I enjoyed reading the things you wish you could tell the patient, here is something I wish I could have told the doctor:
We are standing at the foot of the patients bed...
Doc: Has her foley been d/c ed?
I'm not even going to say what I was thinking, lol, use your imagination folks
Here's another
Doc: Why didn't you tell me about her K level?
This was about an hour after he got mad at me for calling him on Sunday and he hung up on me. Before, of course, I could tell him about the K level. Again, use your imagination.
I'm not sure what to do. What do you think? "I'm flattered that you respect my opinion, but you went to Med school, YOU make the decision. I'm not licinsed to perscribe."
Were you the one who let them go to the hospital "Yes I sent them to the hospital, If you had called back any of the 10 times we called/paged you, maybe we could have avoided it."
I need you to talk to the family, you're supposed to protect me. "No, my job is not to protect you from the families of residents, my job is to provide care to the residents. If you don't want to talk to the POA's, you shouldn't have become a LTC doc."
These pharmacists think they're doctors "If you don't like the pharmacy recommendation, just say no- you're the doctor. "
Is he my patient? "No doctor, he's really not your resident, I just didn't feel like bothering any doctor but you today. "
No, I don't want ativan or valium just to snow the patients so I don't have to deal with them. If you can't stand to go in there for 2 minutes to see them everyday; try 12 hrs.
Please don't order 1 mg of Morphine every 30 minutes IVP when I have 7 pts to deal with just give them a PCA.
Residents/Interns: don't tell me you don't want to make any new or change any orders because at briefing in the morning you will get yelled at because "that attending physicians" yells at everyone for everything.
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
When I said to you "I don't feel comfortable doing that" I did not mean "I don't have that skill."
What I really meant was "Are you out of your ever-loving mind???? I find what you told me to do outrageous and unreasonable and likely to make the patient worse so I'll do that at about the same time Hell freezes over. BTW, Dr. Resident, I think you should get a do-over on that particular rotation because obviously you don't have a CLUE what you're doing!!!!"
You commented on my "poor training" and lack of "skill;" you really don't want to know what I think of yours.
Please don't sit there with 10 charts at 0700 when I am trying to write one little prn given before I go home and you won't give up 1 single chart for less then 2 minutes; because you are afraid you won't get it back. That is called a control issue.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
oh, this is fun! thanks for starting this thread!
when i said, "are you sure you really want to do that, doctor?", what i really meant was "are you out of your everlovin' mind?"
you're sitting next to the patient, you've taken over my computer and you have his order book in your hands. and you're asking me what moron ordered that epinephrine drip and is it really running? look! look at the iv pump 18 inches from you, look at the flowsheet your cursor is hovering over and look at the order book to see who ordered it. as for why they ordered it -- it's in the progress notes -- again you have access right now and i don't.
if you yank on my skirt again, i will break your freaking fingers off and ram them down your throat. i know you want me to get you a cup of coffee, but i'm on the phone to another facility about the train wreck they're sending us and you can get it yourself!
no, i didn't sit on your lap because i want a cuddle. i sat on your lap because you snuck up behind me and sat down in my chair when i stood up to sign for that narcotic drip. since my foot was still hooked around the chair leg, you knew i was planning to sit back down!
that food was sitting at the monitor station unattended because i was in the midst of scarfing down my lunch when the patient in 2b coded. it was not out there for anyone to eat. i was coming back to finish it, and if you enjoyed my lunch so much you can call the cheesecake factory and order me a new lunch, then run out and pick it up. (ok, i did say that.) (no, he didn't get me lunch from the cheesecake factory, but he ordered chinese for the entire shift.)
when the patient coded during rounds: "you -- airway/breathing. grab that ambu bag. you -- chest compressions. you -- call a code then page the attending. you -- (to the pharmacist and pharmacy intern) get the code box and handle the meds. you -- to the r1 -- push the drugs here. you and you -- turn the patient to the right so we can get the zoll pads on him. you -- record and you -- you're running this. yes i know you're senior to him and i've just asked him to run it. you're a researcher and he's a clinician and i just recertified him in acls. you can write me up when this is over." (ok i've done this, too.)
as a matter of fact, i would ask the medical director of our unit to help me turn this 350 pound man if he wanted to listen to the breath sounds from the back. (actually, i didn't have to say this because the medical director of our unit heard the temper tantrum the anesthesiologist was throwing from halfway down the hall and was already in the patient's room, donning gloves before i had to say a thing!)
why yes, i'll have dinner with you friday night. i'd love to meet your wife! (said that one, too. turned out meeting the wife wasn't what he had in mind!)
Boy can I relate to this thread....Although its been a few years since I was at the bedside I remember some of THOSE doctors.
But allow me to play devil's advocate for a moment. My perception has been significantly changed in the last couple of years. I work as a nurse practitioner on a cardiology service. I often find myself in a position to take call....either during the day or at night.
Some of the calls that come in would shock you. Some of them make me embarassed for my nursing colleagues.
Here is but one of countless examples....
beeper going off at 430 am.....Nurse: Mr. x had his prep for colonoscopy yesterday. He has not had a bowel movement yet. His scope is scheduled for 7am do you want to give him anything else?
Me: Why are you sharing this information with me?
Nurse: He is not prepped for colonoscopy
Me: I appreciate that information...much more appropriate to share with the provider actually doing the colonoscopy.
Nurse: Dr. so and so ordered it.
Me: Yes so call him now please....we are cardiology
five minutes later....beeper again....repeat above conversation....same nurse again....
Me: can i please speak to your supervisor.
Or another example....I personally think the hospital I work at is not ergonomically sound. There are not enough computers anywhere. A given unit may have 6 stations with computers....Now at my hospital there is no separate MD area. All patients rooms have computers in them for the nurses to document. I am trying to make rounds on the 70 some patients I see in a day and when I get to a unit and can't sit down because all the nurses are charting there. Well I think it stinks for all of us. I have never ordered someone up...would never do it. People I work with alot often will offer their computer which I appreciate....But what I don't appreciate is someone (rn or md) standing over my shoulder rushing me or trying to take my chart away.
Now I by no means condone being an a** to anyone. And do think that as nurses we do need to stand up for ourselves. But, I would also ask you to have consideration of the shear volume of sometimes inane calls that come in all the time. There are often two sides to every story.
"It's my job to call, it's your job to say 'thanks for calling'" (I've said this LOL)
"I'm not calling you because I enjoy it, I didn't just need to chat, you wrote parameters and something is now outside them"
"when I say I need to you here to eval this patient, it's not because I want to see you or because I want to ruin your day at the office (or your dinner with your fam, or camping trip etc) I say it because I NEED you to eval the patient because I'm concerned"
"when I say she's 8cm and cruising, it doesn't mean see one more patient or take time to take a shower before getting your rear here, I do not get paid nearly enough to deliver babies, thanks"
"you need to tell the patient that she cannot have an epidural that you promised her because you are fishing and do not want to come in"
"fishing and hunting trips are not MEDICAL reasons for inducing everyone of your patients that due in the next 3 wks"
"it's not good customer service to keep someone up all night for an induction just so you can have them delivered by lunch so that you can leave town"
"if you'd let me give you my full assessment before cutting me off then maybe you wouldn't have 10 questions for me"
i had this patient with AIDS and the ID doctor wanted to DC her piccline without gloves,first i asked him in front of the patient if he wanted gloves he said no,then he asked me to bring some gause,i guess for whatever reason he decided to get it himself,i just went after him and asked if he was sure not wanting gloves that patient is aids,the first thing he grabbed was the gloves,and then thanked me for reminding him,but i just thought to myself whatever happened to standard precautions,i guess he forgot that too,and i felt like saying i bet you're really out of your mind doctor x
Oh, You don't want me to call and wake you up at 2 a.m. anymore? Fine, You can just use all that extra money you get paid to be on call to pay another doctor who WILL give a crap.
Doctors dont get paid "extra" for being on call. It comes with hospital admitting privileges, but they dont get paid for it.
What do I think should be done about this? Well, I can tell you what is usually done, but you are the one getting paid to come up with the solution, so I'll let you take an educated guess.
Resident doctors especially have a lot they could learn from experienced nurses, and I feel nurses have the DUTY to offer advice on different patient management issues they are familiar with.
Hmm Doc, You seem a little annoyed. Oh, It's because this resident's BS is 401 and the order that YOU wrote states to call you if >400. Hmm, well maybe you should edit your order OR take responsibility. Either way, I do what the order says.
I agree with this, its the doc's responsibility to change the order if he doesnt like the "notify house officer" parameters.
Please don't sit there with 10 charts at 0700 when I am trying to write one little prn given before I go home and you won't give up 1 single chart for less then 2 minutes; because you are afraid you won't get it back. That is called a control issue.
Well this is a growing problem from everybody's perspective. Consider the fact that at any one time there are about a dozen people who want access to a particular chart:
1) Attending physician
2) Chief resident
3) Intern
4) Med student
5) RN
6) CNA
7) Nursing student
8) NP student
9) PA student
10) Phlebotomist
11) Pharmacist
12) Nutritionist
13) Nurse case manager
14) Unit clerk
All of these people do their work in the mornings around the same time, and in a busy academic hospital with all these people wanting the chart it can get ridiculous sometimes.
All the more reason to ditch paper charts completely and go 100% electronic.
lpn1313
69 Posts
I'm not sure what to do. What do you think? "I'm flattered that you respect my opinion, but you went to Med school, YOU make the decision. I'm not licinsed to perscribe."
Were you the one who let them go to the hospital "Yes I sent them to the hospital, If you had called back any of the 10 times we called/paged you, maybe we could have avoided it."
I need you to talk to the family, you're supposed to protect me. "No, my job is not to protect you from the families of residents, my job is to provide care to the residents. If you don't want to talk to the POA's, you shouldn't have become a LTC doc."
These pharmacists think they're doctors "If you don't like the pharmacy recommendation, just say no- you're the doctor. "
Is he my patient? "No doctor, he's really not your resident, I just didn't feel like bothering any doctor but you today. "