Doctor won't back up his telephone orders!

[In_Chantress]

How do you deal with a surgeon who is angry when you call him in the middle of the night and just as angry when you don't... When he gives a telephone order, and then comes in the next day and denies that he ever said anything written in the order although he does sign off on it... won't even back up orders he wrote in the chart himself, calling you a "liar" until he's shown the page? FYI, this guy has made several big errors ( like complete transecting the bowel during a colonoscopy) causing us to already worry when we see that a post-surgical patient is one of his. How do you protect yourself and your license when dealing with such a weasel. HR says taping his telephone orders would be "too disruptive to the work process" and having two nurses listen to him on speaker phone and co-sign the order hasn't helped as he just says that both of us are idiots. Any and all advice will be appreciated!!

[canoehead, BSN, RN]

Make an incident report every time to establish a pattern of behavior. He won't be credible at all if you can show that he practices in an irresponsible manner.

[caliotter3]

Continue to have a nurse listen in and co-sign. That's what you're supposed to do anyway. If he calls both of you idiots, so be it. It is one way to protect yourself from the real idiot. And write up incident reports as previously suggested. One day, somebody will need this paper trail and that person might be you.

[DDRN4me]

I agree that two nurses need to hear and sign. Perhaps a paper trail of incident reports to the cheif of surgery or the administrator of the hospital will put him in his place?

[nservice]

I don't think this doc is just a jerk. I think he has some big mental health issues that will only get worse.

[santhony44, MSN, RN, NP]

I don't think this doc is just a jerk. I think he has some big mental health issues that will only get worse.

I agree. Mental health, substance abuse, or dementia, perhaps.

This makes that incident report paper trail even more important.

If the floor nurses are noticing this, I have no doubt that the surgery staff is having problems, too. Maybe they're reporting it, maybe they're covering up. In any case, the chief of surgery and hospital risk management need to be aware of what's going on, because something needs to be done before more patients are hurt.

Continue to have phone orders witnessed and have the witnesses sign. I'd probably have someone else listen to every telephone conversation with him, period.

When he denies writing an order until it's shown to him, document those incidents. That, to me, is a huge red flag that he's not just a weasel, but something serious is wrong.

Good luck. I think he needs help. I hope he doesn't hurt anyone else in the meantime.

[justme1972]

How old is this guy? To me, that sounds like alot of forgetting.

I suspect he is very aware that something is wrong...mainly because if he is signing telephone orders, yet CLAIMS none were called in (as if you have time to just sit around and make this stuff up), then WHY would he sign off on that anyway?

To me, the real moral issue is how to bring it up that this physician could possibly be mentally impaired or on medication (script or illegal) that is severely impairing his judgement.

[Azriel1331]

Terrible situation but I agree with what everyone else has said. Keep filing paperwork, document everything - remember C.Y.A. as well as you're patient.

Good luck

[NurseyBaby'05, BSN, RN]

We had this issue with a resident. The entire nursing staff refused to take any verbal orders from him after he pulled the same crap. He had to come down to the floor to write the most mundane of things. If here was something urgent that need done, a call was placed to the fellow or attending. (In other words, someone above his head and they were told why.) Nobody trusted the slimeball. Fortunately he rotated out of our service and hasn't been back. I think he learned his lesson. The attendings were so happy to get called at night for routine colace orders.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

Do you think he is doing drugs of some kind to be so forgetful, or is he just a jerk? We have a surgeon that is very forgetful/dangerous, too. Thankfully he doesn't do much work at our hospital anymore. Our other surgeon does better work but he sometimes seems impaired. It sucks!!

[jessiern, BSN, RN]

Has he ever thrown a chair at a nurse in the nurse's station because she had a pepsi at the desk? If so, I think you guys have one of our old surgeons.

Our hospital admin. handled the problem for us with a surgeon doing that. We don't get to see his happy face anymore. Basically, make sure the higher powers know what it is going on. And cont to have two nurses listening.

[madwife2002, BSN, RN]

Wow this kinda makes me frightened for the poor patients. What if there was an incompetant nurse placed in this senario as well, then you have a huge massive problem. I agree you need to do something about this and keep documenting because he is a tradegy waiting to happen. Good Luck