Working with a new-to-our-ER doc the other night who totally lost his marbles when he found out I disclosed a positive urine pregnancy test to a patient. MD wanted the beds turned over and gave me the chart to D/C patient home (musculo-skeletal), "and just send the urine if it is positive". UHCG turned out to be positive, and became part of my counseling for home care teaching and pain control. I would not have normally just told a patient such a life altering result had I not already talked to her about her recently stopping the pill, her late cycle, and that she tested negative at home. Fortunately I had the tact to assess the patient's desire to keep her young child out of the loop by using adult-friendly terms "OB/GYN", "prenatal vitamins", ect.
The aid returned the d/c'd chart to the doc and showed him the urine as the patient was getting dressed to leave, clueless doc walks in a blurts "i guess you already know that you are pregnant" in front of the kid who clearly knew what that means. Poor woman. After she left we totally had it out because he was livid and said the most ridiculous things i could imagine: "Would you tell a patient that they had cancer? or an MI?" "I can understand that you would want to be a part of revealing such a fun test" and "Why is a +UHCG the only test that a nurse feels like they just have to run in to tell the patient immediately?". I'm not sure what prior issues he had with nurses, if all of his experiences with +HCGs have been great ones, or if discharging the patient as he requested qualified as rushing in. And as for the cancer comment, I told him i would absolutely never give a patient a diagnosis, but I felt it is within my scope to talk about test values, even the ones that patients already suspected they had.
But it is still on my mind and I can't help but wonder if it was out of scope. There is not much to the interpretation of this result to a G2P2 that requires a doctor to explain. What are people's thoughts? How about any difference for a pt who had taken multiple positive tests at home and CC was request for one done in the ER? (like ours are any different!) I find in our ER it is commonplace for the nurse to run the urine and give the result in that case, rather than making them sit there waiting for who knows how long to see the doc knowing full well every time I walk by the room that I already have the result.
UHCG turned out to be positive, and became part of my counseling for home care teaching and pain control. I would not have normally just told a patient such a life altering result had I not already talked to her about her recently stopping the pill, her late cycle, and that she tested negative at home. Fortunately I had the tact to assess the patient's desire to keep her young child out of the loop by using adult-friendly terms "OB/GYN", "prenatal vitamins", ect.
clueless doc walks in a blurts "i guess you already know that you are pregnant" in front of the kid who clearly knew what that means.
First sentence. Problem is control issue with new ED doc.
Middle paragraph. You did the right thing, and you were the one that had the tact.
Last sentence. If that doc thought a positive HCG would not be pregnancy, he sure didn't tell the patient that. Tactless is an understatement.
From now on I would make it a point for the staff to do NOTHING that this doc could even mildly consider to be out of his "realm." It won't take long for him to see that your work helps him with the throughput, and that his attitude is slowing down the patient care. (Especially when you do not initiate any care that he did not specifically order.) Of course, this does not include true emergencies. Oh, and any questions from the patients should of course be directed to the PHYSICIAN, no matter how many times he has to go back to the patient's room to answer them.
In our ER, I always run all test results, no matter how small, by the doc before saying anything to the pt. I think that is the way it should always be done.
This situation just came up with me tonight. I ran the test and went back to the station to note,(girl was in for more than test) I told the doc the results of the test and let it go at that. As I was admitting pt, doc did tell me to go ahead and discuss test with pt. If he had not I would not have, a test is a test and in my facility you don't discuss any results without a doc okay.
btw you did the right thing.
TraumaNurseRN
497 Posts
I'm not sure what flew up that doc's bonnet?