unsafe MD

Nurses General Nursing

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:angryfire--------------------------------------------------------------------------------

i hope someone can help with some advice. i have almost 4 years nursing experiece with close to 3 of those years working on a surgical specialty floor at a major teaching hospital. this past summer i decided to begin travel nursing, my firstassignment is at a small community hospital. at this small hospital i have waited up to 2 hours for MDs to call back after being paged ( more than once). the other day i paged the covering MD about a BP of 165/111 the patient was symptomatic with nausea and being light headed. ( new onset of BP, no hx of htn, pt. admitted for renal stone) after 20 min. md called back, gave no orders stated he would be in to see pt. soon. had to page MD again 3 hours later for phenergan after pt. vomited. MD finally arrived to see pt. 5 hours after initial page. then discharged pt. without addressing bp issue. i tried to address this and finally 2 more hours passed the md agreed to give a one time med order before dc'ing pt.

this was just one example of many from this md in one weekend. he came in today for rounds, wrote notes and ordered labs on patients when he never entered their room. am i too spoiled by working with interns/residents who come see pts daily and address all care issues before discharging or am i right to be deeply concerned about the standard of care at this new hospital? i wrote the incident up but other staff nurse said the MD has been written up alot of other times. do i go to jacho, the state board of medicine? thanks for letting me vent

Specializes in ER.
It's not like this guy puts an ad in the paper that says, "Think you need eye surgery? Come see me!" and patients call him up to schedule a procedure.

They do in my area.

In any case isn't it on the admitting doctor to make sure vitals are WNL, if only to prevent complications in hospital? If he is unable he can always consult out, and refer to a PCP on discharge.

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They do in my area.

In any case isn't it on the admitting doctor to make sure vitals are WNL, if only to prevent complications in hospital? If he is unable he can always consult out, and refer to a PCP on discharge.

precisely, i agree with TiredMD, her/his model is the ideal.....but not the real

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Since you are a traveler, you need to be very sure that you want to get involved in writing up a doc.

I've seen more than my share of docs just like you described and worse. But they bring money into the hospital and 90% of the time, there will be a fight down in the admin offices at which time the doc will threaten the CEO with taking his patients elsewhere, and then the CEO will simply kiss the doc's butt and then come tell the unit manager that the staff need to be more accomodating. And yes, I have actually been a manager and had this exact thing happen more than once.

The question to answer is how much are you willing to fight and are you willing to risk your job. As a traveler you are an outsider. If other nurses have written this guy up and gotten nowhere - do you honestly think and outsider will fix the problem with a write up? Having been in on the hiring of travelers, don't think that just because you anger one hospital that it won't follow you. I have seen admin call around to different hospitals and get the scoop on travelers. It can be brutal since one wrong word can end a traveler's career in a particular area even though they really didn't do anything wrong.

If you don't think you can handle a big fight and the possible consequences i don't blame you. Nursing now days is a constant fight and you have to pick and choose your battles carefully - like a politician does. Sometimes you have to forfeit one battle to be able to win a war later on. In which case, you document all the doc's crap, including any cursing he does at you etc. This will cover you and if something happens to the pt - well, the litigating attorney is going to have a field day but at least he won't be after your butt. Many people advise that you not "tell all" in the chart and to only tell everything on an incident report. That will cover the hospital but not you. Those incident reports are confidential. And few risk managers will even admit to their existence because if they admit an incident report was written on that incident - the attorney can subpoena it. Thus, those reports don't exist if it looks like the hospital might get in trouble for allowing a bad doc to stay on staff. And the hospital has no problem hanging out a single nurse on the line because the nurse doesn't bring in business - the doctor does.

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Having scrubbed on cataract surgery, I can say that any opthalmologist who refuses to adress HTN in a pt going for surgery is risking injury to the pt and a lawsuit on himself. Our optho guys always ensured that pressure was addressed prior, during, and after. So TiredMD, in a fantasy world an optho may be able to say that they don't have to do this, in which case they better get a GP to step in and do something at the very least.

An OR nurse who allows a pt to come back for cataract surg had best be documenting as it can fall on them as well if they bring the pt to the room without having addressed the issue with the doc.

My guess is that this doc feels he is doing "poor" pts a service when in reality it is the language barrier and the low risk of litigation that keeps this guy in practice.

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Since you are a traveler, you need to be very sure that you want to get involved in writing up a doc.

I've seen more than my share of docs just like you described and worse. But they bring money into the hospital and 90% of the time, there will be a fight down in the admin offices at which time the doc will threaten the CEO with taking his patients elsewhere, and then the CEO will simply kiss the doc's butt and then come tell the unit manager that the staff need to be more accomodating. And yes, I have actually been a manager and had this exact thing happen more than once.

The question to answer is how much are you willing to fight and are you willing to risk your job. As a traveler you are an outsider. If other nurses have written this guy up and gotten nowhere - do you honestly think and outsider will fix the problem with a write up? Having been in on the hiring of travelers, don't think that just because you anger one hospital that it won't follow you. I have seen admin call around to different hospitals and get the scoop on travelers. It can be brutal since one wrong word can end a traveler's career in a particular area even though they really didn't do anything wrong.

If you don't think you can handle a big fight and the possible consequences i don't blame you. Nursing now days is a constant fight and you have to pick and choose your battles carefully - like a politician does. Sometimes you have to forfeit one battle to be able to win a war later on. In which case, you document all the doc's crap, including any cursing he does at you etc. This will cover you and if something happens to the pt - well, the litigating attorney is going to have a field day but at least he won't be after your butt. Many people advise that you not "tell all" in the chart and to only tell everything on an incident report. That will cover the hospital but not you. Those incident reports are confidential. And few risk managers will even admit to their existence because if they admit an incident report was written on that incident - the attorney can subpoena it. Thus, those reports don't exist if it looks like the hospital might get in trouble for allowing a bad doc to stay on staff. And the hospital has no problem hanging out a single nurse on the line because the nurse doesn't bring in business - the doctor does.

This is also a good reason to make copies of your incident reports, and to h&** with people who tell you not to. Just don't advertise it. The hospital will hang you out to dry, if the you know what hits the fan. CYA big time!! And make sure that you have you own .

Lindarn, RN, BSN, CCRN

Spokane, Washington

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Specializes in icu, er, transplant, case management, ps.
Having scrubbed on cataract surgery, I can say that any opthalmologist who refuses to adress HTN in a pt going for surgery is risking injury to the pt and a lawsuit on himself. Our optho guys always ensured that pressure was addressed prior, during, and after. So TiredMD, in a fantasy world an optho may be able to say that they don't have to do this, in which case they better get a GP to step in and do something at the very least.

An OR nurse who allows a pt to come back for cataract surg had best be documenting as it can fall on them as well if they bring the pt to the room without having addressed the issue with the doc.

My guess is that this doc feels he is doing "poor" pts a service when in reality it is the language barrier and the low risk of litigation that keeps this guy in practice.

I agree with most of what you have posted. Isn't it the admitting nurse's responsibility to review and report any abnormal vital signs or blood work. If a patient is having eye problems because of diabetes, his blood sugar is not going to come back in normal range. It is the responsibility of the pre-op nurse to report it. I went in, for surgery, at 9AM, with a blood sugar of 70. I am a Type 2 and had not taken my NPH that morning. I was sure I told the pre-op nurse. They kept an eye on my blood sugar thru my surgery and during the thirty-six hours I was hospitalized post op. They also contacted my endo, in Tampa, I was in Sarasota, and informed him of my blood sugar. My surgeon, the pre-op nurse, the RR nurses, the floor nurses all did an excellent job, as did my endo 100 miles away.

There are physicians who I would not let treat a pet crockroach. And there are those I would trust my youngest granddaughter's life with. If a surgeon over-steps the bounds, you report him, to all the appropriate bodies. And you send copies to the travel company you work for, as well as giving their representative a heads up. No patient should have to go what these patients suffered thru.

Woody:balloons:

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Specializes in Med/surg,Tele,PACU,ER,ICU,LTAC,HH,Neuro.
Ophtamologists are eye surgeons, not primary care practitioners. They were referred to him for a specific reason: eye care. It is neither expected nor appropriate for an ophthamologist to initiate blood pressure treatment on a patient they will not be following as an outpatient. While a blood pressure of 200/100 is disconcerting, it's not really a problem that can or should be fixed during a brief hospitalization for eye surgery.

Probably the better way to deal with these patients is to encourage them to follow-up with their PCP (after all, someone had to refer them to the ophthamologist), or provide them with the phone numbers of local Medicine docs who don't mind taking low-income patients.

Giving meds for hypertension during a surgical hospitalization sounds like a good idea, but once the pain and stress of surgery wears off, these meds can make people hypotensive, orthostatic, or even syncopal. Surgeons need to do what they were trained to do, and not try to fix every problem on a patient's problem list.

I agree he had no idea how to treat the hypertension and diabetes, but some of these patients were so out of control they needed a consult. It was hard to get him to address these problems. This was probably the only time some of these folks even saw a doctor.

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