Have you ever done this

caliotter3 · Jun 9, 2012

I would not do this. However, I would continue to try to reach the doctor by phone. I suspect that many doctors would refuse to speak to a nurse about a patient in this manner unless there already was a working relationship. From your description, it sounds as if this doctor actively discourages patient contact. I would continue to encourage the patient to find a more accessible doctor.

merlee · Jun 9, 2012

How does the pt make an appointment if no one answers the phone? That issue aside, if there is a fax number, I would fax the doc a complete list of medications and ask for confirmation. Who is giving the order for home health? Who resumed the care post-hospitalization? Finally, contact the pharmacy where she gets her meds do inquire about interactions.

When I worked home health, as we entered the meds into the electronic record, the computer provided warnings about interactions.

I am on 16 prescribed daily meds, including 2 different insulins. And some prescribed PRNs as well. So I know it can be scary when you see that list.

BTW - that patient needs a med cassette to make it easier to keep track of her med. I always used them for my patients who had more than 3 pills to take in the morning. Pouring pills once a week is so much easier than playing with those bottles every day.

Best wishes! Oh, and if the patient likes her doc and you keep encouraging her to change - - you will be the one to go. She will become annoying to her.

emilysmom,RN · Jun 9, 2012

We do not use computers. There is no major contraindications but on a few psych meds and a few BP meds. She does have family fill her mediset weekly. I did do a ROC fax to PCP and typed a letter breaking down classifications with my concerns with my cell number. Still no answer back. There is a Machine for making appointments. I have even left a message on that line asking for a call back.

amoLucia · Jun 11, 2012

Can your agency's adminstrator mail your concerns via registered mail on their letterhead??? Might look more impressive to the MD.

Just curious --- who accompanies her to her appts now? I'd have to see how my agency's P&P would cover the MD visit. Too many questions about my safety, liability, reimbursement, time, travel, etc. Whats next ... many LTC facilities have wound up having to send CNAs to MD visits/consults because no one would go with the pts who were poor historians, too confused (wanderers in or out of the office), had ADL issues (like getting positioned from whch to up on an exam table or needing toileting and incontinence care).

I see where a precedent could be set here.

cathrn64 · Jun 11, 2012

This is not quite the same, but I recently went to an MD office to get a DNR signed. The patient was a cancer patient and the Dr wrote an RX with DNR on it. This is not the correct way to have a DNR and the patient was not doing well. I went there (not something I would normally do) with the correct form and waited for the Dr to sign. After spending an hour of my (unpaid) time to do this, the patient transferred to Hospice the next day! (in the long run though it was best for the patient, and Hospice was where he/she belonged)

emilysmom,RN · Jun 11, 2012

Pt is back in hospital with double pneumonia. When I saw her lungs were ok no temp. Doctor never returned my fax, never called me. My manager said I dropped the ball. I should have went to the office to discuss this case with her. The pt never did go see the doctor as I told her to do many times. Not sure if me going to talk to the md would have made the difference. Another nurse saw her for me end of last week and said her lungs were clear. Pt even went to a carnival the previous weekend.

caliotter3 · Jun 11, 2012

I think your supervisor saying that you dropped the ball is unreasonable. So they were going to pay you mileage and time to make this visit to the doctor? How were you supposed to document it for reimbursement purposes and to get the pay due to you? If that was what she wanted then all of this could have been made clear to you at the time you were being instructed to do all of this. Again, a precedent being set.

emilysmom,RN · Jun 11, 2012

She would have paid me but me going to see the MD would have not prevented her from going back into the Hosp due to SOB and pneumonia.

caliotter3 · Jun 11, 2012

Another reason why the supervisor's comment was unreasonable.

KateRN1 · Jun 13, 2012

Harrassing the MD is outside of your responsibilities and you should not be expected to do that. You notified the physician of your concerns, I assume that you have it documented, and you advised the patient to seek medical care. You met your obligations to the patient, the physician, and the agency. Your rep/liaison/marketer should be the one to seek out the physician in his/her office if there are further concerns.

Shimmer580 · Jun 14, 2012

Harrassing the MD is outside of your responsibilities and you should not be expected to do that. You notified the physician of your concerns, I assume that you have it documented, and you advised the patient to seek medical care. You met your obligations to the patient, the physician, and the agency. Your rep/liaison/marketer should be the one to seek out the physician in his/her office if there are further concerns.

I agree 100% with this ^^