Disagree with the Dr

I guess I would document what I saw. They can be such jerks sometimes.

It depends on the person and the situation. I'm pretty new so I can still use that as an excuse to question things - since I usually really am asking why or what makes something the way it is.

There is one doc that I don't make any conversation with normally, much less in an iffy situation, I can barely understand him through his accent and he gets huffy easily anyway! There is one other moody one but she can take it pretty ok if you do a "back at ya", and the rest are either ok to question or don't do many questionable things in the first place. I question or disagree with a doc as much as I would anyone else - again, based on the person & the situation.

In the situation you described I guess I'd be documenting, documenting, documenting...

Have to confess that I wouldn't know one from the other (degree of tear) -of course, I'm not in THAT environment, either. To cover your behind, you can always chart that 'per doctor, patient suffered xxxx (or xxx was experienced during childbirth etc etc etc) but if its really sticking in your craw, and you really want to stick to your guns, make sure that your fight is worth the possible results to both you and your patient. You can ALWAYS document what things APPEAR to be to you, -and as long as you put what the doc said in the paperwork, your collective tail should be covered as well :)

I HAVE disagreed with doctors. I will offer a suggestion, but if they don't want it that is fine with me (if its minor). I just chart (completely objectively) what I suggested and that the doctor declined the suggestion. I don't make it sound rude or anything, I'm just covering my butt. But there have been occasions where I will call a doctor numerous times and chart every single call I make. If it's important, I can be charting making a call every ten minutes or so. With each return call, I chart "No return call from Dr. So and So, another call made at this time." If it's something serious, I have had occasion to call the medical director of the facility for what I need - but this has only been in extreme circumstances. Of course, I then chart that I called the medical director and recieved the order from him. I have noticed, though, that doctors don't return calls as quickly to LTC's than when I work med/surg.

Oh heck yea I have disagreed with doctors before. I always chart what I observe, objectively.

In this particularly case, I probably would have told doc "I have to chart what degree the epis it" and made him give me a number. If he didn't say third, I would have charted "x degree MLE per Dr XYZ" and made sure I charted how many suture packs were used. Technically, as RNs I don't think that judging degree of epis/lac is not really within our scope of practice. (Not sure about this, if anyone else knows, please post)

That said, when a doc tells me not to chart late decels or some other such nonsense I chart exactly what I see. The defining line for me is whether the issue is on something for which I am "qualified" to make a judgment call.