unsafe MD

  1. :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
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  2. 18 Comments

  3. by   TazziRN
    Why not go to both? The fact that others have written him up tells us that you are not spoiled or overreacting. If write-ups haven't worked then it's time to go higher up the food chain. Not to hospital admin, unless they're backed into a corner they will support the docs.
  4. by   trethern
    I totally agree. I have had to work with a doctor who told me that I was overreacting when I told him his patient's wound had eviscerated. Luckily I was able to go to this doctor's senior partner who took care of the situation. Does this MD have a competent partner that you could talk to? If he does, they will generally get right on it because they don't want their practice involved in a malpractice case.
  5. by   canoehead
    Page him every 15 minutes until you get an answer, if it takes more than 4 pages go up the chain of command. Document all pages.

    If his decisions are inappropriate express your concerns to him. If he doesn't respond appropriately, go up the chain of command. Document your conversations.

    If he says he's coming right over and doesn't show up page him again just to make sure he wasn't in a car wreck ( ) If he still doesn't show up, go up the chain of command.

    There has to be a medical head of the department, or hospital, and that's part of their job- to make sure the docs on staff don't kill anyone. If you need to contact the department head leave a message for your manager as an FYI. Likely someone will complain to her about what mouthy employees she has, and she'll appreciate the heads up.

    Keep a copy of documentation about the issues you called about and the responses in case nothing changes and you choose to report him to the medical board. It gives you more credibility if you can show them how you addressed the problem internally before going to them.
  6. by   bagladyrn
    A heads up! As a new traveler you need to do one more step - before taking any action above the unit level and/or addressing the immediate problem as it arises (i.e. repeated pages, instituting chain of command) and certainly after taking these actions, be sure to talk to your company, asking to discuss it with the clinical liason for your area.
    It's really important to keep them aware of what is occuring and the actions you are taking so that they are not blindsided by a complaint about you (in which the facts may be twisted). If they already know about an issue over a period of time, they are less likely to respond negatively to you if, for instance, they are notified of a physician complaint about you.
  7. by   rn undisclosed name
    I agree it is so frustrating and I think the hospitals need to stop putting up with this. I work with a doctor who is terrible. One day another nurse counted how long he was in a pt room. 17 seconds. I just think that is terrible. I realize docs don't spend as much time as nurses. This particular doc will keep patients in the hospital until all consults sign off. Some consults don't sign off and will just continue to follow until they are discharged. So with this particular doc I make sure to tell the consults this pt will not go home as long as you are still on the case. It's frustrating when you have other docs ask you why is this patient still here.

    Also, with this particular doc I have to tell him which orders are needed and will have a list on the front of the chart. I feel like I am playing doctor and doing his job for him. I have noticed a lot of other people don't question anything he does. Some of the things I have gotten on him for (1) pt comes in with high K and there are no labs for 3 days - don't you want to know if his K is WNL (2) same pt is getting dialysis and is acute but we are just ordering dialysis and don't have any labs - I thought dialysis was based upon a patient labs. There are more.

    One time we told him we needed him to spend more time than he was. He said he had to go because time is money. Give me a break. The hospital backs this doctor. I have no idea why because they are losing money because his patients stay in the hospital forever!

    Makes me appreciate the docs who are really thorough and want to help their patients. I am glad that most of the docs I work with are good and not of the caliber of this particular doc.

    Kelly
  8. by   lindarn
    Quote from canoehead
    Page him every 15 minutes until you get an answer, if it takes more than 4 pages go up the chain of command. Document all pages.

    If his decisions are inappropriate express your concerns to him. If he doesn't respond appropriately, go up the chain of command. Document your conversations.

    If he says he's coming right over and doesn't show up page him again just to make sure he wasn't in a car wreck ( ) If he still doesn't show up, go up the chain of command.

    There has to be a medical head of the department, or hospital, and that's part of their job- to make sure the docs on staff don't kill anyone. If you need to contact the department head leave a message for your manager as an FYI. Likely someone will complain to her about what mouthy employees she has, and she'll appreciate the heads up.

    Keep a copy of documentation about the issues you called about and the responses in case nothing changes and you choose to report him to the medical board. It gives you more credibility if you can show them how you addressed the problem internally before going to them.
    And don't forget to make and keep copies of every piece of documentation that you write. I would also make copies of my nurses notes in case they also "disappear misteriously", if you know what I mean.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
  9. by   leslymill
    We had an ophthalmic surgeon who would fly all over rural Texas gathering patients to perform Surgeries on a decade or so ago. These were primarily Hispanic non-English folks who were told we would accommodate their families and give them private rooms. What a mess.
    The reason I say Hispanic is because what causes eye problems in the Hispanic population? HIGH BLOOD PRESSURE AND DIABETES. These folks come in not getting a private room like promised. Families sleeping all over the floors. Their blood pressures and blood sugars are SKY HIGH and have never been diagnosed with those problems. This MD only fixed their eyes. He ignored over half the calls of high pre-op and post-op blood pressures and blood sugars and to get anything done was like pulling teeth. He made a lucrative killing$$ with his little Cessna and private Spanish speaking nurse.
    He wasn't unsafe when it came to eye surgery, but how long are they gonna see if their B/P is >200/100 all the time.
  10. by   blueheaven
    Quote from canoehead
    Page him every 15 minutes until you get an answer, if it takes more than 4 pages go up the chain of command. Document all pages.

    If his decisions are inappropriate express your concerns to him. If he doesn't respond appropriately, go up the chain of command. Document your conversations.

    If he says he's coming right over and doesn't show up page him again just to make sure he wasn't in a car wreck ( ) If he still doesn't show up, go up the chain of command.

    There has to be a medical head of the department, or hospital, and that's part of their job- to make sure the docs on staff don't kill anyone. If you need to contact the department head leave a message for your manager as an FYI. Likely someone will complain to her about what mouthy employees she has, and she'll appreciate the heads up.

    Keep a copy of documentation about the issues you called about and the responses in case nothing changes and you choose to report him to the medical board. It gives you more credibility if you can show them how you addressed the problem internally before going to them.
    Yes the nurse manager will hear about it!! LOL It all gets back to CYA.
    This exactly what I did when I worked in a small community hospital. I had no qualms about going up the food chain when I needed to. There was one incident where I reported a particular doctor for writing things about me in the chart like Mz. Nancy Nurse has oversedated the patient so he wouldn't bother her...etc. Needless to say that was inappropriate. I wrote him up numerous times. Administration did nothing to address his behavior. He almost came over the desk after me one day when his patient didn't get extubated exactly when he wanted (RT extubated patients at that facility) Administration finally did something after I went and had copies of everything I had written up and copies of inappropriate chart entries and statements from my coworkers about his harrassment of me and contacted an attorney. They dealt with him quickly after that.
  11. by   TiredMD
    Quote from leslymill
    This MD only fixed their eyes. He ignored over half the calls of high pre-op and post-op blood pressures and blood sugars and to get anything done was like pulling teeth. He made a lucrative killing$$ with his little Cessna and private Spanish speaking nurse.
    He wasn't unsafe when it came to eye surgery, but how long are they gonna see if their B/P is >200/100 all the time.
    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.
  12. by   morte
    Quote from TiredMD
    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.
    did you miss the part about him flying around gathering up patients?
  13. by   TiredMD
    Quote from morte
    did you miss the part about him flying around gathering up patients?
    First of all, surgeons don't "gather up patients". Patients are referred to them for specific concerns, usually by a primary care physician/NP/PA. 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.

    Second, in rural areas it is not uncommon for a physician to fly around (or drive, or whatever) to areas that do not have a local surgeon in that specialty, spend a week operating on prescreened patients, and move on. These docs provide a valuable service, because then patients don't have to drive hundred or thousands of miles to larger centers to have their operations performed.

    Regardless, my point was simply that ophthamologists shouldn't shouldn't manage blood pressure, especially when they're only seeing patients briefly for a specific operation. Would you want your ophthamologist managing your hypertension?
  14. by   canoehead
    Quote from TiredMD
    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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