Doctor upset by charting

smf0903 · Dec 4, 2017

I always chart verbatim, especially with ridiculous/heated/inappropriate situations.

Maybe the doc WAS smokin' something

Sour Lemon · Dec 4, 2017

I work in mental health and sometimes distraught parents have unreasonable demands and expectations. Obviously this isn't a surprise when you're a nurse but I am just curious what other nurses would do in this situation.
My co-worker was talking to a parent who was pretty upset and she charted what the mom was saying. This included the parent saying that the doctor "must smoking something." The doctor ended up coming down to talk to her. He demanded that she take that statement out but the note was final. He told her to never chart things like that. It must have gotten heated because later she came out of his office in tears. Telling someone not to chart something seems pretty ridiculous. I am not really sure why the doctor acted that way, he is usually a pretty chill guy.
So would you document verbatim? I would.

I don't know that I'd quote family members when charting on a patient. I'd only quote the actual patient. From what you've said, it doesn't sound particularly "bad", but I'd have to have more context to say for sure.

mmc51264, BSN, MSN, RN · Dec 4, 2017

Sometimes I will tell a physician on the phone or through our paging system what is going on, but I think it is better to let them know what is going on so they don't get blind-sided. I have never had a physician get mad about documenting a quote. I never put names (of doctors) in though. We use "team" or "house officer" to refer to who is on call.

sweet sunshine · Dec 5, 2017

Doctors read notes?

JKL33 · Dec 5, 2017

This has to have a context, and the context determines whether or not what she charted is appropriate. For instance, if a quote serves to demonstrate a patient's altered thought process or the like, then it is appropriate. The context has to be documented for that to be determined, though. On the other hand if it's a quote that could be taken two ways, such as the one in the OP, I think it's wise to use caution about that.

So the question is, what was the purpose of documenting that quote? To show the patient's dissatisfaction? To show some sort of delusional behavior? To show a pattern of non-participation in care, or maybe just a bad attitude? To demonstrate a serious difference of opinion about the plan of care? To accuse the physician of smoking something? Without context it's anyone's guess why it was felt to be important enough to write down in someone's medical record.

The other thing to be careful about is documenting in such a way that it could appear to be nit-picking/inappropriately or unnecessarily judging the patient's demeanor. We actually don't need to write down every stupid thing they say, especially when documenting it doesn't serve a particular purpose.

And certainly if the patient is actually accusing the physician there are more appropriate channels to address and document that.

allnurses Guide · Dec 5, 2017

I believe it is an appropriate thing to chart if what the parent said, was

indicative of the parent's attitude, given that the patient is a child and

thus, the things that a parent say, can provide much insight into what

the child, the patient, is dealing with.

I'm sure however, that the parent likely had plenty of other wonderful

things to say that could have been charted, instead of an accusation

towards the doctor.

jennylee321 · Dec 5, 2017

I think if the patient said "my doctor doesn't know anything, he must be smoking something" then yes I would chart it. It relates to the trust and therapeutic relationship the patient has with the medical team and would be useful to other health care professionals approaching this patient. I don't necessarily think the parent saying this is key to be in the notes. If they yelled it at the top of their lungs and made a scene, then yes I'd chart it because it is more of an incident.

cleback · Dec 5, 2017

Only if it were a parent or guardIan making the statement and I was trying to document how delusional they were.

Otherwise, if it's just a family member expressing displeasure with care, I would leave it out entirely and direct them to the manager. As a general rule, I do not document statements that would single out a colleague of gross negligence or another accusation. Usually the complaint is about nursing which is easy enough to make general. I can see though why the doc was upset.

cleback · Dec 5, 2017

I think if the patient said "my doctor doesn't know anything, he must be smoking something" then yes I would chart it. It relates to the trust and therapeutic relationship the patient has with the medical team and would be useful to other health care professionals approaching this patient. I don't necessarily think the parent saying this is key to be in the notes. If they yelled it at the top of their lungs and made a scene, then yes I'd chart it because it is more of an incident.

I think it would be sufficient to document "my doctor doesn't know anything..." I know I would not appreciate reading in a medical chart a patient accusing me of practicing under the influence, particularly when they were likely just being flippant. Now that it's documented, it would seem like the manager would have to do due deligence and investigate the claim.

Been there,done that, ASN, RN · Dec 5, 2017

You are recording your observation. Dr. God has no right to tell you what to chart. As long as your statement is in quotation marks, you're good.

smf0903 · Dec 5, 2017

You are recording your observation. Dr. God has no right to tell you what to chart. As long as your statement is in quotation marks, you're good.

I always direct quote. I've had quite a few profanity-laced direct quotes in my charting. It's what happened. I had a post-op patient who was nwb to one foot. Patient was not having that. The doctor who operated is notorious for having RNs' butts for whatever reason. So when the patient told me I should shut my big fat mouth and the stupid bastard doctor could f himself, all while beating that post-op foot on the floor, you bet your butt I quoted that.

I think quotations are our friends in those situations. There's no "reading into" behaviours, they're factual happenings.