Another gripe about an ego-driven doctor

[New2ER]

I work in a psychiatric emergency department. I truly love what I do except for one particular ER doctor we all have to work with. Tonight, I had a patient brought in in handcuffs by 6 police officers. The man was yelling, wasn't following direction, throwing himself on the floor and the police reported that he was threatening his wife and daughter at home and that they found broken glass throughout the home. I immediately asked the attending to come and assess the patient for possible medication administration for everyones safety.

This is the usual course of action in our ER and usually is not a problem. At times the attending will give the order for medication IM (we dont' do IV) based on the nurses' assessment of the behavior.

The ER is slow tonight, a total of 6 patients, all treated and awaiting results. He tells me he's busy he'll be over when he's available. I can see he's surfing the internet. The cops leave, my tech and I are able to verbally redirect the patient, he doesn't quiet down but at least remains in his room. 15 minutes later the attending shows up, "So where's this guy everyone is so worried about". I tell him the family reports no psych history, he's diabetic with a blood sugar of 254 and the family reports that he's been drinking all day. He spends 5 minutes with the patient then leaves, he says nothing to me about medication. The patient is now more agitated, pacing the hallway, angry that he is here, banging his fists against furniture and the walls. I look in the computer and see an order for our standard cocktail ativan, haldol, benadryl. Since this isn't the first time he ordered medication without so much as a word and the pt is increasily agitated, I medicate him IM as is usual.

The patient is then to be transferred to the medical side for rally pack. It's only then did we notice the order was IVP - for an obviously agitated patient who is becoming increasing agitated and unable to redirect. Had I moved the patient to the main ER without medication he would have ended up in restraints.

Now I have to write an incident report because I gave the wrong route. I route that would NOT have been ordered by any other doctor with a stitch of common sense.

This MD will ignore patients in psych for upwards of 4-5 hours when he's busy and when he's not he comes over as soon as he sees a new patient as questions nurses as to why you haven't drawn blood or done an EKG. Alternately, he'll yell at nurses for sending labs if he didn't order them. I've already reported him once, when he told me that a pt who was verbally threatening and kicking doors was "not that bad" because I didn't call him. When I told him that I didn't return his call because I was worried about the safety of the patient and staff he told me he was "more important".

I just can't stand this. I was so angry I was practically in tears. What gets me is that this guy has been working here for 8 years. He's been written up by just about every nurse that has worked under him. And he's still here. *sigh*

[NurseCard, ADN]

I'm sorry you have had to deal with such a jerk. :icon_hug: Unfortunately, docs make hospitals money, and therefore hospitals are reluctant to get rid of them. That's one of the few things I like about where I work right now; I work for a non profit agency, and here the docs, the nurses and the aides are all hired by the same agency. In most hospitals the docs don't get paid by the hospital so they aren't costing the hospital any money. Instead, they are making the hospital money by bringing in the patients!

I guess you can take confort in the fact that you certainly aren't the only person who thinks he's a total jerk.

[New2ER]

I spoke to a couple of the other nurses that I'm working with tonight. They've told me they'll support me if anything comes of this and think the MD tonight is in a "mood" and picking on several of the nurses. One nurse flat out told him he's being a "jerk" to his face.

Amazing. I wonder if he was going to be the one holding down the patient to get the IV in and risk getting stuck, hurting the patient, getting staff hurt. The more I think about it, the angrier I am about the fact that he seemed to disregard the safety of EVERYONE because he's in a "mood".

[IndySkies]

I don't really understand, unless Psych ER works differently, but an ER doctor is not a revenue producer for most hospitals, but rather a salary position, wage earner, like the nurses, that is why in acute private hospital settings they are below the food chain compared to admitting attendings. However, it is quite possible that your hospital puts up with his behavior because no other dr. will take the position.

[RADONC-RN]

Who all have you reported this too? I would call the Nursing Supervisor immediately next time to come to the ER to witness it then. If no good of this, go to your manager asap and tell them that they are creating a "Hostile Work Environment". They usually don't like to hear those words.

[SuesquatchRN, BSN, RN]

You have to do what I've heard of - call a "Code Pink." When he's being a jerk ALL of the nurses must immediately surround him and he can be that jerky in front of them all. He'll stop.

[AngBthatsme]

Im glad I dont work there!! I'd report him, every facility should be fostering a mutually respectful working relationship between nurses and doctors. We need to work together for the good of the patient. :)

[lindarn]

I work in a psychiatric emergency department. I truly love what I do except for one particular ER doctor we all have to work with. Tonight, I had a patient brought in in handcuffs by 6 police officers. The man was yelling, wasn't following direction, throwing himself on the floor and the police reported that he was threatening his wife and daughter at home and that they found broken glass throughout the home. I immediately asked the attending to come and assess the patient for possible medication administration for everyones safety.

This is the usual course of action in our ER and usually is not a problem. At times the attending will give the order for medication IM (we dont' do IV) based on the nurses' assessment of the behavior.

The ER is slow tonight, a total of 6 patients, all treated and awaiting results. He tells me he's busy he'll be over when he's available. I can see he's surfing the internet. The cops leave, my tech and I are able to verbally redirect the patient, he doesn't quiet down but at least remains in his room. 15 minutes later the attending shows up, "So where's this guy everyone is so worried about". I tell him the family reports no psych history, he's diabetic with a blood sugar of 254 and the family reports that he's been drinking all day. He spends 5 minutes with the patient then leaves, he says nothing to me about medication. The patient is now more agitated, pacing the hallway, angry that he is here, banging his fists against furniture and the walls. I look in the computer and see an order for our standard cocktail ativan, haldol, benadryl. Since this isn't the first time he ordered medication without so much as a word and the pt is increasily agitated, I medicate him IM as is usual.

The patient is then to be transferred to the medical side for rally pack. It's only then did we notice the order was IVP - for an obviously agitated patient who is becoming increasing agitated and unable to redirect. Had I moved the patient to the main ER without medication he would have ended up in restraints.

Now I have to write an incident report because I gave the wrong route. I route that would NOT have been ordered by any other doctor with a stitch of common sense.

This MD will ignore patients in psych for upwards of 4-5 hours when he's busy and when he's not he comes over as soon as he sees a new patient as questions nurses as to why you haven't drawn blood or done an EKG. Alternately, he'll yell at nurses for sending labs if he didn't order them. I've already reported him once, when he told me that a pt who was verbally threatening and kicking doors was "not that bad" because I didn't call him. When I told him that I didn't return his call because I was worried about the safety of the patient and staff he told me he was "more important".

I just can't stand this. I was so angry I was practically in tears. What gets me is that this guy has been working here for 8 years. He's been written up by just about every nurse that has worked under him. And he's still here. *sigh*

Has anyone written to the State Board of Medicine? It would be a good idea to start a paper trail on this guy. Be sure to send a copy to the hospital administration, and make sure that you keep copies for yourself.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[NurseCard, ADN]

Well, perhaps an ER doctor might not actually be "bringing in" the patients like a family doctor or any other doc who works out of an office, but at least in my experience, ER docs are still employed by another entity.

This may not be the case for ALL private hospitals, or perhaps teaching hospitals.