How to Deal With Ignorant Medical Professionals

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Is it better working in a larger community? Is there a place where physicians actually embrace the idea of palliative care and hospice and where the rest of the medical community at least is willing to learn if they don't know about it?

For the second time in a month, I've had to deal with an ignorant fool of a physician who insists that hospice is responsible for killing his patients off because we give them too much morphine. I made the mistake yesterday of asking this ignorant horse-behind for an order for morphine as we were heading into a weekend and getting meds in a rural area is very difficult on Saturday and Sunday as we have no Walgreens. I made it very clear to the discharge planner that Horse Behind, MD could refuse the order, and I would understand perfectly, but would someone ask him anyway? That will be the LAST time I ever ask him for so much as a Tylenol for a patient. I met with the patient's family at the home to do the admission and when the issue of morphine came up, daughter showed me a script for 1mg Roxanol q 8 hours PRN. Ok, not what I asked for, but at least it will be in the house, I thought and that shows some progress. THEN daughter says, "Just so you know, Dr. Horse Behind told me I need to watch you carefully because you hospice nurses like to give patients too much morphine and hurt them with it, and I should not let you give him anything because I can't trust you won't hurt him. So I want you to know I AM watching you and you are not to give ANYTHING to my father." :eek:

So after picking my jaw up off the floor, I got hot under the collar and said, "I want YOU to know that Dr. Horse Behind is ignorant and knows NOTHING about hospice. In any case, I'm not giving anything to your father: You all are the ones who will do that, should you choose to." Then, knowing I was going to say something I would regret to a family who is not to blame for any of this I asked if we could take a break and I would come back in 10 minutes. I did, and everything went better after that.

I am absolutely furious, even 24 hours later. It wouldn't be such a big deal if it were one physician, but we have 9 physicians in town, and only ONE of them supports what we do, but he is an OB-GYN........We are constantly fighting with the medical community in this town and it is driving me crazy. And I want to get this particular incident addressed somehow because I feel it borders on slander, as there are only 2 hospice nurses in my town. Any advice?

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it's too bad you can't address your concerns w/dr. horse's *** himself.

i'd like to know from him, what is the role of hospice?

does he believe this pt is terminal/dying? (if not, why is he on hospice?)

if so, does the pt deserve to be comfortable?

and finally, i like to remind doctors that anything they tell me, is duly noted in my nsg notes, i.e.,

"i'm afraid nurse ratchett is going to kill this pt with morphine", while reminding doc of its slanderous implications.

they HATE it when i do that...and is usually followed with a change of heart/demeanor.

i so hear you with your frustration, tencat.

frankly, i don't think i could do hospice in such an ignorant, resistant environment.

kudos to you...you're a better woman than me, clearly.

leslie

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Specializes in Geriatrics.

Just wow.

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Specializes in hospice, home care, LTC.

I would speak to Dr. Horse *** personally, and remind him that slander is a serious charge. Do you have a hospice medical director who will give you orders in this scenario? How about asking the med director to talk with Horse ***. Of course this particular patient's family may not allow you anywhere near the patient, that is until, if and when, the poor patient is suffering in pain. :mad:

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Sorry you're in this position-- when these situations occur, it's always the patient who winds up suffering the most.

You're probably not going to be able to move mountains in this situation, but as long as you're this patient's nurse, you may find the opportunity to find out exactly what the patient's family wants for their loved one. One thing I've observed during these situations is that often the physician, the family and patient, and the nurse aren't on the same page. What are the family's goals for their father? Is it to prolong his life or to minimize suffering? What did/does their father want? What are they most afraid of? Have they had a loved one in hospice before and if so, was it a positive or negative experience?

The same can be said of the doctor. What are his goals for the patient? Has he and the family talked about the short-term and long-term goals for the patient, what appropriate interventions he and the family are wililng/wish to take?

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Thank you all SOOO MUCH for your replies and ideas. I have duly noted in my notes the incident. Thank God we have a fabulous medical director (not from our town) who will get the patient whatever he/she needs to be comfortable. There is no way hospice would even work in this town if we didn't have a doctor we can trust. The only reason I keep doing hospice here is because I feel that the folks in this town deserve the opportunity to die with peace and dignity. Usually I just inform physicians of what care our medical director has ordered, specifically because of this kind of behavior. One big complaint all the docs in town have is that we don't communicate with them, so I thought I'd try to do just that. Didn't go too well.....I would like to see Dr. Horse Behind in person and inform him of what I think, and how I noted it in my notes, but I will be the one who will be in trouble, and I don't know if it's a fight worth having.

Leslie, thank you so much for your kind words and encouragement. It means more than you know! :)

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

Dr. Horse's *** would be facing a slander suit if i were in your shoes. I don't know if it's better in larger towns but I live in a small town and our physicians are all on board with hospice / comfort care.

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.....I would like to see Dr. Horse Behind in person and inform him of what I think, and how I noted it in my notes, but I will be the one who will be in trouble, and I don't know if it's a fight worth having.

why would you be in trouble?

i've had higher-ups, question my notes but ultimately the notes ended up staying...

since they did not involve anyone in the facility (employees), and it was a conversation i had with a doc...

so it was between me and the doc.

they don't like it, but agree that it's my license, and my head on the chopping block.

and, that if the doc complains to them, they refer him/her to me.

you wouldn't get that support?

is that what you're saying?

leslie

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Specializes in Emergency & Trauma/Adult ICU.
THEN daughter says, "Just so you know, Dr. Horse Behind told me I need to watch you carefully because you hospice nurses like to give patients too much morphine and hurt them with it, and I should not let you give him anything because I can't trust you won't hurt him. So I want you to know I AM watching you and you are not to give ANYTHING to my father." :eek:

This is slander. Seriously. And even if HorseBehind, MD has a solo practice and therefore doesn't have a "boss" in the true sense, I would still take this up with your agency's medical director. That can't be allowed to continue.

So after picking my jaw up off the floor, I got hot under the collar and said, "I want YOU to know that Dr. Horse Behind is ignorant and knows NOTHING about hospice. In any case, I'm not giving anything to your father: You all are the ones who will do that, should you choose to." Then, knowing I was going to say something I would regret to a family who is not to blame for any of this I asked if we could take a break and I would come back in 10 minutes. I did, and everything went better after that.

I give you a great deal of credit for that. I don't know that I would have been able to pull that off. But I hope that as long as you continue to do hospice that you use available opportunities to educate patients and families. Bluntly, if necessary, spelling out the alternative to medicating dying patients; e.g., the patient dying in pain.

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Does your employer not have its own Medical Director and physicians to whom you can go for orders when the patient's regular MD is "not available"? Are there established protocols and standing orders for you to follow when certain situations arise? Does your employer have SW and counselors on hand for assistance with the family? Don't risk alienating the family by insulting the doctor. Report what they said to your management, and let them decide whether or not to intervene.

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Perhaps it's a difference in training philosophies thus an indoctrination into a given mindset that divides the medical and nursing activities.

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Specializes in CVICU.
finally, i like to remind doctors that anything they tell me, is duly noted in my nsg notes, i.e.,

"i'm afraid nurse ratchett is going to kill this pt with morphine", while reminding doc of its slanderous implications.

Please do not do this in your nursing notes. This is a legal document and is only for facts. The appropriate way to note it is to say, "I (or RN) requested morphine from Dr. X. for unrelieved pain. Dr. X. refused to order." It is inappropriate and unprofessional to use your nursing notes to editorialize, even if you are directly quoting a physician's statement. Believe me, if you get called in to court you'll be embarrassed that you used your documentation as a soapbox.
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