MDs that lie.......

Mulan · Nov 30, 2007

Did you call your nursing supervisor?

It seems like there should be a medical director that could be called in an instance like that.

RNsRWe, ASN, RN · Nov 30, 2007

The only thing I would have done in addition to having another RN (or two!) witness my call and hear my repeating "just to clarify, you're saying he's fine, it's ok, no action needed at this time" would be to call my house supervisor and let him or her know of that exchange. The supervisor can then decide to call MD himself or call another one (inhouse) if he feels situation warrants it.

And then document the heck out of it.

It's all about CYA. It's up to you to keep from getting thrown under the bus.

Virgo_RN, BSN, RN · Nov 30, 2007

I haven't had a patient with a HR in the twenties, but in general, we don't get overly concerned about bradycardia unless the person is symptomatic. We get a lot more worked up about tachyarrhythmias. I can see how the doc thought the patient was okay. But that is weird that he's now saying he never got a call....

bagladyrn, RN · Nov 30, 2007

I'd ask that the phone records for that shift be obtained. The phone bills for the hospitals should list every number called. This should settle any question as to whether or not he was called. In the future you may also consider routing calls to this doctor through the hospital operator so as to have another layer of proof and have a second nurse actually listen in on the calls since he has proven himself untrustworthy.

EmmaG, RN · Nov 30, 2007

Did you call your nursing supervisor?
It seems like there should be a medical director that could be called in an instance like that.

Yes, report it to both nursing and medical management. An incident report to risk management would be appropriate too. If this has been an on-going issue, then there needs to be an official response, not just an 'unwritten policy'.

We once had a doc who would do this; not maliciously, but he really didn't remember being notified (at times). Page through the hospital operator, don't call directly. Then there is a log of the call. Have another nurse (or even the supervisor) on conference call as a witness, and have them co-sign any orders (or lack thereof) and notes made regarding the exchange.

BBFRN, BSN, PhD · Nov 30, 2007

I'd ask that the phone records for that shift be obtained. The phone bills for the hospitals should list every number called. This should settle any question as to whether or not he was called. In the future you may also consider routing calls to this doctor through the hospital operator so as to have another layer of proof and have a second nurse actually listen in on the calls since he has proven himself untrustworthy.

Yep- the phone records can be checked. We had a similar situation at a facility I used to work in. Phone records were checked, and the doc lost his admitting privileges. This was a reoccurring problem with him, though.

Trauma Columnist · Nov 30, 2007

Unfortunately, I have had this issue once before also. I called a physician at 3am, he answered, seemed AAOx3, gave me one page of detailed admitting orders which I then confirmed with him and thought I was set to go. I documented the call and went on about my business.

Two days later the manager calls me and asks where did I get the orders for this pt. I told her about the conversation and she told me that the physician wanted me reported because he had never been contacted by me and I was practicing medicine without a license! Fortunately, the phone records saved me because we have a central paging system and it showed the time I paged him, the time he answered and the time he then called me!

This particular physician had some type of sleep disorder and he was no longer able to give orders to the ER after this mess.

lindarn · Nov 30, 2007

I'd ask that the phone records for that shift be obtained. The phone bills for the hospitals should list every number called. This should settle any question as to whether or not he was called. In the future you may also consider routing calls to this doctor through the hospital operator so as to have another layer of proof and have a second nurse actually listen in on the calls since he has proven himself untrustworthy.

Also, the answering service keeps a log of calls for each physician.

Lindarn, RN, BSN, CCRN

Spokane, Washington

NurseCherlove · Nov 30, 2007

Unfortunately, I have had this issue once before also. I called a physician at 3am, he answered, seemed AAOx3, gave me one page of detailed admitting orders which I then confirmed with him and thought I was set to go. I documented the call and went on about my business.
Two days later the manager calls me and asks where did I get the orders for this pt. I told her about the conversation and she told me that the physician wanted me reported because he had never been contacted by me and I was practicing medicine without a license! Fortunately, the phone records saved me because we have a central paging system and it showed the time I paged him, the time he answered and the time he then called me!
This particular physician had some type of sleep disorder and he was no longer able to give orders to the ER after this mess.

SOrry, off topic here, but that's just really cool that the doc knew his stuff so well that he could practice medicine in his sleep.

Medic/Nurse, BSN, RN · Nov 30, 2007

Yes, report it to both nursing and medical management. An incident report to risk management would be appropriate too. If this has been an on-going issue, then there needs to be an official response, not just an 'unwritten policy'.
We once had a doc who would do this; not maliciously, but he really didn't remember being notified (at times). Page through the hospital operator, don't call directly. Then there is a log of the call. Have another nurse (or even the supervisor) on conference call as a witness, and have them co-sign any orders (or lack thereof) and notes made regarding the exchange.

I'll second this response.

I'll add that even without symptoms a HR in the 20's in a general bed is a REASON to call the doc. You did a great job for your patient. Even without orders I'll bet that you kept a close watch on your patient.