This is similar to other threads about lazy doctors and nurses.....but this issue is with a twist....and I wonder what your opinions are on this.
I took care of a head inj. patient who also has intract. pain. He was given a pain managment consult by a pain specialist MD. This doctor after initially seeing the pat. placed the pt. on continuous pain medication. TWO DAYS later, he CALLS by phone and says:
"how is "so-and-so" doing?"
I explained due to head. inj. it was diff. to surmise the level of pain control due to memory disfunction, etc....but that the pt. did have periods of rest that was seemingly comfortable."
"well, please note in the chart that I called, and that the patient is comfortable, will you??"
EXCUUUUSE ME??? This is your "consult"??? This is how you treat a person's pain?? Have the bedside nurse give you the "picture" and then have the bedside nurse indicate that you "called", rather than actually have to spend time seeing the patient....or evaluating the patient YOURSELF??
I JUST HATE THIS!!
I get phone calls like this often....from dieticians who are supposed to come to the bedside themselves and evaluate whether or not the patient is being adequately nourished to speech therapists who want to know if the patient is "awake enough to talk".
Why am I, the bedside nurse, the one who is ENORMOUSLY busy with patient care being asked to look up lab values for them, when they have little portable computers they carry around with them anyway? Why do I have to re-write their "recommendations" to the doctors so then the doctor can order what they recommend? Why don't they just do their OWN work, instead of making me their lady-in-waiting?? It's bad enough I get 15 phone calls a day on a patient from everyone from their cousin twice removed to the xray tech wanting to know if they can come and take a picture!!
I'll be doggone if I will chart for a doctor that he "called to inquire" about the patient's pain relief!! Was I bad to just "forget" to do this???
It wasn't exactly on my priority list....since I had alot of stuff going on at the time with a non-draining EVD and a cranky neuro-surgeon....
but, the truth is....I simply think doing other people's jobs is just plain wrong.....
Do I look like a door-mat, mule, beast of burden, multi-tasking nurse to you??? ugh!
Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.
To earle58: here's what I found wrong with the doctor's phone call....
If he had called just to check on the patient, that is one thing....
But he INSTRUCTED ME TO CHART THAT THE PATIENT WAS COMFORTABLE ON THE CURRENT DRUG REGIMEN....and this implies that he has evaluated the patient in person....for which he is charging consulting fees....and that makes me complicit in his fraud....he is charging the patient or medicare for services not performed!
He is supposed to be the EXPERT pain specialist...that is what he is getting paid to do....I am the medication administrator....that is what I am paid to do....I don't think it is professionally wise to blur those lines....because once I step over that line and say, "well, the patient was 'comfortable'" and the doc bills for visits he didn't make, I am in a way, aiding his behaviour because I am charting as if everything is fine!!
Under medicare guidelines, every consulted doctor is supposed to see the patient every 24 hours, unless they are no longer needed, and they have to request sign off from the primary doctor....
Telling me what to chart about him is troubling, don't you think?
Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.
Thank you Chris at LUcas RN for the pain scale....
In this case, because of the pt's severe head trauma and subsequent labile emotions/ short term memory/ aphasia/ vs. periods of quiet/ sleep/ lethargy, it is a tool that would not be very helpful....this poor patient could not rate his pain....he didn't know what a 10/10 pain was....and five mins. later would say he was fine.....then fall asleep....so sometimes, pain scales are not always the best tool....I medicated if he was more restless....although, it was diff. to decide if restlesssness was due to pain, or swelling in his brain....and over-sedation with this patient would not have been good, due to the fact that we needed to check neuro status every hour....
To earle58: here's what I found wrong with the doctor's phone call....
If he had called just to check on the patient, that is one thing....
But he INSTRUCTED ME TO CHART THAT THE PATIENT WAS COMFORTABLE ON THE CURRENT DRUG REGIMEN....and this implies that he has evaluated the patient in person....for which he is charging consulting fees....and that makes me complicit in his fraud....he is charging the patient or medicare for services not performed!
He is supposed to be the EXPERT pain specialist...that is what he is getting paid to do....I am the medication administrator....that is what I am paid to do....I don't think it is professionally wise to blur those lines....because once I step over that line and say, "well, the patient was 'comfortable'" and the doc bills for visits he didn't make, I am in a way, aiding his behaviour because I am charting as if everything is fine!!
Under medicare guidelines, every consulted doctor is supposed to see the patient every 24 hours, unless they are no longer needed, and they have to request sign off from the primary doctor....
Telling me what to chart about him is troubling, don't you think?
and i would chart what he instructed then:
"pt appears comfortable per rn assessment, as reported to md via phone call on such and such a date at such and such a time. nno at present".
this way, you have documented thoroughly and legally.
I worked for HCA for years, from the late 80's clear through all the fraud and the aftermath. As part of the deal made with the Feds, all HCA facilities were required to put their staff through compliance training, over and above what was normally required. This was drilled into us over and over--- you do not want to even appear to be complicit in anything that could even resemble fraud. Being aware of a potential problem such as this and not reporting it is cause for disciplinary action against you. True, you don't know how he is going to bill, if at all. But he is clearly going against regulations by not seeing the patient in person for that length of time, and the whole situation is iffy enough to warrant an investigation into what exactly is going on. You don't have to be certain that he is committing fraud to report this; that is up to those investigating the complaint to determine.
Please notify risk management and corporate compliance officer about your concerns and keep a record of your reports.
Stuff like this raises all kinds of red flags for me.
Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.
I did notify my mngr. today....and she concurred that this was "not okay"...and said it was correct for me to not have charted this exchange....
as for the dr. calling vs. visiting in person:a dr. who doesn't see a patient for two days, now going into three days, and relies on subjective information from a NON PAIN SPECIALIST and then asks that person to chart that the patient is "comfortable" is asking that person to essentially lie for him/her....as nurses, we are not the specialists...we can determine if a patient is painful to some degree....but we cannot cross into the role of pain specialist by charting that the patient is comfortable, as if to then relieve the doctor's responsibility of followup care....when we do this, we are complicit in his/her malpractice....
what if the patient is really hurting, but the nurse reporting is either oblivious to it or doesn't know pain in a brain injured patient when she/he sees it? If a doctor will rely ONLY on that assessment, then he is a fool....and anyone who charts for him a bigger one....jmho.
CRNI-ICU20
482 Posts
To earle58: here's what I found wrong with the doctor's phone call....
If he had called just to check on the patient, that is one thing....
But he INSTRUCTED ME TO CHART THAT THE PATIENT WAS COMFORTABLE ON THE CURRENT DRUG REGIMEN....and this implies that he has evaluated the patient in person....for which he is charging consulting fees....and that makes me complicit in his fraud....he is charging the patient or medicare for services not performed!
He is supposed to be the EXPERT pain specialist...that is what he is getting paid to do....I am the medication administrator....that is what I am paid to do....I don't think it is professionally wise to blur those lines....because once I step over that line and say, "well, the patient was 'comfortable'" and the doc bills for visits he didn't make, I am in a way, aiding his behaviour because I am charting as if everything is fine!!
Under medicare guidelines, every consulted doctor is supposed to see the patient every 24 hours, unless they are no longer needed, and they have to request sign off from the primary doctor....
Telling me what to chart about him is troubling, don't you think?