Doctor Trying To Blame Blunder On Me

[nurselambda]

I work at an outpatient surgery center where minor surgeries and pain management procedures are performed. Those type of interventions are routinely done under MAC, or "twilight sedation". I work there as a perioperative nurse for some time now, the team is nice and I feel pretty comfortable doing my job.  Recently the anesthesia provider usually working there left on medical leave for a few months and was replaced by an older anesthesiologist. He occasionally works there, and is known for is ill bedside manners and heavy sedation style, which patients often complain about. Recently, a young patient came in for a cortisone injection to be done under sedation. I was doing the intake, he was in his early 20's, certainly overweight but with health problems other than pain in his back due to a car crash. He was anxious and his pulse was in the 90's, which I charted. His other vital signs were wnl. He is transported to the OR to have his procedure done. A few minutes later he is brought back to me completely unresponsive. His first set of vital signs show his pulse was now in the 130's, and BP 20 points above the baseline, which is highly unusual for someone receiving sedation. I look at the anesthesiologist who was at bedside, who says "What do you want me to do, just give a minute to wake up"'.

Minutes go by and his pulse remains between 120's and 130's, still unresponsive. After, a few minutes the other physician who performed the injection comes to check on the patient, looking concerned that he hasn't wake up. After 15 minutes in recovery, his pulse still tacchy, he now opens his eyes but looks totally stunned. I reach out to the anesthesiologist who tells me "I'm sure his pulse was already like that before the procedure and you just didn't pick up on it". After 20 minutes, the patient is able to talk a little bit and I ask if he's in pain. He answers "in the chest". I then rush to notify the anesthesiologist who was sitting playing chess on his cellphone. He finally comes to asses the patient. I also notify the other doctor.

His first order was to push more versed, which had no effect on the patient. After a few minutes he then ordered to have him transferred to the ER.

Later in the day when everyone was gone, he came up to me and said "So he was already tacchy before" in an aggressive way, getting close to me. I answered that he wasn't. Then he answered in a smart *** tone "well let's have a look at his pre-op EKG strip". I showed it to him. He looked at it said "he was in high 90's. Well my point is that he wasn't at 60" then walked away.

Fast forward, the patient cardiac workup found nothing wrong with his heart and the ER docs suspected the anesthesia drugs to have caused the ordeal. I kept a professional conduct the whole time, but the way that doctor acted angered and disgusted me by his dishonesty. 

[Davey Do]

10 hours ago, nurselambda said:

I kept a professional conduct the whole time, but the way that doctor acted made so angered and disgusted by his dishonesty. 

Kudos to you, nurselambda, for continuing to be professional in the emotional throes of this situation!

Daniel Gilbert, in his classic book, Stumbling on Happiness, said that we all feel better when we have someone else to blame for our pain.

People who have a good self esteem do not need to be an emotional "smart***". People with good self esteem take such situations in stride, and act professionally in order to deal with problems.

Nurselambda, know that this doctor is in emotional pain and is not happy with who he is. And unless this doctor has an illuminating revelation about who he really is, he will die being a smart***.

Once gain, I admire and support your professional actions and attitude.

[JBMmom, MSN, NP]

18 hours ago, nurselambda said:

known for is ill bedside manners and heavy sedation style

Clearly it's good that you knew ahead of time that you were working with this difficult doc. It's good that you were able to keep your cool and you also didn't do much more to try to engage and try to prove your point. Arguing with someone like that would not have ended well, for either of you.

I can only imagine your frustration. Unfortunately we all have some incompetent coworkers and when it's a doc it's extra frustrating because to some extent our hands are tied on what we are able to do as nurses. Glad the patient turned out to be okay!

[Daisy4RN]

There will never be a shortage of people who will not take responsibility and accountability for their actions. Sounds like you handled it appropriately. Now you know to always CYA around that Doc (as you always should anyway). don't let it bother you, not worth it!

[Hannahbanana, BSN, MSN]

I’ve told this story before, but it’s apropos here. 
My first year out of school  I worked in a 17- bed PACU in a 700-bed regional hospital. We had one grumpy anesthesiologist (Dr. X) who persisted in starting all his IVs in the antecubital, so of course the minute the pts began to wake up and move (or even when they were moved from the table to the stretcher) the IV would blow. This was a pain for all concerned. The OR nurses let us know he wasn’t a prince in there either.
We also had one anesthesiologist (Dr. A) who was a lovely man, always had a well-secured IV, spoke softly and kindly to his patients, charted well, and gave us wonderful reports. 
So one day we decided to do a little behavior mod experiment. When A brought in a pt in good shape and all, we stuck one of those 2” multi-pointed gold foil notarial stickers on his scrub shirt. He looked down, amazed. “What’s that for?” And we told him specifically why we thought he did a good job. When he went back into the OR, they asked him what it was for and he told them we gave it to him.
It didn’t take long for all the other anesthesiologists to want them, so when they did a particularly good thing they got one, and we told them exactly what they did to earn it. We then started hearing from the OR nurses that they would save their scrub shirts in their lockers for the next day, LOL. 
When X eventually asked why he didn’t get one, we told him about the IVs. Damned if he didn’t start putting them away from a joint. He got a sticker for that. He kept doing it, he kept getting stickers. Win-win all around. 

[guest1163268]

On 3/29/2021 at 12:29 PM, Hannahbanana said:

I’ve told this story before, but it’s apropos here. 
My first year out of school  I worked in a 17- bed PACU in a 700-bed regional hospital. We had one grumpy anesthesiologist (Dr. X) who persisted in starting all his IVs in the antecubital, so of course the minute the pts began to wake up and move (or even when they were moved from the table to the stretcher) the IV would blow. This was a pain for all concerned. The OR nurses let us know he wasn’t a prince in there either.
We also had one anesthesiologist (Dr. A) who was a lovely man, always had a well-secured IV, spoke softly and kindly to his patients, charted well, and gave us wonderful reports. 
So one day we decided to do a little behavior mod experiment. When A brought in a pt in good shape and all, we stuck one of those 2” multi-pointed gold foil notarial stickers on his scrub shirt. He looked down, amazed. “What’s that for?” And we told him specifically why we thought he did a good job. When he went back into the OR, they asked him what it was for and he told them we gave it to him.
It didn’t take long for all the other anesthesiologists to want them, so when they did a particularly good thing they got one, and we told them exactly what they did to earn it. We then started hearing from the OR nurses that they would save their scrub shirts in their lockers for the next day, LOL. 
When X eventually asked why he didn’t get one, we told him about the IVs. Damned if he didn’t start putting them away from a joint. He got a sticker for that. He kept doing it, he kept getting stickers. Win-win all around. 

Behavior modification at its finest! 

HB Pavlov ????

I usually use reverse psychology. Bad attitude docs always know about themselves and are usually that way because they are insecure and are using bravado to distract or just really competent and confident. I usually tell them that they are really brave screwing around with the nurses because anything goes down, they will not have your back and they already don't like you! It's a blanket statement so they can't confront anyone and if they are always creating friction, I believe they have it coming. 

Guys can't do stickers. It's a man thing, you women won't understand ?????

[Hannahbanana, BSN, MSN]

Well, our guys loved stickers, LOL. 
 

As to the OP, this anesthesiologist is dangerous. Report your very valid concerns in writing to your manager and ask her to follow up c her chain of command eventually to reach the ears of the chief of anesthesiology. Also cc the risk manager c your concerns; they will be interested to know.