Doctor issues

[Kari Whitey]

A lot of the doctors that I have had the opportunity to work with as a nursing student have been great; they've taken the time to teach and explain things to me. But one day at clinicals I experienced something that I think classifys as medical misconduct. A patient had excessive drainage from his post-surgical wound that was brown and foul-smelling. We cleaned the patient up and notified the doctor. He came to look at it, didn't think it was bowel contents and ordered some cultures to be done. Later on in the shift, it happened again and the patient was more symptomatic (elevated HR, decreased BP, SOB, shivering, and decreased O2 sats). We again notifed the doctor, who came to look and said that the situation was much different than when he came in earlier and the patient had taken a turn. He seemed annoyed when he first arrived, that we had called him again, but then said we had a life threatening situation on our hands and needed to transfer the patinet to pre-op holding. We, as the nurses, know what we saw both times and it was the same drainage and the same situation, exccept the patient was more symptomatic. I thought that the doctor wasn't listening to us as we reported the situation and in doing so, placed the patient's life at risk. I feel like we should have done more earlier in the situation. What do you all think? What should have or could have we done differently? Any suggestions about working with doctors who don't take the nurse's observations and assessments seriously?

Thanks,

Kari Whitey

[EricJRN, MSN, RN]

It sounds like you or someone on the nursing team convinced the physician to take action before it placed the patient in a dangerous situation. Once the doctor saw that the new signs and symptoms weren't matching up with his initial impression of the patient, he changed the plan to reflect that.

It's frustrating to not be taken seriously at first, but this just might change the doc's perspective the next time you call him with some suspicious findings.

[ellakate]

Without being too harsh, you will be best served to let the doctor do his job, even if he does it poorly. You will encounter far graver circumstances, and need to learn to let it go. You can only control. . . .? Yes, yourself! You are not learning to be a doctor, you are learning to be a nurse. Now you have a story to tell and an experience. Welcome to our world!

[traumaRUs, MSN, APRN]

You did well - you documented and called the physician. You then continued to monitor the pt and again documented and reported to the physician. Both times the physician came to see the pt - so the doctor took you seriously. There are seveal reasons he might not have done something the first time around:

1. This was expected drainage.

2. He was hoping it would seal itself off.

3. The pts vitals were stable so there was no emergency

4. Sometimes a wait and see attitude is best for the pt

So....you did well.