I'm very curious. I'm sure we've all been there. We've dealt with doctors from all spectrum and mindsets. Most are very good at their jobs and have sound ideas!
But sometimes docs just say and do the craziest things
My example: at my last LTC facility I had one doctor seriously outright refuse/fight giving and prescribing pain meds (for patients who really, really needed it/were on vents/dying) because he honestly believed that these residents who had been stuck in a bed for years were going to get better and go out to buy/smoke crack cocaine.
According to him "prescribing narcotics leads to methadone and crack usage." These poor residents have been here for years taking the same medications and pain meds for years...just WHAT?
This M.D. once gave me an order to, "Continue same medications that the patient is taking at home." We almost ended up at the Arbitration Board of the hospital.
I saw a resident googling on a computer different types of NG tubes and something about intubation. Yeah, please don't come at me with any tubes near my throat if you have to google it! ������
I google stuff like that all the time to make sure I'm up to date with all the new stuff the bring out and such...
Called the doc to let him know his A&Ox4 patient was refusing everything, meds and fluids through his gtube, being combative, struck me 4 times, attempting to get out of bed. Doc replied "so what? You want restraints? Sedate the man? I'd be mad too if you woke me up!" I said "that gives him permission to hit a nurse because he was woken up? Never in my 12 years of nursing have I been hit by a patient." Doc replied "well consider yourself lucky because I've never heard of a nurse that has not been hit by a patient within the 1st few years in their career!" I said "oh so I guess I was overdue then, huh?!?" His reply "YES!" I then told him I was going to let the director know of his rude behavior and document every word he said... Right then he changed his tune and gave me the orders I needed to deal with this patient!
I had a doctor tell me to do a rectal check on a patient like the one you described. Doc said he must be constipated and that is why he is agitated. Patient had hit 4 staff members and was going up and down the hall pounding on other patients' doors, yelling loudly. And he thinks I am going to attempt to do a rectal check, that that is going to stop the agitation.
This is definitely not the dumbest thing but it was the first thing that came to mind.
I had a resident (3rd year, PhD, extremely arrogant) write an order: RN to take patient in w/c outside hospital during daylight hours to assist with confusion.
This man was 1) advanced dementia 2) totally hoyer dependent to get OOB 3) combative when awake 4) asleep 90% of the time. NO amount of sunshine was making this guy oriented.
To quote Sweet Brown: Ain't nobody got time for that!!
while I agree, Ain't nobody got time for that, and the resident was obviously on a bit of a power trip, you may have found that although no amount of sunshine is going to orientate him, it may have made him less combative. I worked in Aged Care for 5 years they may not remember your name, know where they are or what decade it is but on some level they know who takes that extra bit of time to make their life a bit more pleasant. To everyone's disgust I implemented similar strategies and although it made everyone's job that little bit more difficult we found that it was very effective in decreasing aggressive and resistive behaviours.
In the mid-70's, on a step-down unit which also took overflow from med-surg floor. Can't remember any specific details of pt except there was a need for Lasix pronto. Newish Doc, also new to the hospital, was at the nurses station. I gave him the pertinent info he needed, and he said, "Give her some Lasix."
Me: "How much?"
Him: "80 to start with."
Me: "80 what?"
Him: "Milligrams, you ninny!"
Me: "How do you want it given?"
Him: "How do you think I want it given, for Christsake?!"
I turned my hands up and shrugged in slow exaggeration, and said, "I'm not allowed to guess."
Him: "Oh, mumblegrumblesnort."
Me: "If you can't tell me a complete order, or write the order in the chart and sign it, NOTHING will happen. Now, care to tell me again what, how much, when, where and how?"
He told me the order the way he was supposed to, and he still steamed for a while, but he never gave an incomplete order again!
Tell me about it! I swear sometimes they do it just so you have to ask.
I work in general practice and the Drs are constantly sending pts around with orders like maxolon or 100 tramadol, etc, etc... it's like, ok so you want them to have it now? in an hour? IM? O? how much do you want me to give them?
then they get stuffy with you when you call them for a proper order, like your doing it for the sole purpose of irritating them and not because it's legislation and policy.
I was in the middle of a sterile dressing when I was overhead paged. A doctor "needed" me in another room. When I got to the room, the doctor told me the patient needed the head of his bed put up!
Same doctor also refused to help with a patient of his who had fallen. He just walked away!
A patient was referred from a hospital to my unit (ER) I collected the referral note from the patient relatives to show to the doctor, he met me on the way to his office gave him the referral letter told him the patient's condition h just started shouting at me infront of the patient and relatives I was angry had to reply that what is wrong with him.
while I agree, Ain't nobody got time for that, and the resident was obviously on a bit of a power trip, you may have found that although no amount of sunshine is going to orientate him, it may have made him less combative. I worked in Aged Care for 5 years they may not remember your name, know where they are or what decade it is but on some level they know who takes that extra bit of time to make their life a bit more pleasant. To everyone's disgust I implemented similar strategies and although it made everyone's job that little bit more difficult we found that it was very effective in decreasing aggressive and resistive behaviours.
I agree, ain't no sunshine going to change it up really. I would tell the resident that he/she can implement this order as you don't have sufficient staff to do so. The song "Ain't No Sunshine" has taken on a whole new meaning for me now.
I was in the middle of a sterile dressing when I was overhead paged. A doctor "needed" me in another room. When I got to the room, the doctor told me the patient needed the head of his bed put up!
Same doctor also refused to help with a patient of his who had fallen. He just walked away!
These docs don't know how to operate the equipment. Really clueless in some areas. I witnessed a doctor step around a patient who was lying on the floor unresponsive. Big specialist on a neuro ward. Obviously could not assess unresponsiveness. Or just didn't care.
Vishwamitr
156 Posts
This M.D. once gave me an order to, "Continue same medications that the patient is taking at home." We almost ended up at the Arbitration Board of the hospital.