Dealing with on call Doctors

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xxxHow do you deal with an oncall doctor who doesn't want to do anything? It has been a while since I have dealt with this. Our facilities physician was on vacation and we had to deal with a md that doesn't listen to nurses. Never mind we spend so much time with our pts. Twice last night there were pts that the regular doctor would have sent to the ER but this one didn't. One was a woman with dementia, we have wanderguards and alarms all over her room and one on her, but she dismantles them. When she was put to bed last noc we found a football size swollen hard area on her hip with a baseball sized bruise. It was hot to the touch. She had been ambulating earlier but she also doesn't seem to notice pain. When I called he said to just watch it so another nurse called him back and said she felt she should be seen. After much discussion he agreed. She had a fractured femur. Can a nurse over-ride an md about sending a patient to the hospital? I had a pt. with a colostomy with such severe diarhea that it leaked out from under the seal and I had to change the entire thing twice. It was to the point where we were worried about dehydration. When I called him about that he said to just watch it but I said we really need to do something about it. He asked me what I thought he could do and I asked about a stool hardener or such. He agreed to order Lomotil. Does anyone have this problem and if so what should we do about it?

Specializes in NICU, Post-partum.
xxxHow do you deal with an oncall doctor who doesn't want to do anything? It has been a while since I have dealt with this. Our facilities physician was on vacation and we had to deal with a md that doesn't listen to nurses. Never mind we spend so much time with our pts. Twice last night there were pts that the regular doctor would have sent to the ER but this one didn't. One was a woman with dementia, we have wanderguards and alarms all over her room and one on her, but she dismantles them. When she was put to bed last noc we found a football size swollen hard area on her hip with a baseball sized bruise. It was hot to the touch. She had been ambulating earlier but she also doesn't seem to notice pain. When I called he said to just watch it so another nurse called him back and said she felt she should be seen. After much discussion he agreed. She had a fractured femur. Can a nurse over-ride an md about sending a patient to the hospital? I had a pt. with a colostomy with such severe diarhea that it leaked out from under the seal and I had to change the entire thing twice. It was to the point where we were worried about dehydration. When I called him about that he said to just watch it but I said we really need to do something about it. He asked me what I thought he could do and I asked about a stool hardener or such. He agreed to order Lomotil. Does anyone have this problem and if so what should we do about it?

Ah, you are dealing with an MD that doesn't so much not want to do anything, as much as they don't know what to do.

We have some residents like that, but not our Neonatologists.

With the foot-ball sized bruise? I would have sent the patient first to the ER and THEN called the doctor..that was a medical emergency when you see something that huge....the bleeding issue alone could have been major or life threatening. You do have the right to treat an emergency as an emergency.

Sometimes repeating back to them what they are doing "rings a bell" on how stupid it sounds. For example, if you are concerned about dehydration, just say, "Ok, so I understand, we have a patient who has diarrhea and is showing ____ signs of dehydration and you do not want to send this patient to the ER for fluids at this time, correct?" ...then you call the next MD who is over their head to get the order if you still cannot get it when you are 100% sure it is necessary.

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Specializes in Med Surg, Home Health.
I had a pt a few weeks ago with sugars 350+. Called the doc, as I was completely confused...he had abruptly d/c'd her insulin orders that day, including her 40 units of Lantus BID.

His response: "Quit checking her sugars, she's going home on hospice in the morning." Me: "Can I change her from a full code to comfort measures then?" Him: "No, she wants to be a full code." Me: "I am completely confused by this situation, but I will write an order to not treat glucose abnormals so that it is documented why I did not follow up on the high sugar." Him: "That's not necessary." Me: "Yes it is, you are giving me an order to not treat and it will be documented."

Made me want to reach through the phone and beat him with the glucometer.

I don't know the full details of the case, but sounds like yet another doctor who mistakes "hospice" for "give up on doing a thing". What on earth could make him associate COMFORT measures with keeping the pt hypergycemic? What's "comfortable" about that?

To the OP: One of the things my nurse manager said was to take advantage of any changes in condition that could be justified as emergent. So, your lady has a knot on hip, doctor said not to send out. An hour later you send her..."You said not to send her for knot on hip but you didn't say what to do if there was also a FEVER. It seemed like more of an emergency so I just sent her out."

What do y'all think? Is this a plausible (and defensible) use of nursing judgment in LTC?

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Specializes in Home Health/Hospice.

yeah I've had that issue, first if my House Doc is around I will call him. If he's not then I would call my DON, and she would most likely give the okay to send out. In my facility I cannot send out without a doc's order, however, I have had two occassions where I did send out without doc's order, one was when a lady fell cracked her head open and needed stitches, another was when a shunt basically popped open squirting blood like crazy didn't have time to call the docs on that, so I just called after I sent out and left them a message.

But again I would go call your DON or whoever is on call if you feel the doc didn't do what s/he was supposed to do.

Michelle

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Specializes in Home Health/Hospice.

Also if a doc does not give orders despite you insisting that it's necessary I document, if they hang up on me I document exactly what the doctor said and that he promptly hung up the phone, then I think of ways to call that same doc back for stupid things.......

Michelle

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Specializes in LTC/Skilled Care/Rehab.

If I think a patient needs to go to the ER I will tell the doctor. They have agreed with me every time. In some emergency situations we call 911 and let the doctor know about it later. If a doctor doesn't call back in a timely manner or we don't agree with orders (or lack of orders) we call the medical director.

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