Things you'd LOVE to tell the doc and get away with it....

[nerdtonurse?]

Since the patient version is so popular, and I had a bad weekend (and no hope for a better one this weekend....)

You've been giving this schizophrenic Alzheimer's pt 10 mg Ambien, plus 50mg Benedryl, plus 100mg Seroquel every night at their NH for years. Could you please, PLEASE explain why you stopped giving it to them when you put them in the hospital? Do I look like a lion tamer?

Yes, I am going to report you when you take the packing out of an abdominal wound with your bare hands, despite me waving gloves in front of your face. That's what the risk management software's for. BTW, did you not see the big isolation gear on the door? Pt. has hx. of MRSA in the wound, and you just stirred in it barehanded....

When I call you at 3 am and tell you your pt's BP is 212 over 179, resp are 32, and O2 sats are 78, could you please say something other than "So what do you want me to do?" Because, one night, I'm going to tell you what to do, and it's going to be something that only a hermaphrodite can physically do.

We all know this pt's a junkie; could you please, PLEASE, not admit everyone who comes to the ER with a pulse tonight? I've got two evolving CVA's and an acute MI, along with my OOB q5minutes Alzheimer's pt, my drama queen post lap chole, and one in restraints that the NH sent simple to get a break from him trying to bite them. I don't need a "demerol, phenergan and diet soda" q4h, too.

[canoehead, BSN, RN]

Thank you, thank you, thank you for that coffee lift at 3am, and the skankydance moves to your AC/DC ring tone. You gave us a lift, and the charge nurse nearly peed her pants. Ummmm, we still don't know who made that call...hope you called them back.

[cherrybreeze, ADN, RN]

OMG, I love this. Love it.

Especially after yesterday, oy!

"Doctor, I realize you THINK you wrote it in black and white that the patient is supposed to go home today, but you didn't. You wrote a bunch of post-discharge orders, which generally you do when your partner on call with be discharging them over the weekend, but you did NOT say 'discharge home today.' When you also do NOT write orders d/c'ing the PCA or the foley, or starting PO pain meds, do you REALLY think I'm going to conclude that they're ready to leave?? The patient and the nursing staff are not 'changing your orders.' You didn't write them, jack*ss. 'Well, take out the foley and start some Vicodin and send her home' ?? Sir, I'd be HAPPY to, NOW THAT YOU JUST GAVE ME A FREAKING ORDER. You want to talk to my nursing supervisor? BE MY GUEST, if that means I don't have to talk to you any more."

This conversation really took the cake. I have to think more on this topic and I'll be back!!!

[blondeoverboard]

"well no sir, i'm not a neurologist but i do believe the patient is having a seizure. why? well, because he's flopping out of the bed, peeing on himself and ohhh yea, you were the one who stopped his prophylactic AED's this morning so how bout you shut your yap and gimme the lorazepam order and i'll let you get back to sleep."

[platon20]

Most of these complaints are legit but there are a few that are borderline and the doc aint necessarily in the wrong....

I'll give examples in a few.

[platon20]

When I call you at 3 am and tell you your pt's BP is 212 over 179, resp are 32, and O2 sats are 78, could you please say something other than "So what do you want me to do?" Because, one night, I'm going to tell you what to do, and it's going to be something that only a hermaphrodite can physically do.

This is borderline. Doctors get griped at a lot because they just put in orders without considering the nursing point of view. Perhaps this doctor was trying to get your perspective first before just entering a bunch of random orders that may or may not make sense. Its actually a GOOD thing for doctors to ask for a nurses opinion, as long as its done in a respectful/polite way.

A sign of a good doc in this situation is to first ask for suggestions from the nurse. He should consider them carefully, and then formulate a plan with nursing input. Your gripe seems to suggest that he should just do whatever he wants without getting input from the nursing staff. Thats bad for patient care.

[platon20]

So, could you just give me the courtesy of updating me on the patient and the plan, because deciphering the scrawl really isn't helping. Just toss me a few bones now and then, would you? I'm not on the team -- I AM your team.

From a doctor's perspective this is another borderline thing. I've seen some nurses who, when you tell them the plan, they obviously dont give a rats ass and look at you funny as if to say "i dont care, why are you telling me this." On the other hand there are nurses who want to know lots of details about the plan of care.

Its probably better for the nurse to just ask the doc for details on the patient if you desire them, then the doc should respond in a clear, polite manner.

[platon20]

When I call you up and say something like "The patient has s/s of a yeast infection, can we get her something for it?" the correct answer is not "OK". The correct answer would include a med name, dosage and route. (That conversation ended with me getting hung up on after I sarcastically asked "And would you like to order it, or should I make something up?")

I dont agree with this necessarily. Depends on the context. If he didnt provide a drug/dose/route immediately, you could prompt him without being rude. Just saying "what dose/drug/route do you want" works a lot better than your sarcastic diatribe.

If I was the doc on call and I said "OK" and your immediate response was your sarcastic phrase, I'd hang the phone up on you. Its incredibly rude and unnecessary.

Same doc, at three am...what I wish I would have said but didn't..."Well, the reason why I'm calling you about the two PVC's that my patient has had in the last hour is b/c the last time I didn't, you complained to my nurse manager and I got counseled. You're both idiots. And you better believe I'm going to make your nights hell every time you're on call, just for the sheer fun of it."

Again, this is overly hostile. If he reported you for it, then by all means explain why you are calling him. But the side commentary and insults are uncalled for. You sound like a very angry person, probably very similar to the very angry docs you work with.

[southernbeegirl, BSN, RN]

"well no sir, i'm not a neurologist but i do believe the patient is having a seizure. why? well, because he's flopping out of the bed, peeing on himself and ohhh yea, you were the one who stopped his prophylactic AED's this morning so how bout you shut your yap and gimme the lorazepam order and i'll let you get back to sleep."

omg this post made me almost pee from laffing

[blondeoverboard]

southernbee...

you know there's a pill you can take for that, right :wink2:

[morte, LPN, LVN]

platon....this is a vent thread, not meant to be instructional

[AngelfireRN, MSN, RN, APRN]

It never fails, someone always has to be a killjoy.

How about..."I don't put up with that kind of treatment from my father or my husband, and I'm SURE not going to put up with it from you."

[Virgo_RN, BSN, RN]

Doc, you really dropped the ball on this one. How can you say this patient's anemia is stabilized when you haven't ordered a hemogram for three days and the guy's still as white as a sheet? How can you say his fever has resolved when this is the first normal temp he's had for three days, and it's because he had a gram of APAP at four am? You're a really nice guy, which is why we let you come to our potlucks, but when I'm in this hospital and you walk through my door, I'll be firing you. Nothing personal, I like you just fine, but I like being alive even more.