Never Assume

Ginger's Mom, MSN, RN

At work, I was participating in an accreditation survey. This is a nerve-wracking experience where a seasoned surgeon spends the day reviewing the program. My colleague received notification that the surgeon was coming from Puerto Rico, her reaction was "this is terrible he will not know the details of the program since he's not "American".

I pointed out that a Puerto Rican is an American and after looking at his resume that he was surgeon within the VA System. Initial communications with this doctor where tension-filled. He mispronounced everyone's name, he demanded items instead of asking and some of the requests were unreasonable.

The days before the survey was filled with anxiety and dread.

The day of the survey quickly came. Initially, I thought, he was our worst nightmare, his answers were short and terse. He would not start the survey until the VP (who was stuck in traffic) was in the conference room.

Worse the Surgeon in Charge of our program was a woman and tension was so thick we could have cut the tension with a knife. I could not help by thinking why did we get stuck with this surgeon and it was going to be a very long day and would we pass the survey?

The survey finally started when the VP arrived.

The surveyor's opening sentence was that he had reviewed our application and that he commended the manager of the program. His issue was that she was overworked. He said he had to perform her duties in Puerto Rico due to the language barrier and she was overworked.

This was great news since she did need help (and had pleaded for help on deaf ears) now she has two people assisting her thanks to this surgeon. He put our application on the overhead projector, he said he was going to make changes (our self-assessment). He went through the application line by line, in every case he changed our rating, but in our favor! He made wonderful suggestions to the program which has enrich the care to our patients.

At the end of the day, he departed, the committee felt foolish we all made assumptions this would be a horrible day due to the ethnicity of this surgeon. We did great, we learned how to improve the program and score high on re-accreditation. I especially felt foolish since this is one of my pet peeves.

Liddle Noodnik · Jan 13, 2009

Wow how awesome!

mzloco · Jan 17, 2009

Sounds like your hospital is due for some cultural training.

Dragonnurse1, ASN, RN · Jan 18, 2009

I have a very different case for never assume. Our city has rotating ER of the days. my hospital and one other but the same physicisn group worked both ERs. :confused: One night while I was working the Chest pain hall and a little lady came in complaining of nausea, vomiting, pain in her right shoulder and her right ear. We had a critical pathway we could use, also I suspected a problem. I got the work up going and took the chart to the ER Physician who, as it turned out, had seen her the previous nitght at the other ER. I heard him tell her she did not have anything wrong with her, she needed to get a life and he was not going to do anything for her that night.

I wanted so much to lash out at that Physician I was so mad :angryfirebut I did get to humilate him more than he did the patient.:wink2: I had a set of cardiac enzymenes working and they came back 5 times normal - a major MI. I took the chart around to where he was sitting and held the chart so he could see it and asked " do you really want me to send this patient home?" I thought he was going to have an MI himself.:smackingf

He called in the Cardiologist on call and the cath lab. He went to see the patient and told her that I had saved her life because he had ignored her symptoms. She went to the Cath lab and then to open heart - Send her home indead.

Vito Andolini · Jan 19, 2009

I'm glad she got the proper care and I'm glad you were on duty but I wonder about the "I got to humiliate him" part. I had a nurse friend at work many years ago who didn't seem to need to retaliate, humiliate, and get even when most of the rest of us did. She said it was her Christianity that made her grateful for everthing that Jesus had done for her that enabled her to love and pray for others. Just my wild musings.

Dragonnurse1, ASN, RN · Jan 20, 2009

Normally :saint:I would never be vindictive with a MD or any other person:nono: but the back story on this particular MD is quite a lengthy one. I will try to sum up: Was hired by the ER Md's group, spent time groping nurses,:barf01: if nurses rebuffed him their life was miserable, treated male patients more thoroughly than female,:doh: sent 2 different women home with fractured hips:eek: etc etc etc and so on and so on-------------Shall I go on? I could, I really could!:typing That is why I took particular delight that night rubbing his nose in a very potential law suit.:chuckle The humilation part was just gravy.

patrick1rn, MSN, RN, NP · Jan 20, 2009

I read and re read this article. It makes no sense to me.

I am lost. Loster than lost.

Dragonnurse1, ASN, RN · Jan 20, 2009

Patrick1RN

Sorry maybe this will be better.

The Md that I "humiliated" had a long-standing habit of treating male patients very thoroughly but dismissed women with the same symptoms. He often sent female patients home that either got called back by the Radiologist because he found fractures that the ER Md missed or returned with same symptoms (and in 2 cases died - one sitting in the waiting room). I had done the basic cardiac workup, just as our Chest Pain Centers protocol. When the patients enzymes came back indicating a severe MI I was intent on pointing this out to the ******* that once again he was about to send a female patient home to die!!!!!!!!!!!!

He assumed that her symptoms were "all in her head and you have nothing wrong with you. I am not going to do anything for you tonight so get dressed and the nurse will be with your papers". When he walked into the room he did not even notice her IV access, the monitor with the BP alert going off. She was a female and females do not have heart attacks.

patrick1rn, MSN, RN, NP · Jan 20, 2009

Patrick1RN
Sorry maybe this will be better.
The Md that I "humiliated" had a long-standing habit of treating male patients very thoroughly but dismissed women with the same symptoms. He often sent female patients home that either got called back by the Radiologist because he found fractures that the ER Md missed or returned with same symptoms (and in 2 cases died - one sitting in the waiting room). I had done the basic cardiac workup, just as our Chest Pain Centers protocol. When the patients enzymes came back indicating a severe MI I was intent on pointing this out to the ******* that once again he was about to send a female patient home to die!!!!!!!!!!!!
He assumed that her symptoms were "all in her head and you have nothing wrong with you. I am not going to do anything for you tonight so get dressed and the nurse will be with your papers". When he walked into the room he did not even notice her IV access, the monitor with the BP alert going off. She was a female and females do not have heart attacks.

No , not you dragon, the original poster is the one who lost me.

alan headbloom · Jan 30, 2009

Patrick1RN,

Allow me this attempted summary. Alexk49 has her (religious or ethnic) identity constantly mistaken for something she is not. And it bugs her. This story is about how she and her survey team made the same mistake: making (false) assumptions about people! She is chagrined and reminded that all of us are afflicted with occasional Judge-Before-Knowledge disease.

in the story, her team assumed that the visiting evaluator would be unable to render accurate assessments of their group because he was not from the continental US. As a Puerto Rican, he is assumed to be Spanish speaking and clueless about Mainland American hospitals. His pre-visit communications were terse and the group feared the worst for their upcoming evaluation.

When he got there, he praised their program, helped re-write their application, and recommended some staffing changes (which were implemented--to the appreciation of everyone involved). In short, he was actually competent--despite their (prejudicial) misgivings about this "foreign" doctor.

As a footnote, let me offer a few observations. 1) Professionals can be competent (or incompetent) regardless of their skin color or country of birth. 2) Terseness (aka brevity of expression) is frequently the communication style of those in the surgical subculture. It's just the way they talk. 3) Terseness is heard by "more communicative" folks as "rude" or "critical" or "harsh." 4) People who speak English as a second language are often judged as "rude" or "blunt" because of their short sentences when, in fact, most of us who speak a second (or third) language are not as chatty/fluent/confident as in our first language and we therefore minimize the word count in order to minimize our mistakes (or because we lack the extensive vocabulary).

Hope that helps.

Alan

Wendy Leebov Ed.D. · Mar 18, 2009

That's quite a story. I love your conclusion, "Never assume." It's so true that when we act from a preconceived notion, we close ourselves off from opportunities to learn.

Thanks for sharing this.

Wendy Leebov

Never Assume

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