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!!

[pickledpepperRN]

One evening at the bedside I asked a surgeon if he wanted to order morning labs and X-ray. He looked at me and walked away.

I followed him to the desk and asked again. He said, "Don't inrerrupt me." He wrote progress notes but no orders.

In the morning he came in asking for the chest X-ray and lab results. I told him they weren't done because there was no order. He yelled and called me "stupid nurse'.

The patient asked, "What's the matter, Doc. She asked you last night.

There were many witnesses and this was common for this guy.

Our medical director asked us to report him to the Board of Medicine. We did.

Months later he asked my in the elevator if I reported him. Another physicians was present.

I told him, "Yes" and why.

He has been polite since then. It was a few years ago.

I think the fact that many doctors as well as nurses signed the letter made a difference. I have no idea what the Medical Board did.

[suanna]

We had a resident with similar issues years ago. Turns out he had BAD sleep apnea. Once he went on BiPap at night he became a pretty decent doc. We did have another attending with this issue. We did the 2 RNs listeing for a while. Fortunately for us we have a pretty responsive hospital and department of medicine. The attitude improved as the orders went under the microscope. It's amazing how smart a doc gets when his decisions are all being reviewed by his peers.

[sharona97, 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.

I'd write a letter to the Chief Operating Doctor of the hospital with your concerns. They do not take lightly to this type of behaviour, esp if it's been dcumented.

[HM2VikingRN, RN]

Document everything.....

[emmycRN]

Nobody and I mean nobody stands up for the nurses in my hospital, Doctors bring in the work and they are supported. Fact

Ditto. There should be a whole thread just for this issue. It makes me so mad!!!! :angryfire:madface:

[TiredMD]

As I said earilier, our facility has terminated a surgeon before because of compliants from nurses about the same things.

Be weary of spreading that around, even if you do know it for a fact and not just hearsay.

Physician termination from hospitals is an enormously litigious process, and usually is bound up in tight confidentiality clauses. If word got back to these docs that you were disseminating this information (ie - why he is no longer with the facility) you would likely find yourself the star witness at a deposition for his suit against the hospital.

[NurseyBaby'05, BSN, RN]

Nobody and I mean nobody stands up for the nurses in my hospital, Doctors bring in the work and they are supported. Fact

Kay-Definitely the atmosphere where I work too. Especially if it's a surgeon.

Administration was not happy with what we did with the resident in my previous post at all. The only reason it worked was that "our" doctors on our floor backed us up. It would have been a cold day in hell before the "suits" would side with a nurse over a doc.

[little_fang]

be weary of spreading that around, even if you do know it for a fact and not just hearsay.

do you mean "be wary"? i'm not familiar with the legality of such affairs, but it seems to me that physicians should be held to the same standards as everyone else. as a nurse, if i am fired from a facility due to negligence or incompetence or deceitfulness, and this fact makes it to my next prospective employer, i have no one to blame but myself. a lawsuit against whoever told them makes little sense, unless i am self-deluded and willing to lash out at others out of spite. furthermore, i could not see any jury upholding such a lawsuit. why would it be any different for a physician? of course, there is almost always a double standard when dealing with doctors, but i think that's what this thread is discussing in the first place, don't you?

[TiredMD]

do you mean "be wary"? i'm not familiar with the legality of such affairs, but it seems to me that physicians should be held to the same standards as everyone else. as a nurse, if i am fired from a facility due to negligence or incompetence or deceitfulness, and this fact makes it to my next prospective employer, i have no one to blame but myself. a lawsuit against whoever told them makes little sense, unless i am self-deluded and willing to lash out at others out of spite. furthermore, i could not see any jury upholding such a lawsuit. why would it be any different for a physician? of course, there is almost always a double standard when dealing with doctors, but i think that's what this thread is discussing in the first place, don't you?

if you were fired for one reason, and former staff members spread the false rumor that it were for some other (worse) reason, you would have every right to sue. in the case mentioned above, it is unlikely that the poster was privy to the actual proceedings that resulted in the physician leaving the hospital; i would be willing to bet that the "reason" was really just the rumor mill running at full speed like it does in every hospital.

but really, that's beside the point. you are an employee of the hospital. in most facilities, the physician is an independent contractor who has a contractual agreement with the hospital, and is not an employee. when physicians are "fired" from a hospital, they aren't really fired, their contract is dissolved. depending on the nature of the discussions that lead to this relationship being terminated, there may be a nondisclosure agreement involved, or other legal requirements that could potentially result in a lawsuit if breached.

don't see physicians as employees. most of the time they are not. physicians are a business entity, often a limited liability corporation. if any employee of a hospital is spreading rumors that dr. x was terminated from the medical staff for unprofessional behavior, and it is not backed up by documentation or by the administration, that is slander that harms future earnings, and therefore subject to a legal tort.

i'm not saying lawsuits like this are the rule; i'm saying that you don't want to be the exception.

[ShayRN]

But really, that's beside the point. You are an employee of the hospital. In most facilities, the physician is an independent contractor who has a contractual agreement with the hospital, and is not an employee.

I think that sentence should be blown up and placed in EVERY nurse's station throughout the world. The physician is an independent contractor with an agreement to the hospital. NOT an employee, therefore NOT MY BOSS. I follow a doctor's written order on how to treat a patient, NOT a doctor's order on my conduct, professionalism, intelligence, etc... The doctor's may bring the patients in the doors, but the nurses are the ones carrying out the hands on care. I refuse to allow a doctor to insult or degrade me.

I shared this story before, had an ID doctor tear me a new one because I called him 9:30 on a Saturday night for an order to culture a new wound. He started cursing at me and calling me names, I very calmly told him. Dr. stop the abuse this instant or I will document word for word our conversation. He didn't and I did. He complained to the unit manager about me and basically the thought was, well, did you say those things? Hmmm, guess you shouldn't have, I was "talked to" about increasing his chances of being successfully sued, but really, do I care if he is? I was doing my job, if he didn't want to do his, not my problem.

[Azriel1331]

shayrn, tiredmd and others, please keep in mind.... that most of the above is correct except many hospitals are beginning to use a hospitalist service - meaning they are employed by the hospital servicing pt's who do not have a md that has privileges.

now at my hospital the hospitalist service are wonderful and i could never imagine anyone ever having a problem with them.

please keep that in mind before 'going to battle' w/an md re: this. it won't change the need to confront him/her re: this, it may just change the tact you need to take with them, it also may make their supervisor much more accessible and empathic to your concern.

[Selke]

Where is/was your charge nurse, your unit manager, in dealing with this surgeon? was anybody else on the floor with you at the time who was higher up in the food chain? Did you involve your immediate chain of command in this ASAP? Did you notify the charge nurse and administrator on staff for your shift when this incident occurred, and followed up with the unit manager, as well as write an incident report? The charge nurse or administrator on the unit could then go right back to the surgeon and have him tell her what he told you.