked the progress notes before calling the first time, but still think the MD's reaction was totally inappropriate, especially after he spoke with the mother the second time. I went to the nursing director for our unit and complained. She thanked me for confronting the MD on his yelling, and said she would speak with him. I am still waiting to hear back.
- I really hate encounters like these with MD's, and while they aren't the norm, they happen too often. If I treated anyone like that (yelling, making accusations) I would expect disciplinary action. I love my job, but those kind of encounters really eat at me. Any suggestions on what I could do?
Apr 11, '03
Not surprising; "he who yells loudest..."
Good grief, one minute you're fighting tooth and nail to GET adequate pain control for pts, the next the docs are overmedicating.
It sounds like you were trying to be an advocate for your pt. Maybe the note should have been read first, but there was no need for that temper tantrum.
I've been a nurse for a long time, and you would think I'd be used to hearing about this, but it still surprises me every time. And people wonder what the reasons are for the lack of nurses.
Apr 11, '03
Next time you deal with this ****** give him the "look" and wait to see if he starts babbling.
Apr 11, '03
I don't quite know what the misunderstanding was? The doctor did wright to start the po meds the next day. No one should have to be yelled at though. You did right by talking with you supervisor. Just don't back down from that doctor, don't make a big deal out of it and when you show him you are the better person by not backing down and standing up for yourself he will end up respecting you for it. I am glad to see how well the boy progress. Narcotics can be so depressing. The attending probably didn't like the idea that you turned to the resident. I would be more aware of that resident for he was probably the one that told the attending that you called him. I have had a lot of dealings with doctors taking their anger out on the staff including myself. I used to work in the OR and there is no where more stressful but did learn as long as you kept doing your job regardless and held your ground and showed them I was going to work with them regardless then I earned their respect two fold. Good Luck! Kathy
Apr 12, '03
these stories are why i have lost all respect for doctors. who taught them to treat people that way? what happens a lot of the time is that i see nurses go with the flow so they don't have to have encounters like that----the patient loses out on that one. i, personally have just thrown up my hands and gone with the flow. if the *******wants his patient treated that way, fine
Last edit by P_RN on Apr 12, '03
Apr 12, '03
Part of the problem here seems to be the doctor coming to the floor and talknig to everyone but you. He's looking for a misunderstanding so he can jump on your back. He is too full of himself and his power tripping to realize that you, he, and the patient/family, as well as the pain team are just that-a team. If you are the one directly caring for this patient, how can he come to the floor and not communicate anything to you? I don't care what he wrote in the chart. He should have spoken to you with or without the family present or you should have made it a point to speak to him before he left the floor so you at least are on the same gameplan. That's how mistakes are made-when someone is left out of the loop. And that someone is a vital link in the chain. Refuse to be blown off or disrespected. The "look" really works!
Apr 13, '03
There are a small handful of docs where I work who are jerks everytime they come to the floor (or anytime you page them). They sneer, snarl, are rude and arrogant. One even said,"Who can I piss off today?" to one of the nurses. Finally, after giving them the "look" and of course, remaining professional and calm at all times, some of the staff decided to QA the "rude" docs. Being a little grumpy is one thing (we all have our bad days) but some of these docs do not communicate with nurses, and actually are nasty to be around. So, keep that in mind if the behavior persists. Start documenting the problems you are having. Maybe the medical director would like to know about it, especially if it is a pattern.