When Hospitalists Attack

Specialties Emergency

Published

Just venting.

Pt. in persistent AF c RVR. Had two doses of Diltiazem, was on a Dilt gtt, got 0.5 of Dig. Slowed down for a little while after each med, but after a bit was back to his old tricks in the 140s-150s. Totally asymptomatic, but yes I do understand the importance of rate control despite lack of symptoms. In fact, I explained this concept to the patient when he asked why he couldn't just go home and live in a rapid rate, since he didn't feel anything.

Hospitalist comes in, sees rate on monitor, says to me "So he's at a rapid rate and we're not doing anything for him?".

I dunno, maybe look at the chart. Maybe talk to the ER doc. Maybe ask me the question in a different way, in a different tone of voice?

Totally unnecessary to come in here and flip me attitude, like it's my fault the guy is refractory to everything we've done.

I know in hindsight that I should have calmly and methodically reviewed the chart with the hospitalist and told her everything I had done so far and what the results had been, but I was pretty taken aback by her attitude, had stayed an hour late because things were so busy, and really felt attacked. I'll do better next time.

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Specializes in school nursing, home health,rehab, long-.

Don't beat yourself up. We are just mere human folk. It is normal when you have been doing everything you are supposed to and then the above happens. Like you said hindsight and all. I am notorious for having the perfect response in my car on the way home: ).

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I would have looked at her with my nicest smile, turn and make direct eye contact...."Hello 'Doctor'....We've done several things 'doctor' but the patient remains in the present rhythm AND rate, what do you suggest next...would you like for me to get you the chart so you may review the meds already given?" and add if not at the patient bedside "Hey Joe (ED doc) the hospitalist is here and would like you to review the patients treatment so far"

OR

"Hello 'doctor'...we've done several"...and list of time and dosages of meds and patient response..."the patient remains asymptomatic and in the present rhythm what would you like to give next...would you like for me to get the chart so you may review what has already been given?"....and add if not at the patient bedside "Hey Joe (ED doc) the hospitalist is here and would like to review this patients treatment thus far"

And give her my FULL attention for her next response....:bored:

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Specializes in CICU.

Thankfully, our hospitalists are not jerks.

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Specializes in ER.

I hate it when, the admitting doctor comes in, the patient they are admitting is just waiting for orders and a room and you, the ER nurse, are super busy with others. She interrupts you while doing something and says "The patient needs a warm blanket and some ice water", as if you, the bad nurse, have been neglecting her poor patient this whole time!

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if you did not belt her up side the head, I think you are good to go.

Just venting.

Pt. in persistent AF c RVR. Had two doses of Diltiazem, was on a Dilt gtt, got 0.5 of Dig. Slowed down for a little while after each med, but after a bit was back to his old tricks in the 140s-150s. Totally asymptomatic, but yes I do understand the importance of rate control despite lack of symptoms. In fact, I explained this concept to the patient when he asked why he couldn't just go home and live in a rapid rate, since he didn't feel anything.

Hospitalist comes in, sees rate on monitor, says to me "So he's at a rapid rate and we're not doing anything for him?".

I dunno, maybe look at the chart. Maybe talk to the ER doc. Maybe ask me the question in a different way, in a different tone of voice?

Totally unnecessary to come in here and flip me attitude, like it's my fault the guy is refractory to everything we've done.

I know in hindsight that I should have calmly and methodically reviewed the chart with the hospitalist and told her everything I had done so far and what the results had been, but I was pretty taken aback by her attitude, had stayed an hour late because things were so busy, and really felt attacked. I'll do better next time.

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I would have looked at her with my nicest smile, turn and make direct eye contact...."Hello 'Doctor'....We've done several things 'doctor' but the patient remains in the present rhythm AND rate, what do you suggest next...would you like for me to get you the chart so you may review the meds already given?" and add if not at the patient bedside "Hey Joe (ED doc) the hospitalist is here and would like you to review the patients treatment so far"

OR

"Hello 'doctor'...we've done several"...and list of time and dosages of meds and patient response..."the patient remains asymptomatic and in the present rhythm what would you like to give next...would you like for me to get the chart so you may review what has already been given?"....and add if not at the patient bedside "Hey Joe (ED doc) the hospitalist is here and would like to review this patients treatment thus far"

And give her my FULL attention for her next response....:bored:

Your a lot nicer than I would have been.

My response to "So he's at a rapid rate and we're not doing anything for him?" would have been "maybe your not, but I have been".

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Specializes in Emergency.

Reminds me of an incident I had a few weeks ago while sending a patient upstairs. College age girl with SOB x5 days. Chest CT reveals multiple PEs... described by the radiologist as "significant" clot burden. As I'm waiting for her bed to be ready, I give her the heparin bolus & start the drip, as well as do a lot of teaching.

Talk to the nurse that will be getting her and when I ask her if she as any questions, she says in this really snotty tone, "well it doesn't look like we've DONE ANYTHING for her." To which I ask her if she means have we started her heparin & bolused her? She says yes. I respond as politely as I can, that yes, in fact I had done all of that and if she had looked at the MAR, she would have seen that.

Gah.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Your a lot nicer than I would have been.

My response to "So he's at a rapid rate and we're not doing anything for him?" would have been "maybe your not, but I have been".

trust me when I say non verbal clues can be very persuasive.
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Specializes in Family practice, emergency.

I do that all the time, in hindsight, think of all of the clever responses I COULD have said, kicking myself all the way home. However, forces beyond my control have held my tongue for me. You WILL do better next time :-)

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I do that all the time, in hindsight, think of all of the clever responses I COULD have said, kicking myself all the way home. However, forces beyond my control have held my tongue for me. You WILL do better next time :-)
As one who usually *can and does* come up with pointed ripostes, I can tell you that it's a blessing that you don't come up with them on the spot.

My wit has gotten me into trouble more than once.

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You guys are wonderful! Thank you, I'm starting to feel better. Onward!

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