Physicians bullying patients...

  1. we had a pt in the ed today who was ready to go home. the doc on call wanted to admit him, even though he was well enough to go home on meds. (i didn't get all the dx etc. since i'm not back there to work.) the went back and forth a while and then the pt requested the papers to sign out. during this, the ed doc called pts pcp to come to the hosp to talk the pt into staying. the ed doc then tell the rn to go 'make him stay.' he replies, i will not make him stay if he doesn't want to. doc then goes to tell him he cannot go until pcp arrives. the medic and rn try to tell the daughter and the pt(about 80ish) that they can leave and it is their choice. multiple times they try this. pcp comes in. both docs insist that they stay, the whole business lasts well over 2 hrs. charge nurse is brought in to try to help, to no avail.
    pt finally concedes to be admitted, the daughter and pt both are actively crying, want to go home, but are somehow convinced that the docs can keep them there!
    also, the ed doc offered to admit the daughter so that she could stay in the room with her dad! now i know thats wrong!!!
    has anyone ever experienced this sort of thing? i don't know if the staff involved will write it up or what, but it really saddens me.
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    About Nurse`Chief~Chickie

    Joined: Sep '06; Posts: 87; Likes: 15
    ICU/Med-Surg

    8 Comments

  3. by   GingerSue
    [quote=

    pt finally concedes to be admitted, the daughter and pt both are actively crying, want to go home, but are somehow convinced that the docs can keep them there!
    also, the ed doc offered to admit the daughter so that she could stay in the room with her dad! now i know thats wrong!!!
    has anyone ever experienced this sort of thing? i don't know if the staff involved will write it up or what, but it really saddens me.[/quote]

    i think that it was kind of the doctor to offer to arrange that the daughter could stay.
    both the patient and the daughter were probably frightened of hospitalization, and the father's health - at that age - think of what hospitalization might mean.
  4. by   casey12873
    isn't that false imprisonment??
  5. by   TazziRN
    I used to work with a doc who would try and bully pts into accepting tests , and if the pt refused, wanted me to have them sign out AMA. I refused to do that, because A) refusing a test is their right and B) refusal does not mean they are refusing treatment. This usually happened with a young woman who refused a pelvic exam, wishing instead to see their PMD for that.

    For pts who refuse to be admitted, the other option is to have them sign out AMA. This is their right. When a pt asks me if they have to do what the doc says, I tell them that it would be in their best interest, but that they have the right to refuse.
  6. by   Nurse`Chief~Chickie
    Quote from gingersue
    i think that it was kind of the doctor to offer to arrange that the daughter could stay.
    both the patient and the daughter were probably frightened of hospitalization, and the father's health - at that age - think of what hospitalization might mean.

    i should be more specific here. small hosp, small town.
    the daughter has always been allowed to stay in house, in the room(previously with mom who has passed on and with dad)
    the doc was trying to coerce the daughter into being admitted as a pt.
    they have been there many times and this was evidently not something dire enough to be only handled in the facility.
    this is a family that all staff is familiar with and fam is comfortable with us.

    i wonder if we can say false imprisonment, they were under the impression they could not say no.
  7. by   sanctuary
    Is there some kind of kickback system that gives the doc $$$ if he admits patients, hence the admission of both of them. I don't know if it is false imprisonment unless they were in a locked area of the hospital, but it is unethical as heck. Unfortunately, the hospital board will not be a resource for you, as they are the very source of this kind of agreement. The Board of Medical Practitioners might be interested in this sort of behavior. A simple phone call would get it off your chest...er...mind.
  8. by   jo272wv
    I have seen Drs. point blank tell pts who go outside and smoke that if they continue they will be asked to leave AMA or their pain meds will be cut off because obviously they are not in pain if they can go down and smoke.

    Now I know this is a touchy issue but some pts just can not quite cold turkey just because they are in the hospital. patches help some but not others, We dont let them smoke in the rooms anymore and we force them to either lay there and suffer through withdrawl among other problems they have to deal with or we force them outside in all kinds of weather.

    I firmly feel that pts have the right to choose and these Drs. that give them altimatums is an ethical issue. I always inform my pts that I can not stop them from going out to smoke but I encourage them to use the patch first and of course I document I have offered these and client still left floor to smoke.
  9. by   Daytonite
    nurses need to do their own jobs and leave the physicians to theirs. it is obvious that two physicians, one of whom knew the patient very well, felt the patient needed inpatient care. that is part of their medical assessment and decision-making. have you considered that there are things about the patient and his daughter that the physicians were aware of that the ed staff did not know? we nurses get incensed when physicians interfere with our autonomous practice. we have to extend that same courtesy to our colleague physicians.

    the time to have done something about this was during the ed visit. the nursing supervisor or someone in nursing management should have been notified at the time all this was going on. these are the people who can link this to administrative review if there is any question of wrongdoing on the part of the physicians. i can guarantee you that there is a system in place at your hospital for the supervision of the way physicians practice. i recommend that you contact someone in the medical staff services office at your facility and ask them what the proper procedure and protocol is to report the questionable actions of a physician.
  10. by   Antikigirl
    I tend to agree, there is proably something going on where it was definately more benificial to stay then to go. I don't know too many docs that would go beyond saying 'fine than go AMA' and be done with it. Something was up, maybe a social situation where both pt and daughter were not safe going home?! And with HIPAA and confidentiality if you were not in the need to know...you wouldn't know.

    I think there is more to the story, and the nurse that was tending the pt, and the charge nurse should pick up the reigns if they feel the patients was being wrongfully treated.

    I typically do not argue with a physicians admission or tx of a pt (unless I feel it is unsafe or remind them of the pts rights from time to time), they know things I don't about their own protocols, their pts, their personal ethics and preferences, and tx's. I go with the MD till otherwise questionable then I ask! (I have no fear of MD's...I ask questions even if they get a little bothered...but I do it in a ego stroking way! LOL!).

    I tend to wonder why the MD would go so far as to get the PCP there, and charge nurse involved. That is a lot of effort for an ER doc, being as busy as they are, and knowing the same of the ER staff...well something was up that if the pt went home, it was a bad idea. (I find that some social situations make MD's order admission...like abuse {daughter or other family member???} and we may not know it right up front).

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