TERRIBLE medical director at LTC facility - what do I do??Register Today!
- by HM7380 Jan 4, '12I need some advice as to how to handle the medical director at the LTC facility I work at... I work at a 150 bed LTC/acute rehab facility, in which there are 3 MDs (including the med. director, who is assigned 75% of the patients). He is from Africa, and I've had nothing but problems with him since the day I was hired. Let me list the issues I'm having, and you can just refer to the number in your replies...
1. He never comes into the facility - during a 'good' month, he might show up once a week, though I've seen him not come in for weeks at a time (I'm not just talking about my shift... he doesn't come in at all, on any shift.) Not to do new patient MD assessments or anything.
2. He undermedicates people for pain, because it's an 'inconvienience' for him to have to write hard copies for the pharmacy. He actually told me to 'just give them some tylenol q4h' when I had a new 65 yr old patient (who was in a great deal of pain) in with a broken hip. Sometimes, he'll even refuse to give people orders for tylenol (for no good reason). I had a pt with a broken arm and broken humerus, and when I asked him to write an rx for pain meds, he said angrily, 'All you American women are the same... You can't handle any pain and it makes me sick', and hung up on me. I've had dozens of patients just moan and cry themselves to sleep every night because they're hurting so much and he refuses to do anything. From stage 4 terminal cancer to arthritis, he seems to have a MAJOR aversion to giving anything out. The more I ask, the more he seems to want to say 'no'. He also undermedicates for anxiety, but thats another story for another day.
3. He refuses to return virtually ANY of his pages. (Its a 1:20 ratio.... not just with me, but with all of the nurses.) I work 2nd shift, and he once told me that unless it was the biggest emergency of my life, that I'd better not ever call him again after business hours. He then proceeded to curse me out and yell at me in a foreign language. His attitude is beyond unprofessional (which I can deal with), but it's to the point where I'm afraid to page him/call his office (even though I pretty much know he's not going to call back/reply) because he will scream and belittle you. I can handle it, but its very depressing, and has most every nurse I work with scared to call him, which is resulting in a much poorer quality of patient care.
I understand MDs are people too and everyone has a different personality. However, I feel like I'm stuck in a terrible situation where I can't take care of my patients, PARTICUARLY the ones in pain, because he just doesn't have time to be bothered with them. I had a 103 year old patient whos feet were rotting off from gangrene and she cried so much from the pain that I had to change her pillowcase at least 2 times a shift (because it was soaked with tears). I finally got her family to agree to hospice so she could get the relief she so desperately needed.
What can/should I do?? Even my immediate supervisor has said she's not going to be calling him ever again because of how rude he has always been to her. I don't want to be labeled a whistle-blower (though I have no problem doing so), but do any of you think this man is breaking the law somehow? He seems like some sort of closet sadist to me... he has no compassion for the elderly, and to refuse to help them makes me so depressed. I feel helpless and I want to do something... my patients are like my family and it kills me to see them abused like this, because of some LAZY/ANGRY/RUDE dr treating them like trash. (And just for clarification, I have a very large age range of pts... they're not all very old.)
Sorry this was so long, but I need ideas as to what to do. Is what he's doing something I should report to the medical board? I feel like keeping people in pain because you're too lazy to write the RX is ABUSE. (I know the majority of responders first instinct is to say 'Get another job!!', and I plan to do so in the spring when I get married (insurance reasons), but that still isn't going to solve the problem of him abusing his patients. I want it to STOP, and I need to know how to make it happen! I'm leery about writing nursing notes that allude to his indifference, etc, to my patients complaints, but if you all say it would be ok, I'll go for it. :-/
Thanks again for your help!!
- Jan 4, '12 by lindarnI would start by
1.Keeping a log for when he is called: date, time, patient, reason for the call.
2.Time call returned, response-try to remember what he said in as much detail as possible include foul language used by him.
3. It is HIS JOB to care for the patients in the facility. Hand a piece of paper and pen to the patient and/or family, to write a complaint to give to the Medical Board. Keep copies of all complaints.
4. Report him to the Medical Board, JCAHO, and the parent company who owns the facilty. You might also call/write the Facilities and Licensing Division in your state. They are the ones who license health care facilities. I am sure that they would be interested in his conduct.
5. I hate to be an "in your face, opinionated, New Yorker". But, obtain a copy of his job description and, "remind Mr. Abusive, that, " this is his job description, and that he is paid alot of money to be the medical director of the facility to do this job". What is his excuse for not wanting to do his job? What exactly does he think he is being paid for? WHO is HIS boss?
He is being paid to care for the residents, provide orders for pain medication is part of caring for them, and what he is doing is considered abuse. It is not important to their care what he believes patients should get for pain medication or how often they ask for it. Patients deserve adequate pain relief. Period. He is obligated to provide that to them.
I would also call DSHS, and the Elder Abuse Line and describe what is going on. What is is doing, IS ABUSE. Again, keep a log of times called, response time, his response to being asked for an order, or whatever, etc. If he believes that his license and job are in jeapordy, he will get a load of defense attorneys to circle the wagon around his detractors, to discredit you. Include complaints from patients and family members. Remind the patients and family members, that "MD" does not stand for, "mighty deity". He is legally responsible to care for the patients according to the laws of your state, and every and all, administrative agency regulations, like JCAHO.
If he doesn't like it, he is welcome to go back to where he came from.
Also remind him that YOU are a licensed medical professional, and you DEMAND respect for your job! Let him know in no uncertain terms, that you will not stand for it. If he gets out of hand, call the police.
If you have a cell phone with a camera and a recorder, I would have it on and ready to record him, his complaints, refusals ,etc. I picture is worth a thousand words! He does not have to know you are doing it. Let it be a surprise.
Also, when you write your nurses notes, phrase it something like, " Dr. so and so called at 0200 about Mr Smith' pain, Call returned at 0700. Dr so and so informed about Mr. Smith's pain. Dr so and so responded, "all you American women are the same. You can't handle any pain and you make me sick". Dr so and so hung up the phone and did not give me any pain medication orders for Mr. Smith".
That is factual and to the point and objective. Make sure that you make copies of your notes, and his orders, because they WILL disappear, if and when the you know what hits the fan. Just don't tell anyone what you did.
You have a big hurdle to jump over, but your patients deserve it. You might want to call a lawyer, and get some feedback. You might also contact the law firm that defends the facilty. Speak to the senior partner.
JMHO and my NY $0.02.
Lindarn, RN, BSN,CCRN
Somewhere in the PACNW
- Jan 4, '12 by caliotter3Linda's answer is spot on. I have seen instances where some of these actions actually happened. For instance, a nurse charted in quotations the tirade our horrible doctor told her on the phone. The DON or ADON told her to do so. I would do these things if I wanted to continue working there or I would decide that this is not worth it and I would get another job. But if you leave, still consider making the complaints. No one deserves to be without pain meds when they have broken bones. Perhaps this doctor needs to go back to Africa to practice. But then, why would anyone in Africa deserve to have him for their doctor?