Hold patient wants to change docs NOW!

[TinyNurse, RN]

I've been a nurse less than a year., so this is my first experience with this. I have an acute MI transferred in from a smaller facility. "A" doc accepted/direct admitted him to our facility. The patient/daughter was fine with this until about 7 hours later when the grandaughter came to visit in the ER..... Now it's "Well we don't want doc "A" to care for him we want doc "B" to care for him."

I wasn't really sure how this worked. I know that doc "A" now is writing the orders and the ER doc is out of the picture. I asked my former preceptor and she was "sorta stunned". She told me to have the family call doc "A" from the room and tell them their wishes. I instructed the patient/family and provided a phone book.

Turns out doc "A" is in house and visits the pt about 15 minutes later., and the family says nothing to him about not wanting his care...........

1/2 hour after that., family visits me at the nurses station again wanting to know how to get doc "B" ON the case instead of doc "A".

Everything turned out fine in the end......

My question is... Has this ever happened to you? if so., what do you do if your hold patient wants to change docs mid-care????? I know they have a full right to do so., but how does the nurse play into the situation?

Please excuse the ".," my two keyboard buttons are stuck together.

[canoehead, BSN, RN]

Send the doc into the room and let them tell him themselves. Tell the pt you have no power on this decision, they must speak to the MD about it (which is true) and you are no longer the middle man.

[Tweety, BSN, RN]

I usually stay out of these kinds of things as it has nothing to do with nursing. It is the patients job to communicate with the docs. If family wants Doc B, it's just a matter that if Doc B has priviledges there and accepts the patient then Doc B can take over care if Doc A agrees. But it's their job to ask Doc B and tell Doc A, not yours.

At least they picked Doc B. I've had patients want to fire their docs without a clue as to who they wanted to take care of them, and make it your job to find a doc for them.

[veetach]

Send the doc into the room and let them tell him themselves. Tell the pt you have no power on this decision, they must speak to the MD about it (which is true) and you are no longer the middle man.

my suggestion exactly.. It should be a discussion between the doc and the patients family.

[purplemania, BSN, RN]

This did happen to me. The family was totally unreasonable and thought of the hospital as a sort of hotel with nursing being the wait-staff. Anyway, we have policies about this. I just called the House Supervisor and got out of the picture ASAP.

[nialloh, RN]

In my hospital it is easy. The pt/family tell Dr A themselves, and if Dr B accepts the case, it is transferred. Dr A is still responsible for orders, etc., until he writes the transfer order.

As for the family who don't know who they want, we supply them with a referral number that will give them a list of Dr's to choose from. Dr A is still on the case until they choose.

It is simple and easy. It keeps nursing out of it.

[RN_Amy, RN]

At our hospital, patients have to sign a form on admission saying that (as a public patient) they do not have a choice in the doctor that they see....

[Tweety, BSN, RN]

At our hospital, patients have to sign a form on admission saying that (as a public patient) they do not have a choice in the doctor that they see....

Sometimes patients, families and doctors don't click. That's a shame. But I guess it's the price to be paid for public health.

[Nurse Ratched, RN]

As indicated above - family talks to doc - I don't play that game. Assuming pt has some capability of making a decision, would be nice if he had some say, but families are sometimes overbearing....

Explain that they need to communicate this to the doc and another doc needs to actually accept the care of the pt before his care can be transferred. Doc B might not even be taking new patients.

I like our psych unit because you get the same guy regardless as he is the hospital-employed psychiatrist. You don't like his care, you can tranfer to another hospital.

[TinyNurse, RN]

Thanks for everyones reply.