Kudos to this doctor

[MsPebbles]

Overheard a conversation the other day between a pt's family member and a doctor. I was sitting at the nurse's station and he was sitting beside me. Family member walked up to him and began yelling that her loved one is not getting the proper nursing care and demanded to know why the pt was not any closer to discharge status. Dr says pt had been educated on post-op plans and had been refusing to take initiative to begin the recovery process (i.e. getting up, ambulating, incentive spirometer, etc.). Per documentation, RNs have been charting (in detail) that pt has been refusing.

Family member screams, "It's THEIR job to help him heal!" Dr responds, "If he doesn't want to help himself, they can't help him. They provide excellent nursing care and it's evident where the problem lies."

Family member continues to yell/scream (literally screaming) about an NA who "got urine all over him while helping him use urinal in bed." Dr says, "I don't understand, why can't he use the urinal without assistance?" She says (through gritted teeth), "if my son, who is sick and in pain and unable to sit up or get out of bed, needs to pee, you better be darn sure someone here is gonna hold his member in a bottle for him...and NOT spill his **** all over him!!" Dr replied, "well ma'am, then I suggest you re-familiarize yourself with your son's anatomy and provide that care yourself."

At this point, I'm picking my jaw up off the floor. On behalf of all RNs and NAs, I wanted to give him a big, fat wet one!!

FYI, pt is twenty-something 3 days s/p lap sleeve gastrectomy.

[Ruby Vee, BSN]

While you mentioned that the nurses have been educating the patient as to the need to get up, ambulate, and use the incentive spirometer, you didn't mention what efforts the staff have made to discover the reason for the patient's refusal to do these things. Why was the patient refusing to get up? Were staff available to help the patient get out of bed, and to assist with ambulation? Why was the patient refusing to use the incentive spirometer? Was the patient shown how to use the incentive spirometer, and did they do a return demonstration? Were they encouraged to use it regularly? Was the incentive spirometer easily within their reach?

The attitude conveyed by your post to me is that the staff (nurses and doctor) may have taken a rather arrogant, passive-aggressive, negative attitude towards the patient and their family member. I am not suggesting that the patient and/or their family member may not have been difficult to take care of. When the family member approached the physician with a complaint about the care a family member is receiving, whether justified or not, stating that it is the job of the staff to help their family member, it is appropriate to investigate the complaint and to work with the family member/patient towards a solution for the patient/family member.

Has anyone investigated why the patient isn't participating in their healing as expected?

Being a family member, as numerous nurses on this forum have posted, is often a very stressful experience for NURSES when their own family members are hospitalized, and nurses have an understanding of hospitals, patient care, and disease processes. For family members who may have problems of their own and patients, there are even more difficulties and stressors; they don't understand everything that is happening in the hospital as nurses do; it is often difficult for them to articulate their concerns and to understand medical terminology that is used, and they don't have a knowledge of various disease processes, etc.

A softer attitude and being willing to listen and understand why people are behaving the way they are goes a long way.

Also, in my experience, just because something is documented (i.e. patient education) does not necessarily mean it was done.

Oh, good lord. Sometimes patients are just jerks and their families are just donkeys and the surgeon gets it. I'm not sure that you do.

[Ruby Vee, BSN]

Seems like you're picking on the OP and I don't know why. OP was sharing a rare moment of a doc sticking up for nursing staff, it is safe to assume the situation warranted it. We all know the type of pt. OP is talking about and those who don't probably don't work in direct patient care.

OP - I don't think you need to keep explaining yourself, and I appreciate you sharing.

Some folks just need to be holier than thou, or in this case, "nursier" than thou. I thought the original post was great and I applaud that surgeon. Susie doesn't seem to get it.

[Nurse Leigh]

Oh, good lord. Sometimes patients are just jerks and their families are just donkeys and the surgeon gets it. I'm not sure that you do.

And while I certainly don't know for sure, I wouldn't be surprised if this patient and his mother had been educated on a lot of what to expect *prior* to surgery. It's often helpful have classes before surgery to teach people what they need to do to make recovery successful and what discomfor/pain they can expect and how that will be treated but zero pain is not a reasonable goal, and they will need to put in the work to keep things improving.

So they sound like an awfully difficult pair who assumed the surgery was a magic "cure" rather than a step in a long difficult journey.

(Ok, I admit it - I've watched several episodes of "My 600 Pound Life" and was so annoyed by the patients who never even tried and in awe of those that gave it their all, even (especially?) if they "fell off the wagon" and jumped back on. Also thought the surgeon and staff on those bariatric floors have to have an awful lot of patience to deal with these types of situations.)

[Evening_Primrose, ADN, RN]

And while I certainly don't know for sure, I wouldn't be surprised if this patient and his mother had been educated on a lot of what to expect *prior* to surgery. It's often helpful have classes before surgery to teach people what they need to do to make recovery successful and what discomfor/pain they can expect and how that will be treated but zero pain is not a reasonable goal, and they will need to put in the work to keep things improving.

So they sound like an awfully difficult pair who assumed the surgery was a magic "cure" rather than a step in a long difficult journey

I was thinking the same thing. Full disclosure: I am not a nurse yet, I'm starting nursing school this fall. I realize that all patients are different and my experience is not everyone's experience, etc.

I did have a lap vertical sleeve gastrectomy almost 2 years ago. Throughout of my pre-op appointments my surgeon provided verbal, written, and video documentation of our responsibilities as patients and what to expect before, during, and after surgery. On two occasions close to surgery it was a group meeting of 5 of us who would be patients. At a post-op appointment I saw of the girls who was in my group meeting screaming at the nurse that no one told her a bunch of things we were most certainly told in our group meeting. People hear what they want to hear.

Again, I know all patients and circumstances are different, but wow he spent 3 days in the hospital? I had mine done as an outpatient. My surgery was at 9am and I was walking around the surgical center at 1pm and discharged out at 5pm. I was handed a bottle of 30 Vicodin at discharge and took exactly 3 of them. Dilaudid PCA? Wow!