Am I wrong?

[emmy41lgpn]

Hi, everyone:

Ive belonged to allnurses.com for a couple of years, but this is my first real post--I'm a reader, not a poster.

I was an LPN for 20 years---had to give it up after rupturing my L-4-L-5 disc on the job.A laminectomy and 8 years fixed that. I miss nursing terribly, but don't think I could hack it the way things are today.God bless all of you who keep at it.

I am writing to ask a question about , I guess, medical ethics.

I have Barrets Esophagus, a hiatal hernia, and long standing gastritis.

No, I dont drink.

I had an upper endoscopy done on July 8th.By a gastroenterologist.

He took 40 biopsies, 4 per centimeter for each of 10 centimeters.

I had stopped taking Plavix on July 3rd.

I was okay until July 12th--nothing I could put my finger on, just felt lousy, slept all day.

At 10 p.m. that night, I vomited a large amount of black coffee ground material.I I called the Dr.s number, assuming that he had an answering service. Dummy me! The hospital operator came on the line, told me that he was not on call and there was no-one covering for him. She advised me to call my family Doc, which I did. He was on vacation at the beach, but called me back, anyway.He advised me to go have a CBC at the hospital in the morning.

I vomited again at 1:30---at 3 I had a tarry stool---another at 6--I called my family Doc at 7--he told me to go to E.R..

I was a little dehydrated, my hemoglobin was 10.2.

E.R. Doc tried to call the gastroenterologist--took 5 calls for him to respond.

He ordered I.V. Protonix---this is getting much too long--I was admitted

-he had ordered blood if my hemoglobin fell below 8---it hit 7.2. I got 1 unit of packed cells.

My REAL complaint here, I guess, is that he never came in to see me until my family Doc had written my discharge---then siad that the bleeding was from the EGD, which I had already surmised. SO--from Saturday night until Tuesday afternoon, he , essentailly ignored me.

I called the hospital today and lodged a compaint.

Am I right?

ALL replies welcome--thanks!

Emmy41lgpn

[emmy41lgpn]

MagsMom

Thanks for your response.

[emmy41lgpn]

chenoaspirit-thank you for your kind post, I appreciate it.

I was born in Hazard,Kentucky---just thought I would throw that in--------

[Dolce, RN]

The EGD was 4 days prior to the vomitting of coffee ground material. It wasn't the same day (not that I think that makes any difference).

If she feels "ignored" it is not the doctors problem. She is obviously a stickler for details with every symptom and detail written down with finite detail. I don't know that she would be satisfied with any doctor.

I know you are trying to play the devil's advocate here but I really think that the OP had a valid and legitimate concern about her GI doctor. You have stated earlier that a physician shouldn't have to be on call 24/7. I agree. That is why they have a partner(s) who they share call with. He obviously was on call, however, because he finally responded to the ER physician after being paged 5 times.

[Kwontor]

Maaybe I need to tell you more about WHY I might be a stickler for details, which I am not.

In November. 2004, I was diagnosed with cecal adenocarcinoma, stage 2, with lymphovascular invasion.I had 18 inches of my colon removed, and had 27 5FU and Leucovorin chemo treatments.

I had 3 Docs at the time--my family Doc, a cardiologist, (had a triple by-pass in 2002 for unstable angina, then a "mild M.I. 5 weeks later), and a pulmonologist for C.O.P.D. and sleep apnea.

I had been telling all 3 of them that I was so S.O.B. that I had to lie down after walking across my living room.

I suppose they all assumed it was my heart disease and C.O.P.D. causing it.

Or, that I was one of those famous middle aged, anxious females we hear so much about.

In October , 2004 , the pulmonologist finally ordered some blood work---my hemoglobin was 6.2. my hematocrit was 22.

I was admitted through the E.R., given 3 units of packed red blood cells, started colonoscopy prep, had a CT scan, etc.

Had my hemi-colectomy, went home after 10 days.

I could have died----------one little blood test saved me.

I trusted my Docs to look out for me--they let me down.

It has been almost 4 years ---so far, so good.

This experience taught me to always be your own advocate---if that makes me a person who would not be satisfied with ANY Doctor, and a stickler for details, so be it.

All of you will, one day, be a patient. Look out for numero uno.

When I realized that the endoscopy had caused a G.I. bleed. I of course went a little off the deep end. Wouldnt you?

Especially when your hemoblobin hit 7?

You are absolutely right, we MUST be our own advocates!

In 1995, I was discharged from the ER with a diagnosis of a viral infection that "had to run its course". The next day I saw my FP, by late that night, after countless tests and a major surgery, I was diagnosed with ovarian cancer. The ER had missed a 10 lbs., volley-ball sized tumor in a 13 year-old girls abdomen. If it wasn't for my mother's persistence and not settling for what the ER had told us, I wouldn't be here today.....

So yes, you are 100% right on that. But we must also remember that we are turning over our health to human doctors, not super-human medical machines. We must always listen to that little voice telling us that something is not right and be thankful we did when it makes up for unfortunate yet unavoidable human error made by medical professionals. Glad that you are in better shape!

[MeJane19]

I totally disagree but it doesn't matter. You did what you felt you had to do and that's the bottom line.

[emmy41lgpn]

I checked it out--the gastroenterologist who did the upper endoscopy does NOT have an answering service, and is , apparently . never on call, and no-one covers for him.

Perhaps it would be a good idea for him to tell his patients that, and to tell them them what to do if there is a problem after a procedure?

[ilstu99]

I checked it out--the gastroenterologist who did the upper endoscopy does NOT have an answering service, and is , apparently . never on call, and no-one covers for him.

Perhaps it would be a good idea for him to tell his patients that, and to tell them them what to do if there is a problem after a procedure?

My PCP doesn't do on-call hours, either. She's one woman in a private office. I like that, so I stay. I realize that there are downsides, but the overall care I receive is more important to me that being inconvenienced sometimes with after-hour's issues. I also realize that she HAS to maintain the same policy for everyone, or there'd be no stopping the "emergency" calls.

I'm totally NOT saying that your issue isn't/wasn't important, just that tons of people call with "emergency" things like hangnails....so you usually have to be rigid for everyone. I do agree that he should have made his lack of on-call availability clear from the onset of your treatment in his office.

[Dolce, RN]

I checked it out--the gastroenterologist who did the upper endoscopy does NOT have an answering service, and is , apparently . never on call, and no-one covers for him.

Perhaps it would be a good idea for him to tell his patients that, and to tell them them what to do if there is a problem after a procedure?

Wow, I am surprised he is able to get away with that considering that he does procedures on people. I really think you should be looking for another GI doc, but thats just me.

[Mara123RN]

Mejane19 I am just curious do you have any experience in the medical field or are you just here as the daughter of a doctor?

emmy41lgpn I think he should have told you up front that he did not have an answering service or anyone covering him. I think it was wrong of him not to visit you in the hospital if he knew you were there.

[chenoaspirit, ASN, RN]

chenoaspirit-thank you for your kind post, I appreciate it.

I was born in Hazard,Kentucky---just thought I would throw that in--------

Im in Morehead. There arent many kentuckians on here. Oh, BTW, I also had a hemicolectomy...then later another colectomy. I know how that is, its rough stuff. How are you feeling now?

[MeJane19]

Mejane19 I am just curious do you have any experience in the medical field or are you just here as the daughter of a doctor?

I stated in my introduction that I am taking prereq's to go to either nursing school or medical school. I'm not hiding anything from anyone.

I feel qualified as the daughter of a doctor that doctors deserve their time off just like anyone else. Would you like to be eating Thanksgiving dinner with your family and your cell is ringing because a patient had complications from a procedure done 3-4 days ago, that's what ER's are for. The OP comes across as though she is the "only" patient because she has a chronic condition. Is that the doctors fault? I can tell you that every patient thinks they are the "only" patient when they have complications and that's alot of patients and alot of calls interrupting

your dinner,

your alone time with your kids,

your shower,

your vacation,

your movie,

your church service,

your afternoon nap,

your childs ballgame,

your childs college orientation

the birth of your grandchild

a family picnic

your own doctors appt

Yes my father has been interrupted during all those times and 100's more. When he is on call he doesn't mind a bit, alot of times just stays at the hospital rather than coming home. Spends countless hours with patients, their families, makes phone calls to family members who can't be there to explain what is going on, what is going to happen, prays with his patients, holds their hands, attends funerals. He has a heart as big as the state of Texas but when he is off of duty, he is off. He does make exceptions to patients who he knows may get into trouble and gives them his cell phone number to call directly. He can't possibly be responsible for the 8 or so patients he cathed each day for 3-4 days. That's why he has on call time and off call time. When he is on, he's 100%, when he's off he's about 99% off. There are special patients who tugs at heartstrings and he knows which ones he can trust to be responsible with his cell phone number. 99% of the time the one's with the number don't even call.

I'm sorry if you think I won't be a compassionate nurse or doctor, I know I will be very compassionate because I've learned compassion from the very best of the best. No one has ever accused my father of being incompassionate, quite the opposite. He deals with the heart in more ways than one.

I agree that the doctor should tell his patients he doesn't have anyone covering call at night/weekends. Shame on him, that is sooo wrong.

I don't think you should knock every doctor for not being on call 24/7, they have lives and families too. If your patients called you day in, day out, at all hours of the day and night on your day off I don't think you would like it.

Try walking in someone else's shoes before making snap judgements.

[Katie82, RN]

Thanks, dria-----I really thought that nurses would have more to say about the way some Docs treat, or, more accurately, dont treat, their patients.

I think the reason a lot of folks aren't replying is that they just don't have enough info - there are a lot of variables to this situation. Many docs now use hospitalists, which means you probably won't see your PCP or a specialist. Hospitalists are practices that contract with docs to see their patients in the hospital, and they control your care while you are inpatient, although they often consult with PCP or specialists. If you saw a lot of docs you did not recognize, they were probably hospitalists. My first reaction was that your PCP told you to wait til morning, and then it occurred to me that if you were previously on Plavix, some bleeding after so many biopsies wouldn't be unusual, and your emesis was coffee-grounds, not frank bleeding. Most docs tend to err on the side of caution when doing telephone triage, so he probably should have sent you to the ER sooner, would have relieved your anxiety a little. Luckily, your Crit was low, but not critical - that came later. In my area, hospitalists were first hired by hospitals to manage ICU patients because PCPs and specialists don't have enough time to give those patients the attention they require. Over the years, they have expanded to cover most services and docs have found them very helpful because it allows them more time for patients in the office. Sounds to me like you received appropriate care, but someone should have explained to you why the right doctors weren't there. I would find another GI specialist. Trust and respect is a large issue when selecting a doc, and sounds like this one failed in both respects.