Difficult Doctors...Vent

[joanna73]

Hi Everyone

Early this morning, I called the MD to inform him that a resident had very low urine output (60 ml in about 6 hrs). The resident was very lethargic, distended abdomen, constipated. The Dr as usual was annoyed, did not want any info, and kept cutting me off as I was attempting to give report. His demeanor is nothing new, and he treats the nurses like we're morons. However, I feel I have a duty to report when I know that something is off. If the Dr chooses not to follow up, at least I know I did my job. Another time, a resident fell. The resident was fine, but I called the Dr before I went off shift to let him know. Again, Dr was annoyed. This Dr does not make rounds either, so if we didn't inform him of certain instances, he would never know. I just cannot believe how disrespectful and unprofessional this man is! It is very hard to work with him, and we all dread when we have to call...

[interleukin]

Documenting, "Pt condition reported to Dr. Whoever. No orders given," is not good enough. A doc can claim you omitted important information, and a year later your memory will be faulty.

Documentation should read: "Changes to pt condition(list change) specifically detailed and conveyed to Doc Whoever during 16:00 phone call...he/she voiced disconcern...no orders given."

If you ever have to recount details long past, you'll be happy you took the extra minute to write in a manner that unambiguously reflects your actions and prevents a lawyer from spinning the information/event against you.

[joanna73, BSN, RN]

That's basically how I documented it. Pt condition, doc notified, no orders, doc will assess pt in am.

[xx--RN--xx]

Chart...chart ...chart!

XYZ problem.

Notified Dr. A of XYZ.

Dr. A gave no new orders at this time.

CYA so you can live to nurse another day!

[platon20]

Can you call another doctor re the patient? A specialist maybe?

No, this is inappropriate except in circumstances where a patient needs an ICU bed and the primary doctor wont call you back. Only in that circumstance is it OK to call another doctor (ICU doc).

I'd be making a quick, anonymous call to the medical director about this - or get a few nurses together to complain - and get something done.

I agree with this; best way to go.

One of those patients is in acute renal failure and needs to be assessed.

Call a nephrology doctor for a consult instead.

NO, this is not acceptable. Nurses cant and shouldnt call for physician consults. A consult is specifically a physician to physician deal. First off, a specialist wont get paid for a consult thats called by a nurse. Secondly, most specialists would be rightly angry at a nurse calling a consult, ESPECIALLY in the middle of the night. Thirdly, consults generally require knowledge of pathophysiology that nurses dont have. If a nurse called a nephrologist in the middle of the night with a chief concern of "this patient is oligouric/anuric" thats not very helpful information in and of itself. Its incredibly rare that you need a nephrology consult in the middle of the night, even for a 100% anuric patient. Dialysis can usually wait till the AM, and nurses arent qualified to know when someone needs emergent dialysis or whether they just need conservative management until the primary doctor can talk to the specialist in the AM.

[bsveillon]

Well, all I can say is, something needs to be done. I can't tell you to do what I would do, because I don't know what your outcome would be! But I know, I've risked disciplinary action(and received it) to let a Dr. know how I feel. This has nothing to do with how he treated me, but he's not even paying attention to the pt.! I told him, if this was my grandmother in the hospital, and you showed this lack of concern, and something happened, you WOULD be sued. Why should I care less because instead of my grandmother, it's a pt. NO! Do your job that you get paid too much for! Do it or let someone else do it for you!

Again, perhaps you aren't in a situation to do something that outspoken, but you must do something.