Doctors and nurses aren't human...or so they think

weezieRN · Mar 27, 2004

quite true in every respect. Your fellow or should i say my fellow collegues think she can't be sick, yes i am or was. My thing is pts or pts families think just because the prn med is every 4 hours they should automatically receive it every 4 hours. They expect you to drop everything you are doing and come right away. I tell them please be patient, you see this WHOLE hall, they are my pts too, please give me a minute to finish up what i am doing. Today husband of pt comes out to station, "can you come look at my wifes foley its not the right color and it has stuff floating in it"(hx of slings etc) I go back it is clear as a bell with some mucous. He tells me someone told him if your urine is real clear that means your kidneys aren't functioning. I told him it would be a problem if she had blood or it was brown or she had no output, then that is a problem, otherwise your wifes urine and kidney function or good. He then apologized and said he would cool his tails. What a day!

Nurse Ratched, RN · Mar 27, 2004

OMG, Laura - this was just going through my head. I tell a pt he needs to call ahead before bringing in stuff for a pt assistance program so he makes sure I'm there as we need to also have him sign forms. He shows up unannounced and is irritated because he either has to wait or come back because I'm out at lunch. Sorry - I eat. I'm human.

I'm human and I get sick, too (rarely, but it happens.) If a patient has waited until the last possible second to request something that only I can provide, and is stymied by the fact that all the stars weren't in alignment and his poor planning has now caused him problems, this is not my issue.

Thankfully, I am excellent at limit setting lol. I get the sorts of patients you referred to in your original post, and they get the broken record technique of "no" on unreasonable requests until either they FINALLY understand or they do something rude/abusive enough to allow me to have them ejected.

Good for your practice for refusing to allow this kind of nonsense :).

darla80 · Mar 28, 2004

Laura

It is a sign of the times ......societal woes ;-)

I worked in an office .. 20 years ago ( showing my age) and people were much more respectful of the physician, nurses and the medical profession.

we have a fast food drive through mentatlity with a "me me me me" attitude

My doc and I joke that a drive through clinic with a nurse hanging a stethoscope out the window would satisfy some ;-)

Setting limits is great!! I need to hone that skill.. tell me some of your tricks nurse Ratched? I get bogged down in the "Try to be nice to everyone thinking" when it is not really treating them well to give in to all the demands. people do NEEED limits.

I got berated friday because a pt requested a written RX for Zocor..thursday at noon and it was not ready friday at 8:00..I tod her I had samples and she could pick them tup to hold her over until the doc returned.

she literally screamed at me.. you know what I did .. hung up!!

ahh we do get the challenges with the rewards!!

it is 80 here today .. I am on my way to church and then to mow the lawn this afternoon..ahh I love summer

Joy and Smiles * Darla

Nurse Ratched, RN · Mar 29, 2004

Wasn't it a beautiful day? :) Hope you enjoyed the weather and even the lawn mowing!

Limit setting examples - hmmmmm.

OK - pt calls: "I have a cold and I need atbx; I need the doctor to call me in a prescription."

Me: "Our policy is that we don't prescribe atbx sight unseen. I would be happy to set an appt for you so the doctor can evaluate you and see whether atbx are indicated in your case."

Them: "But this happens to me all the time. I know I need atbx. My doctor at home always just calls me in a z-pak."

Me: "That may be, however, our policy here, because of the risks of antibiotic resistance, is that people must be evaluated in person."

Them: "Well that's just ridiculous. I can't believe I have to be seen to get antibiotics when I obviously need them."

Me: "Can I make you an appointment?"

(Them - 9/10 times, yes. I do also advise them that the fact that they are being seen does not guarantee getting the particular medication they think they need and that their treatment will depend on what the doctor sees on evaluation. Always important to look for any obvious major misconceptions the pt may have and correct them to avoid conflict later.)

The biggest trick is stating (1) your request cannot be fulfilled as is (2) offering what you CAN do (3) reiterating again (usually necessary at least once) that the alternatives offered are the only alternatives (4) determining which of the possible alternatives the patient wants to avail himself of, and (5) where possible doing a little patient education on policy stuff so that similar confusion can be eliminated in the future.

I don't know that, for instance, you have patients that come into your office the day after they took their last dose of a scheduled med, expecting to get a refill authorized immediately? We do - the joys of working with a patient population that doesn't really uderstand how the health care system works. I have a strict policy that their lack of preparation does not become my emergency. I take it as an opportunity to educate the patient on how things work, and chart said education so if they show up unannounced again (and they rarely do since I don't reward it) then we can be a little stricter still.

I had one pt who clearly had a personality disorder who would repeatedly show up late (1/2 - 2 hours late) for appointments and still expected to be seen. He would attempt to argue with and bulldoze over whoever he got to first. I have a special policy with this type of patient that only I am to deal with them, whether it be on the phone or in person. If that pt calls and I am not available, the staff takes a message and I call the person back - the other staff do not attempt to do any problem solving for that pt as consistency of approach is so vital it can only be achieved by having the same person dealing with him every single time so you know exactly what the patient has been told (no rule bending whatsoever for this guy.) If he shows up for an appointment, late or on time, I deal with him. If I am going to be out for any reason, there is another person designated as the go-to guy. Some people you just can't leave to chance. We don't really have the option to fire people unless there are extrememly extenuating circumstances, unfortunately, but I can make sure that I minimize the havoc he wreaks by limiting the number of people he comes into contact with.

Nurse Ratched, RN · Mar 29, 2004

Forgot to add: actually had one pt making an unreasonable request respond to my limit setting with "Well, I'm not going to accept that as an answer." My response, "Reality can be difficult to accept, but that is the ways things are. Is there anything else I can do for you?" Sometimes people require a closing line that leaves no room for argument. I'll occasionally get, "I want to speak with the doctor about this." My response, "The doctor does not argue policy questions. If you have specific policy concerns you can speak with (administration/office manager.)" This is rarely employed and it's still rarer to have someone take me up on it, and when they have, the powers that be have backed me because I am following the policies they established.

darla80 · Mar 31, 2004

I like all that you said..I do think the firm approach works..basic psychology

I am striving for warm yet professional ..I need to concentrate on firmness as well ;-)

it was good to hear your examples as they are the same things I deal with on a daily basis..

I have also been known to suggest to patients that the reason RX is a RX and that the medication being prescribed requires a physician evaluation ..If the med was OTC and they wanted to treat themselves then an appt would not be required...

What kind of practice are you in?

Thanks again

have a great day!!

Joy and Smiles * Darla

Nurse Ratched, RN · Mar 31, 2004

I understand the "warm but professional" goal, Darla - ideal in my line also. I work with college students in a student health clinic. I come across a little less hard line with the same words lol, which is a hard feel to impart on a BB. Everything is with a smile :). But I do feel very strongly that I need to educate these first-time adults on how to properly navigate the health care system. That includes having them check with their insurance companies for preferred providers when a specialist referral is warranted - stuff like that.

I get the "when are antibiotics going to go over the counter" question a lot lol. I usually say something along the lines of "when people can differentiate among bacterial infections, viral infections, and allergies at home." Right now they do a pretty bad job of it .

The biggest challenge is dealing with the parents. (1) I can't talk to them without the students permission (even tho in every case where parents are calling, I'm sure the parents are paying the bills and (2) the parents want to tell you what the students' pediatrician/uncle-who's-a-physician/sister-who-is-a-secretary-for-a-dentist thinks the student should be treated with .

laurasc · Apr 1, 2004

I'll occasionally get, "I want to speak with the doctor about this." My response, "The doctor does not argue policy questions. If you have specific policy concerns you can speak with (administration/office manager.)" This is rarely employed and it's still rarer to have someone take me up on it, and when they have, the powers that be have backed me because I am following the policies they established.

Unfortunatly in my office, the ones who enforce office policy are the receptionists and me. When push comes to shove and the patient gains access to the doc on this issue, a lot of the times they cave. Makes me really mad because it makes me look like the fool.

My all time favourite line...usually delivered over the phone....is "I'm going south, can the doc write me a script for an antibiotic just in case?" Then they get mad when I say that the doctor will not write a "just in case" script.

darla80 · Apr 1, 2004

The IM doc I work for rarely caves ..he genuinley treats the bacterial as bacterial adn the viral as viral

He is a firm beleiver in policing the germ world and trying to stymie the ABX resistance.

But every once in awhile I see the Zpak RX go by even though I know he does not think it is bacterial ..

The pts often call back a few days later lamenting the fact that the ABX did not work

gives me one more opportunity to explain the nature of viral infections, the valididty of tincture of time and the necessity for rest to be the ultimate medicine.

Today here in TN it was allllllllll about allergies.. ,, pollen count is high

We did have one pt today who was taking a Zpak prescribed by the urgent care clinic 2 days ago attempt to insist on a new ABX as that one "was not working..."

educate educate educate

have a great day!!

Darla