Doctor upset by charting

[LalaRN9000]

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.

[AlwaysLearning247, BSN]

In my opinion, I don't think it is appropriate to write about another professional like that. I'm sure this patient was saying much more than accusations toward the doctor. There are other ways to make the point known.

[canoehead, BSN, RN]

I would have made a direct quote. If the speaker makes that statement, but doesn't follow up with a formal complaint, it diminishes her credibility. If she has concerns about the treatment, but doesn't address the doctor directly, that's going to cause trouble negotiating a care plan. If she continues to make wild accusations about the physician, or anyone else on the care team, it speaks to her sanity and ability to care for the child or herself.

If we don't have a direct quote, the power of the statement is lost, and the accuracy. Being vaguer increases misinterpretation, and tomorrow the speaker might say she was only talking about needing a cigarette.

And the doctor doesn't get a vote on nurses' notes, as long as they are truthful.

[NICUMurse87, BSN, RN]

A lot of people seem to be forgetting that this is PSYCH nursing, which is a whole different beast from Med/Surg nursing with different morays and a different way of doing things. Quotations are often vital in psych nursing because it needs to be known EXACTLY what was said when making a diagnosis or a plan of care. Unlike medical patients where they don't even need to be conscious oftentimes to make a diagnosis, there are many times where the only way to discover anything about a psych patient is by their words and actions, which need to be explicitly conveyed to other care providers. That's not to say that OP couldn't have stated it a different way, just that I can fully understand why they didn't.

[Libby1987]

A lot of people seem to be forgetting that this is PSYCH nursing, which is a whole different beast from Med/Surg nursing with different morays and a different way of doing things. Quotations are often vital in psych nursing because it needs to be known EXACTLY what was said when making a diagnosis or a plan of care. Unlike medical patients where they don't even need to be conscious oftentimes to make a diagnosis, there are many times where the only way to discover anything about a psych patient is by their words and actions, which need to be explicitly conveyed to other care providers. That's not to say that OP couldn't have stated it a different way, just that I can fully understand why they didn't.

In this case it wasn't the patient who was quoted. Unless the parent was saying something related to the patient that could indicate contributing factors to the patient's condition, it was more of a short sighted **** move.

[JKL33]

A lot of people seem to be forgetting that this is PSYCH nursing, which is a whole different beast from Med/Surg nursing with different morays and a different way of doing things.

Nope. We aren't forgetting that and it doesn't matter anyway. But one could make the argument that one should be even more careful with quotes in a psych setting where the quote could also be assumed to represent a delusion, in addition to possibly being taken for a literal accusation or just a run-of-the-mill show of frustration.

In psych or med-surg it may be useful to quote, "Santa Claus was here in person and has warned me that you all are trying to kill me." Worlds different than to quote a patient who states the doctor must be smoking something.

This topic has nothing to do with the fact that someone was quoted. It's about what was quoted, which was a statement that could either be taken as sarcasm or as an accusation.

[jodispamodi]

For me, having worked in pysch, I generally do quote verbatim, with the exception being a situation like this; in this case (and it would also factor in if the patient was a minor), but rather than putting in "patients mother states md is smoking pot or crack, or whatever" I probably would have put my thinking cap on and worded the exchange something like; "patients mother came in, reports feeling upset over (whatever she was upset about) and made derogatory comments about team members"

But I also feel I would have to take into context exactly how she made the smoking comment, did she say it because she was making an accusation? Or did she say it in the vein of he doesnt know what he's talking about, he must be smoking something. The latter honestly I probably would not have charted. So much of what a patient or family member says goes under the context of what/how they're saying, and usually by the tone of the conversation you're able to suss that out pretty easily.

IMO, a doctor cannot and should not tell a nurse what to chart, but honestly in this doctors defense, that sentence is in that chart forever, anybody who cares for that patient will be reading it, if it were you would you honestly want your peers reading something like that about you?

[J.Adderton, BSN, MSN]

You will never be wrong if you follow your state's board of nursing published standards of care as it relates to charting.

[Rnis, BSN, DNP, APRN, NP]

There is not enough context here to know the whole story. I think that putting incitory language that a parent says in the heat of the moment into the chart to not be the most professional........and certainly not something that adds value to a continued therapeutic relationship. why not just state " mother expressing frustration at direction of care" ? this gives credence to her concerns while not impeding their ability to have a calm discussion about this once she calms down.

As nurses are job is to be a patient's advocate.....sometimes that includes listening to them vent.

[Al Kalosis]

A lot of people seem to be trying to validate or invalidate the actions of the nurse, but this is not really the question here. There may be valid reasons for quoting or not quoting in chart notes, and had any of us been in a similar situation, our actions may have aligned with this nurse's actions, or not.

The question is: Is it acceptable for a physician to demand that a nurse remove part of his or her charting based on personal vanity? This particular doctor is a narcissist and a bully. He is accustomed to amassing control by threatening and intimidating others. His behavior was unacceptable, and it is no exaggeration to say that he is dangerous.

[JKL33]

From the OP:

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.

The question is: Is it acceptable for a physician to demand that a nurse remove part of his or her charting based on personal vanity? This particular doctor is a narcissist and a bully. He is accustomed to amassing control by threatening and intimidating others. His behavior was unacceptable, and it is no exaggeration to say that he is dangerous.

This is not a nurse vs. physician power struggle at its core; a lot of things aren't even when they involve a nurse and physician encounter. The OP made huge assumptions based on the fact that the friend cried.

I don't think you understand the issue or could possibly have read replies that contradict your POV if all you can say about this is it's someone's problem of "vanity." You have no information whatsoever to warrant calling this individual a threatening and intimidating bully. The fact that he expressed his concern about the type of quote and felt that it was inappropriate is proof of absolutely nothing.

I once had a physician write something with a negative tone in a patient's chart regarding something my orientee did, and then he wrote an order to "fill out an incident report." Meanwhile it was an absolute "nothing" issue to begin with. So...I went and "talked to him" myself and relayed why his charting was inappropriate. Was that bullying?? Give me a break.

If people are so concerned about physician vs. nurse "bullying" they/we should start having professional conversations instead of crying bully. This reminds me of kids on a school bus: "Bus driver! Make him stop looking at me!" When you act like a professional, it is RARE to not be treated like one by physicians. Those who attempt to bully and intimidate are outliers and have a well-known pattern of such behavior; they are not "pretty chill guy"

What the hell would've been so bad about simply responding, "I hadn't looked at it that way. I will give it some thought for the future" and then discontinuing the encounter if it becomes clear that the physician simply means to berate and humiliate?

[Here.I.Stand, BSN, RN]

A lot of people seem to be trying to validate or invalidate the actions of the nurse, but this is not really the question here. There may be valid reasons for quoting or not quoting in chart notes, and had any of us been in a similar situation, our actions may have aligned with this nurse's actions, or not.

The question is: Is it acceptable for a physician to demand that a nurse remove part of his or her charting based on personal vanity? This particular doctor is a narcissist and a bully. He is accustomed to amassing control by threatening and intimidating others. His behavior was unacceptable, and it is no exaggeration to say that he is dangerous.

You make some pretty significant assumptions of someone who isn't here to defend himself. If you truly consider it narcissistic to not want a statement connecting you to impaired practice... I don't even know what to say about that.

Would you truly feel peachy keen if you read in someone else's note: "Pt's mother states, 'Al Kalosis is such an idiot, he MUST be smoking something.'?" If this mother sued, do you honestly believe that a standing-to-profit attorneys would look at the notes, read the above statement and say, "oh I'm sure this mom is just being irrational; Al Kalosis is a highly competent nurse?"

[Al Kalosis]

You have no information whatsoever to warrant calling this individual a threatening and intimidating bully. The fact that he expressed his concern about the type of quote and felt that it was inappropriate is proof of absolutely nothing.

Expressing one's concern and demanding (according to the OP) that information be removed from a legal document are not in the same ballpark.