Like Water Off a Duck's Back.........

[VivaLasViejas, ASN, RN]

Life is just chock full of surprises......

You know, I used to be intimidated when doctors yelled at me. Even though I was close to 40 when I graduated from nursing school, and learned quickly to have all my facts and figures lined up before I called an MD, I was easily cowed by their angry outbursts and could hardly wait till I got off shift so I could go cry in the bathroom. And even though I haven't had that many bad experiences with physicians overall, some of the ones I have had were pretty traumatic.

Today I managed to get not one doctor, but THREE of 'em, plus a nurse practitioner, hopping mad---in one case, enough to rip me a new hiney and hand it to me. They all practice in the same building along with a number of other physicians, NPs and PA-Cs, but I'd never known them to gang up on other healthcare professionals; in fact, I've worked with two out of the three MDs as well as the NP, and had decent relationships with all of them. Until today.

The backstory is, one of the MDs who recently retired from this clinic---a fact neither I, nor my resident, nor the pharmacy had any idea about until this morning---has a bad habit of not responding promptly to faxes and phone calls from my facility and the pharmacy about renewing this one resident's Duragesic patches. The resident's insurance, as well as state administrative rules, require that the prescription must be renewed every 30 days, so we have had to fax this doctor at least two or three times almost every time the med came up for renewal, and sometimes he hasn't responded---despite early requests for renewal---until she was as much as 48 hours overdue for a patch change.

To say that this has been frustrating would be the understatement of the year. The last time, the poor woman went almost THREE DAYS without a new patch. The last time I had to intervene, I sent a fairly strongly-worded fax that said, in essence, that this was unacceptable and that I expected my resident's pain to be managed in a manner consistent with best practices.

That got his attention, and for a couple of months we had no problems. Then this morning I got a call from our house pharmacy saying that they'd faxed the physician three times (we requested the refill two weeks ago!) with no response. Of course, no one calls a doctor's office anymore unless they have time to spend ten or fifteen minutes on hold, listening to elevator music and falling asleep. So, Super Nurse here went into Patient Advocate Mode and sent an urgent fax to the office that left no question in anyone's mind about where I stand on pain treatment, its priority in my building, and doctors who can't be bothered to take five seconds to scribble their signature on a fax to renew the order.

I had HAD ENOUGH OF THISSS!!!!!!!!! as Bill Cosby would say, and when I fired off my fax, I really didn't care who knew it. And I didn't think a thing of it until the office manager came to my office and said "Dr. P is on the phone for you". Well, I hadn't faxed Dr. P, so it was a genuine surprise when he began to yell in my ear, "That fax was the most unprofessional and inappropriate thing I've seen in my career!" He proceeded to inform me that Dr. N had retired, and that Dr. S, who had replaced him, was FURIOUS about all this and would be speaking with my supervisor. Now, this was the first I'd heard about Dr. N---even the resident herself didn't know he was no longer her doctor---but Dr. P was so mad I couldn't get a word in edgewise. All I could do was let him finish, say "I'm sorry you feel that way" and let him hang up on me.

A few minutes later, Dr. S called wanting to talk to both my boss and me; he was out of the building at the time, so she got me. By this time I was fully prepared for another butt-chewing, but it didn't take many words of conversation to figure out that she and I both had been the victims of poor communication: she's brand new at the clinic and didn't even know she was supposed to be the resident's doctor until this very morning. And of course, we knew nothing of the change ourselves, so when she got my fax, she was totally mystified and upset; but at least she allowed me to express MY concerns, and when I was done she wasn't the least bit angry. She even chuckled when I apologized for inadvertently dumping on her but maintained that I was glad I'd gotten a response, even if it was like ripping the lid off a keg of gunpowder!

In fact, she told me that if I ever have trouble getting a response from the clinic, I am to use the private physician's line to talk to the doctor personally (rather than go through the voice message system and listen to "Don't Cry for Me Argentina" until I'm ready to commit hara-kiri). She did talk to my boss later when he came back from lunch, but of course by that time I'd already told him what I'd done and why and showed him the fax I sent, and nobody was upset any more.........except maybe the other doctor and NP who had called demanding to speak to him about the same fax, even though it didn't involve either of them.

Meanwhile, I got backup from my administrator and an apology from Dr. S, and the resident got her fentanyl patch, which was the only reason I'd stuck my neck out in the first place. As for the other members of the practice who got so hot under the collar............well, I hope they get over it, because I was right to advocate for my patient and I'll do it again if necessary.

I'm sorry these folks didn't appreciate the way I pointed out their (former) colleague's neglect of my resident, but dang, if you don't like signing endless faxes on endless patients, then don't take the big bucks.:angryfire And for Pete's sake, when you retire........LET YOUR PATIENTS KNOW!!!

Anyway, I'm making like a duck with water running off its back: it doesn't affect me personally. No, thank Heavens, I've finally gotten past the fear of offending the great god Doctorus Medicus Ad Nauseam. I guess most nurses do, eventually. I just didn't know I had until today.

[Altra, BSN, RN]

:bowingpur:bowingpur My hat is off to you.

But here's what sticks in my craw (whatever my craw is ...)

These professionals got their collective knickers in a twist because they received a strongly worded fax that wasn't even addressed to them? My, oh my ... Imagine the vapors that would have resulted if you had (rightly) demanded to speak to someone on the phone?

[VivaLasViejas, ASN, RN]

Yeah. I sort of wondered about that too.

I'll be the first to admit I was VERY unhappy when I sent that fax. But it was a lot more diplomatic than I'd have been on the phone with the MD who'd repeatedly neglected to renew my resident's fentanyl patches in a timely manner.....

[Idon'tcodgerdodge]

I'll never forget the time I was writing an order in a chart and literally got shoved out of the way by the big dog cardiothoracic surgeon!! He didn't so much as say excuse me or I'm sorry..all I could do was stand there smiling wondering how you can have so little respect for another human being.

[deeDawntee, RN]

You are truly a hero!!

You can be my nurse or my families' nurse anytime!!

I would walk a little taller the next time I saw any of those people, you did your patient proud!!

Way to go!!

:yeah:

[BillEDRN]

Anyway, I'm making like a duck with water running off its back: it doesn't affect me personally. No, thank Heavens, I've finally gotten past the fear of offending the great god Doctorus Medicus Ad Nauseam. I guess most nurses do, eventually. I just didn't know I had until today

IMHO - you should take this incident to the administrators with your own claims of unprofessional behavior and also claim a hostile work environment. No one should be subjected to the treatment you got, especially for advocating for the patient, and especially in light of the legitimate issues of patient abandonment. If we collectively allow this type of behavior to continue unchecked, it is bound to continue. If there are no consequenses to the physicians and NP's poor behavior, it will seem to them as if it were OK. As you experienced with the "new" doc, issues can, and should be resolved in a professional manner.

I'll never forget the time I was writing an order in a chart and literally got shoved out of the way by the big dog cardiothoracic surgeon!! He didn't so much as say excuse me or I'm sorry..all I could do was stand there smiling wondering how you can have so little respect for another human being.

I had a similar incident many years ago, back when the radiologists had to come in to read the CT scans for our ED patients. I was sitting in a chair, in front of the window, in the CT room, so I could visually monitor a vented trauma patient. One of the hotshot radiologists came bounding into the room, looked around, and seeing no empty chairs, demanded that I get up and give him mine. I of course, remained seated, explained that I was busy with charting and monitoring my patient, and that if he wanted a chair, he should ask one of the many residents, or med students observing, to get up. This only made him more upset, and he threatened to "kick my a**" if I didn't get up. At that point, I did get up, and being 6 foot and used to fighting with drunks in the ED, got "in his face" and suggested that if he really wanted an altercation, he could have one, but that since I was bigger, and well schooled in self-defense, that he might want to reconsider. He thought about it for a second, and then asked the resident to give up his chair.

The moral - Like children and bullies, tolerating bad behavior only causes that behavior to continue.

[justme1972]

I am so sorry that you had to go through that difficult situation....the doctor that called to yell at you had it wrong...they were the ones that were unprofessional in having a physician retire, not sending the resident so much as a letter or an e-mail and then the new doctor not informing anyone either and leaving their patients out to dry?

Talk about an ego!

I think you did the right thing....these people are not Gods and you don't work for them, you work WITH them...the only people you work for is the patient and the hospital.

YOU GO GIRL!

I am very thankful, however, that Lesson #1 in my nursing school (I just started this week), covered this very topic.

[joyflnoyz, LPN]

from dictionary.com

CRAW:-noun 1.the crop of a bird or insect. 2.the stomach of an animal. --Idiom 3.stick in one's craw, to cause considerable or abiding resentment; rankle: She said I was pompous, and that really stuck in my craw.

BTW: I'm in LTC, and **DON'T** get between me and what my residents need. It aint pretty.

LTC may not be an adrenaline rush every day like ICU or ER, but I get *HUGS*.

[al7139, ASN, RN]

Thanks for the post!

As a new grad I sometimes wonder how much is too much! We have MDs at my hospital who are famous for not returning pages, calls, faxes etc, and then get mad at you when they finally do call back. I try to remember that I am calling for my patient to get them the best care possible, but it's hard sometimes. This past Saturday, I called a pts MD because he ordered IV potassium replacement for a pt who was already on a high dose of PO potassium. All I wanted was to ensure that the MD was aware that the pt was already getting oral K. He asked me if I would like to treat the pts potassium deficiency, or would it be alright with me if he treated it. I just had to laugh. I said that I would like him to treat it, but that I was just making sure that he was aware of the oral supplement. He hung up on me. Whatever. I dont' really let it bother me, because I ran it by other RNs with more experience before calling him, and as a nurse I am supposed to advocate, and protect my patient. Besides if the pt had gotten a lethal dose of K because I didn't question, it's MY A**, not the MD's.

Amy

[hope3456, ASN, RN]

A couple years ago I was working on a tele floor.....the MD had just removed a chest tube and then didn't stay 'in house' which was protocol. A couple hours later the pt started to go bad....something about his lungs collapsted on his heart. It was a totally freak thing, but the MD couldn't be reached by page, ect in time. The charge RN had to beg his partner cardiologist to come in (when she finally got a hold of him)- who attempted open heart surgery in the room but it was too late. The pt. died.

The MD is now in court, being sued for everything he has. The sad part is the pt's nurse and the charge nurse are also being sued.

[traumaRUs, MSN, APRN]

You go girl!

[fultzymom]

Good for you! I hate it when there is a doc who does not sign those scripts. You know they have to be renewed Q 30 days so just do it and get it over with. How long does it take to write your flippin name on a piece of paper?? UGHHHH! This is one thing that drives me crazy. And if you do not want to do it, then why order the med?