No, I haven't been scolded, counseled, or even looked at cross-eyed, but after the day I've had, it would not surprise me. Tell me, y'all, if this was you, what would you have done differently?
Case 1) Grandma brings in kiddo, around age 5, multiple c/o: cough, runny nose, sore throat, thinks she has a UTI, vomiting, etc. Typical viral picture. Drainage is clear, vomiting not excessive, 2-3 times over the last few days. Kiddo looked a tad puny, but was responsive and giggling when I examined her. All tests negative. Explained to GM about viral syndromes, symptomatic tx, etc. Did not want to jump straight to an antibiotic, as no real s/s to warrant such. Told GM that I typicall do not do Phenergan for a kiddo that young (and skinny as a rail), and that Emetrol was what we had had success with with this bug. She agreed to the treatment, and left.
Fast forward a few hours, GM is steaming mad, wanting to knwo why all I did was send a med that she already had at home to the pharmacy that she had to drive 30 miles to get. I was stunned. Explained again about viral syndrome, the treatment she agreed to, etc. She was having none of it, said that WHEN she brought the girl back, she'd make sure I didn't see her. Fine and dandy by me. Thank God I always do a note on my charts.
Case 2) Woman seen for an URI 3 days ago, represents and requests cough meds with narcotic, specifically. Was told by the other provider that saw her 3 days ago that she would not be prescribed this, as she was on a narcotic regimen already. I told her that I would not deviate form the treatment already prescribed (no cough heard the whole time she was here, chest clear, already on an antibiotic, etc.) She became irate and tried to say that she was no longer on her narcotic regimen, but as we had no way of knowing this for certain, I declined. She called the lot of us "worthless" and stomped out.
This is an urgent care setting. Both of these patients have PMDs, and no, they had not contacted them prior to coming in. The GM even said she brought the kiddo because the mom did not think she needed to be taken to the doc. Just wondering if I should throw in the towel. Yes, I'm thin-skinned today.
Although I'm not a nurse, I've seen plenty of doctors in the ED where I volunteer do pretty much the same thing. I don't see either of those as a big deal at all.
Specializes in Critical Care; Cardiac; Professional Development.
New GN here (as of yesterday, yee haw!) - I have a question re: the scenario outlined with the grandmother. Here it is:
If the mother of the child doesn't want the child seen, how is it legal for the grandmother to take the child to a doctor of her own accord and have the child seen? That seems kind of wackadoodle to me. How DO people prove they have the right to seek medical care for a child? How do we verify it? How far does our responsibility and liability extend?
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
New GN here (as of yesterday, yee haw!) - I have a question re: the scenario outlined with the grandmother. Here it is:
If the mother of the child doesn't want the child seen, how is it legal for the grandmother to take the child to a doctor of her own accord and have the child seen? That seems kind of wackadoodle to me. How DO people prove they have the right to seek medical care for a child? How do we verify it? How far does our responsibility and liability extend?
Good question and sometimes not a simple answer.....start a thread especially in the ED section and we deal with that all the time!!!!
Specializes in Peds Urology,primary care, hem/onc.
Angel... I have worked in Peds my whole career...you did exactly the right thing. With kids, it is not fun when they are sick and a lot of times, parents are not happy when it is viral and there is not much you can do but wait it out. I agree with not doing phenergan. When I did primary care (a long time ago), we NEVER do phenergan. If typical supportive measures where not working (slowly rehydrating etc) and they had persistant vomiting that would require phenergan, we always would want a recheck to make sure they did not need IVF's, not getting dehydrated etc. Have to be careful with phenergan with kids. They dehydrate quicker and it is so sedating that they just sleep (and obviously not drink) wake up when it wears off and continue vomiting. Parents (or grandparents, whoever is caring for the child) sometimes have an agenda on what they want, even if it is not in the best interest of their child. They really get unhappy when you derail them. Happens to me ALL the time. Just document the wazoo out of it, make sure you document your rationale behind your decision making, that you discussed it with the parent and what their response was. If you do that, you are covered. When I have days like you have had, or a really unreasonable family/patient or get a response that is completely over the top... I will run the scenario by one of my colleagues (either MD or NP) just to make sure I did not miss something. Most of the time, they agree I was right. As far as the second patient, just treat patients like that like you would have at your old practice...you are used to drug seeking patients!!! Hang in there you will be fine!
I recently had a conversation with one of our midlevel providers ... we've agreed to a tag team approach with the pediatric-sniffles-and-won't-leave-without-antibiotics crowd:
"We could do that. After about the 4th day you can probably expect some diarrhea."
I'm not an NP but I used to do phone triage for a pediatric clinic. The standard answer for phone requests for ABX or narcs was that the MD or NP would need to examine the child, we dont just call in meds at parents' request. My documentation of the phone call, in the patient chart, would include in quotation marks every 4 letter word and insult to my parentage that the caller responded with.
The next time they brought kiddo in the doctor would open the chart and say "oh, I see you called our nurse a %$#&(( and threatened her with XYZ" One of the physicians would just give a stern look but the others would inform the parent that they had 15 days to find another provider, and a certified letter would folow.
If they grovelled, cried, begged and apologized to me sometimes they would be re admitted to the clinic.
Seeing their own words in quotes in the chart embarrased them into acting right. And no, I did not delete my charted phone call after they apologized. It was there for eternity.
P51Mike1980
28 Posts
Although I'm not a nurse, I've seen plenty of doctors in the ED where I volunteer do pretty much the same thing. I don't see either of those as a big deal at all.