Got Yelled at by MD.

[angel36]

Hi,

I got yelled at in front of my patient and two other physicians because my pt did not have sequentials on one of her legs. Now, I am over the getting yelled at part because as we all know we take a lot of crap in this profession. However, this is my real problem with all this. After he made a fool out of himself he said now you cant place the SCDs on pt without a venous doppler. By the way, he told me to go write myself up over this. Keep in mind, it was my first time I had this patient and I was only two hours in my shift when this all happened. The SCD had been taken off on the previous shift when pt received a bath and not put back on. From the get go that morning, I had critical labs and stat IVP etc etc. You guys know how it is. Her SCD was not foremost on my mind. So, its the weekend and doctor did not put the order for the doppler until I followed up. Order in and since it was the weekend I had to call vascular surgeon to get this ball rolling. They refused to come up on weekend to do this doppler. Resident made attending aware of this and I was told to leave SCD off. So, she went a day and half with no SCD on and I felt if she did not have new DVT before she would now. Heres the kicker, this pt had greenfield filter placed to prevent a DVT that developed prior. I asked another resident about this and was told filter takes care of both sides. So, isnt SCD contraindicated on this pt? In other pt with greenfield filters placed we leave SCDs. off.

Thanks for reading all this.

[UM Review RN, ASN, RN]

Here's the thing:

I may be wrong, but I've heard that there have never been any evidence-based studies that prove that the use of SCD's lowers the rate of DVTs.

If any exist, please provide a link.

Because of the greenfield filter, I would've thought that took care of the DVT prophylaxis and left them off and explained my rationale to the doc.

Regardless, the doc was wrong here twice because first, he has no business yelling at anyone, and second, if he wanted a stat US, he should've ordered a stat US with a wet read and orders to call him if positive.:trout:

But .... somehow it becomes our job to remind them. :icon_roll

[MaryAnn_RN]

As soon as the procedure/whatever is done, we are required to clean up their sharps/anesthesia needles/trays, etc.

I don't think so...their sharps, they clean up. I don't mind cleaning up after a procedure but will not pick up other people's sharps, nor do I expect others to clean up after me.

As for shouting, the very first time I met one of our new consultant anaesthetists, he shouted at me in front of everyone, pt and relatives included. He doesn't do it anymore :D:D:D:D

[Virgo_RN, BSN, RN]

Heres the kicker, this pt had greenfield filter placed to prevent a DVT that developed prior. I asked another resident about this and was told filter takes care of both sides. So, isnt SCD contraindicated on this pt?

First, let me say that I'm sorry you were treated rudely.

The purpose of the Greenfield filter is to prevent a thrombus from traveling into the pulmonary vasculature, causing a Pulmonary Embolism. The filter does not prevent DVTs from forming in the lower extremities, so I'm not certain why SCDs would be contraindicated simply because the pt. has a Greenfield filter. We still want to prevent DVT, even if there is a filter in place. While a LE DVT might not be life threatening, it is still very painful and can lead to postphlebitic syndrome. Obviously, if the patient has a Greenfield filter, then they are in a hypercoagulable state, so they are at high risk for developing a DVT. I can see why the doctor would place high importance on the use of SCDs since anticoagulation is ineffective for this patient.

That still does not excuse rude behavior, though.

[Ginger45]

I can remember that happening to me once. I was a new RN and I had a patient who was going bad. I had been calling the DR but I got no response. I called his office and they didn't know where he was. I went ahead and ordered a chest xray. The DR then comes prancing in and yells at me for not calling him. Luckily it was not in the patients room. I let him have it. I told him that I had called and it was not my fault that he was not answering his pages and his office didn't know where he was. He later apologized to me. It is hard when they yell at you in front of a patient because you can't really say anything. I am sorry that happened to you. You can complain to your boss. Dr's are not supposed to talk to us that.

[Flightline, BSN, RN]

It's all economics. If the MDs worked for the hospital, management would deal with the problem, but they don't. They bring patients to the hospital and therefore produce income for the hospital. I wonder if it would be the same if we had nationalized healthcare where hospitals belonged to the government and neither opened or closed unless the government wanted them to be opened or closed. Would MDs have the same domination of the work environment?

Of course we need MD orders to do things. No doubt. Of course MDs need nurses to care for their patients. No Doubt. But as it is, hospitals can't stop doctors from acting rudly, not without cutting off their nose to spite their face.

[lpnflorida]

I do not feel any doctor should yell, does it happen yes.

Now for the other side of the coin. This doctor is ultimately liable for his patient. This patient ends up with dvt, and worse case scenario ends up losing a leg. Of course other things can enter the picture not just the scd's not being on. But this will be where the focus will start. In a doctors mind there is no such thing as a little thing in regards to their orders and their patients. Like it or not.

Do some of the docs accept human error and fraility and the real world versus perfect world in regards to the care of their patients? Some do, and some don't.

Now how do you feel about the doctor being upset. Will he possible face a patient and their family blaming him and trying to take him to court. Yes, it happens.

[RN1982]

Here's what I would have said...I'm just feeling feisty right now so forgive me.

First, I would ask him to come into the hallway, then I would say "Dr, next time you want to question the care the I provide my patients, please ask me to step into the hallway so that you don't make a jackass out of yourself in front of a patient"

[angel36]

Thanks everybody for your input. I thought I would save this bit of information for last about my situation. THERE WAS NO ORDER FOR SEQUENTIALS on his patient. Our orders are on the computer and indicated DVT ASSESSMENT: Low Risk. Obviously this order was old but there was no new order. I work Neuro Trauma/Surgery and we do take SCDs seriously but in all cases I have had before the SCDs are left off of pts with greenfield filters. Now whether that is right or wrong then not sure now anymore but that is the standard. As far as the doc yelling at me. Here is how I feel about that. He made a fool of himself. There were plenty of other more professional ways to handle the situation than what he did. I said nothing at the time to him and just nodded that I got it. I did not crawl up in the fetal position and cry about it. The last person posted after saying all the ultimate responsibility is on the MD now how do I feel about his yelling at me. Well heres my bottom line " I respect what he does and I fully understand his responsibility and he should respect mine and fully understand my responsibilites". We have to work together. There is always a better and more professional way to handle the situation. If he would have pulled me aside and handled it that way instead of making a scene then his point would have gotten across just as well. Plus, I would have respected him more not less.

Thanks everyone for your input.

[lpnflorida]

Angel,

I do not. did not say it was right for him to yell..

the end paragraph is for nurses to realize there are two ways of looking at things only. Our perspective/their perspective. Good relationships between doctors and nurses make for good opportunities to share information and to educate each other.

It is never okay to yell.

[Virgo_RN, BSN, RN]

Thanks everybody for your input. I thought I would save this bit of information for last about my situation. THERE WAS NO ORDER FOR SEQUENTIALS on his patient. Our orders are on the computer and indicated DVT ASSESSMENT: Low Risk. Obviously this order was old but there was no new order.

You know, that's not really a nice thing to do. When you withhold pertinent information that could change the entire picture, and people reply based upon what you originally posted, they can feel a bit used and abused when you come forward with the info that you left out originally.

At any rate, I don't think anyone defended the doctor's behavior. There was no excuse for him to treat you badly, especially in front of the patient. We need to stand up for ourselves and our profession by letting doctors who behave this way know that it is not acceptable.

[lpnflorida]

Someone felt that patient was at risk as evidenced by the SCD's on the bed, also the fact that they had greenfield filter placed is also evidence of risk for dvt.

Think about it, if you had said when the doctor asked Why doesn/t the patient have scd on and you stated " I am sorry it won't happen again" would he have gotten mad, versus you gave him alot of excuses as to why you were unable to put it on that leg....

Again, yelling is wrong, but just imagine how sometimes we make excuses instead of first off saying I'm sorry. Taking responsibility is what we are suppose to do.

I am playing devils advocate, to help facilitate looking at it from both sides and to get a clearer picture.

[lpnflorida]

http://www.innovations.ahrq.gov/content.aspx?id=1708 I found this protocol in regards to patients risk assessment for Dvt. I like it enough that I will bring it up to my own management for review to see if it could be considered for use in our system.