If you go to a hospital get ready to YELL

Lauraingalls, BSN, RN · Mar 3, 2017

You know, a nurse should not have to deal with this yelling. I get that the doctor wants better treatment for his mother but don't we all? He is yelling at the wrong person. I bet administration never heard from him.

BSN16 · Mar 3, 2017

You know, a nurse should not have to deal with this yelling. I get that the doctor wants better treatment for his mother but don't we all? He is yelling at the wrong person. I bet administration never heard from him.

Also notice that he never yells at any of the other doctors, who have the real power in this situation, only the nurses. So frustrating to always be the punching bag when we have no control over many things.

Ben_Dover · Mar 3, 2017

Yikes!!! I can't imagine working with (not "for") this Ducktor!. For those who have and did and still are..... share your stories! :woot:

MunoRN, RN · Mar 3, 2017

I think you've confused a few things. The purpose of an immediate CT for someone with a persistent neurological deficit is not to look for a clot, it's to look for the absence of a bleed, a clot is often evident at this point and a CT will read as negative. If it's been less than 3 to 4.5 hours from symptom onset, then the patient could rule-in for tPA if they meet inclusion criteria. If the symptoms are not persistent, as is the case with a TIA, then the critical timeline doesn't apply.

That critical timeline does not apply to a carotid ultrasound, in patients with unstable TIA symptoms, "emergent" endarterectomy is associated with poorer outcomes and increased complications, which is why these patients are termed "urgent" endarterectomies which refers to surgery occurring within 2 weeks, not a matter of hours.

BSN16 · Mar 3, 2017

I think you've confused a few things. The purpose of an immediate CT for someone with a persistent neurological deficit is not to look for a clot, it's to look for the absence of a bleed, a clot is often evident at this point and a CT will read as negative. If it's been less than 3 to 4.5 hours from symptom onset, then the patient could rule-in for tPA if they meet inclusion criteria. If the symptoms are not persistent, as is the case with a TIA, then the critical timeline doesn't apply.
That critical timeline does not apply to a carotid ultrasound, in patients with unstable TIA symptoms, "emergent" endarterectomy is associated with poorer outcomes and increased complications, which is why these patients are termed "urgent" endarterectomies which refers to surgery occurring within 2 weeks, not a matter of hours.

Yes I agree. Especially considering the patient started showing symptoms much earlier. I have had many stroke patients who have waited to have carotid US until morning. Also just to clarify, i did not write this article lol

KatieMI, BSN, MSN, RN · Mar 3, 2017

Well, that doctor passed his neurology part of Boards with good, solid "F". Because carotid stenosis per se is a rather stable condition. Carotid US is not an emergency study, unlike CT scan. A plaque, should it be there, will be the same size, same place 10 hours, or even 10 days after. 10 weeks would probably a different thing to speak of.

If there is a study which would make theoretical sense to do STAT in such situation, it could be TEE to watch for small thrombi in left atrium. Unfortunately, it requires anesthesia and 8 hour NPO. Brain angio/noninvasive still not so common and too expensive to be performed on every TIA, plus uncertainty with dealing with results, if any.

(P.S. if it is speaking about "wards" and shift-working hospitalists , then I suspect the talk was about Great Britain or Canada, not the USA. But, anyway, the doc made himself a subject of not a great love in that hospital for a good time ahead).

MunoRN, RN · Mar 3, 2017

Yes I agree. Especially considering the patient started showing symptoms much earlier. I have had many stroke patients who have waited to have carotid US until morning. Also just to clarify, i did not write this article lol

Sorry, I missed this was a linked article. Looking at the original article, I can't tell if he's giving an example of how patients and their families can get really upset based on a poor understanding of treatment standards, or if he really believes the family members complaints were valid.

KatieMI, BSN, MSN, RN · Mar 4, 2017

Medscape: Medscape Access

one relatively recent source.

The doctor in question appears to be a surgeon, and at one point he was the Chief resident in surgery. This explains a lot of his behavior.

LovingLife123 · Mar 4, 2017

Yeah, the person that wrote that article obviously doesn't understand stroke protocol and how a stroke center deals with them. As I was reading the OP, I was thinking to myself that carotid ultrasounds are not done immediately. Usually they are done the following morning. CTs in the ER are protocol and don't need a physician to physically examine the patient. A clot is usually not visible. Bleeds are though. It's done to determine if TPA can be given.

This man I'm sure used his title to get what he wanted without knowing at all how strokes are actually handled. I have no respect at all for the way he treated those nurses. It wa not their fault. He apparently has no idea how a hospital is run.

Libby1987 · Mar 4, 2017

I can't believe he left his 83 yr old mom to advocate for herself. Seems he'd rather be right than do the right thing.

cocoa_puff · Mar 4, 2017

I can visualize this physician yelling at me about the "poor care" he thinks his mother is receiving. I absolutely hate how he feels that he can just YELL at nurses and other staff members to get things done the way he thinks it should be done. Unfortunately, this is the mentality of most of my patients and their family members. They think we are so incompetent, so careless, and so inattentive to their loved ones that they just have to intervene. As the family member of someone who was recently in the ER for chest pain, I understand the frustration of waiting and waiting for the results. Even as a nurse, it was hard to remember that she wasn't the ONLY patient in the hospital who needed care. On a side note, I would never leave my mother in the hospital, especially before she is transferred from the ER to the floor!!

I thought the article sounded...different, and I agree with the previous poster who said that this physician probably is in the UK or Canada (and he also doesn't understand stroke protocol).