Doctor Knows Best?

[logicalfallacy]

Goodbye

[Flatline, BSN, RN]

Insolence? We have all had horror stories happen but the way the post reads is a little one sided, almost like a TV show.

Was the issue what you did or how you did it? Very different things. Too strange for me to otherwise comment on.

[beekee]

Whenever I run across a patient with an allergy to a prescribed medicine, I try to find out what the reaction is. Sometimes, the "allergy" is really a side effect (such as an upset stomach or itchiness). I then will talk to the pharmacy about it. If I'm still not sure, I'll call the doctor and tell her about the listed allergy and what the patient says about the reaction. I might ask for something to minimize the side effect (itchiness for example, I might ask for Benadryl).

The doctor who never makes mistakes may respond better if you approach it as "I just want to make sure" instead of "I'm not giving it because you made a mistake." In the end, however, you get to use your judgment as to whether to give the med.

[Here.I.Stand, BSN, RN]

If things are as you say, first of all I wouldn't use the word "sir" -- unless you're in the military and he outranks you.

I would advise that I am documenting our conversation in the pt's medical record -- "so to be clear, you have been reminded of a documented allergy, and you are not altering the Rx at this time?"

Involve the pharmacist. You can't give the med until the PharmD verifies it anyway -- so ask them, "do you know if this 'allergy' is actually a side effect like diarrhea? Or any other information to indicate it is safe to give this med?" If the pharmacist also lacks that info, it is his/her responsibility to notify the prescribing provider that s/he is unable to verify/dispense that med.

Your responsibility to get a new order? No... it's your job to notify and document, and to be that last line of defense. But you can't force anyone else to do anything -- especially a megalomaniacal donkey like this guy?? Unless something happens to change his attitude, he will NEVER listen to a nurse, no matter how logical the nurse is. His ego would never allow it.

[ItsThatJenGirl, CNA]

Aw man, I missed it.

[macawake, MSN]

I had to call the doctor a couple of evenings ago because a patient was prescribed an antibiotic that he is allergic to. This was the conversation:

"Doctor, the patient in question has a documented allergy to the antibiotic prescribed. How do you wish toprescribes ceed?"

The doctor screamed, "You're a *** idiot! I never make mistakes! Give the medication I prescribed, you *** ***!"

The doctor hung up and called back. The RN on duty answered and he asked her if I still refused to give the medication. She said yes, the patient is allergic. He yelled at her, said he was going to make sure we "paid for our arrogance and isolence."

I documented what happened and explained what happened to my DON.

My question is: Has anone else had a similar problem?

No, I've never had a similar problem. I agree with flatline, the situation you've described is bizarre. If it happened the way you described and the two of you had no previous history, you simply calling him up and making a calm statement and the physician immediately escalating to SCREAMING and cussing, I would have to assume that there's something seriously wrong with the doctor. Even if he does indeed hate LPNs (like you wrote), a rational person would have realized that this could have consequences for him too, since he'd prescribed it and been made aware of the allergy. I feel like there's some information missing here?

Just to satisfy my curiosity, what kind of allergic reaction had the patient had previously? Mild, moderate, life-threatening? If mild, is it possible the physician was aware and decided to prescribe anyway?

If the physician reacted the way you described and started screaming after you made a simple statement, I don't really see how that is something you can just "work around" as your DON suggested. It doesn't really matter if you were right or if he was right, it's vital for patient safety that nurses can bring problems to a physician's attention without getting their head bit off. So, from the information available to me, I think your DON was wrong. Screaming and cussing isn't acceptable behavior in the workplace and shouldn't be tolerated.

Oops, this is what happens when you take forever writing a post Fixed dinner and just noticed that things have changed..

(I realize that you've deleted your post, but despite that I still added some additional thoughts. You did come here and you asked a question and I started writing this post in response to your question, so I might as well finish what I started).

[Davey Do]

Aw man, I missed it.

It was a rerun, IsThatJenGirl.

Robert Young as Jim Anderson suffers from Disassociate Disorder and becomes Marcus Welby MD.