things you wish you could tell the doctor

[celery]

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.

[EmmaG, RN]

C'mon, Indy. Tell us how you really feel

Learn your drug dosages so people don't laugh at you.

Priceless. LOL

[buggal1989]

Next time you admit a person who has fried their brain on drugs who acts like an animal and has absolutely no intellect left and whose brother keeps her chained up at home so she wont kill them (after several attempts) and she is capable of bucking and moving the bed from the wall all the way over to the nurses station (where we DO NOT want her to be) where she spits on us despite being in 4pt restraints with a chest restraint with her head taped down and being intubated and I call you for an order for sedation as she is whipping her head side to side and catching her ET tube on the bed side rails to pull it out AGAIN and you DON'T order sedation and curse me out because during the plea for sedation she extubates herself and you have to come in to re-intubate her AGAIN and you curse me out again not only will I tell you what you can do but I will pull every one of those stupid braids (which more than one patient has grabbed you by and tried to pull you into their bed and we have to pry their hands off them) out of your empty head and strangle you with them or force you to sit at her bedside 24hrs a day and restrain her yourself because you do not want to sedate her for some reason that is ludicrous like "we want to wean her off sedation"! BTW: This patient when transferred to the floor where she was also not being sedated despite pleas to the same doc and whom the nurses wanted to tell her much more creative things than I could think of which I can not print here due to the shock value, later stood in the window of her room sans gown and the administrator happened to be inspecting that all the blinds in the front of the hospital are all down at the exact same length (????) ands sees her and then orders a nurse to sit by her door (where she chooses to sit as the patient spit at anyone who entered the room, threw things, and her vocabulary - that was left to her after being gorked by drugs - seemed to consist soley of curse words, to prevent such another happening despite the fact that every bed on the floor was full and without this nurse they were greatly outnumbered and us in the ICU where she was pulled from had to take care of three critical patients with the ER calling for another admit by herself and there is no ward clerk, no aide, not another single person in the whole area and the nursing supervisor comes by to see why you are not answering the phone and sees you up to your ears in patients and desperately pleas for any warm body and the supervisor just waltzes out of the ICU without answering her what you want to tell her something that needs to be another thread. I am trying for the world's longest sentence!

[UM Review RN, ASN, RN]

Buggal1989: Wow, I think you succeeded. What's even more amazing is that I followed it, all the way through. Is there no ETOH withdrawal protocol at your hospital? We've been able to go over the docs' heads a couple of times using that.

****

I wish I'd had time to say this:

Thanks, Dr. A, for not only calling me back on that patient, but actually coming in and seeing her for the second time that day, calling the family to discuss options, and discussing therapy options with me. It was a very complex case. I really believe that by listening to what we nurses were saying and following up in such an appropriate and timely manner, we really saved this patient's behind. Three cheers for collegiality!! :anpom:

[zuzi]

Well, yesterday evening (friday night) I needed to contact one of our primary doctor for one of our patients in a emergency state.

What I would to tell now to special doctors with who I work is: THANK YOU! Thank you, that this type of doctors are on our world, and they have cells, and they are here for patients 24 by 24, and they stay and hear your medical information and comunicate with you like partners in the same team healthcare, and you can discuss with them and make togheter the perfect decision for well beeing of patient. Thank you that they don't know what means to be arrogant ( an belive me the best doctors meet ever by me NEVER was arogants), or fullfil of them position, are MUCH MORE THAN HUMAN!

My mother teach me a lesson one day: A good doctor is one who if you will wakeup him in the middle of the night (dosen't matter why), he will listean the nurse, asking and responding togheter on patient medical issues, is a doctor that YOU want to be your family physician because YOU have trust in him! We need to respect these type of doctors and say them thank you that they are here (FEW but still they are here.....looooool).

Thank you!

[EmmaG, RN]

My mother teach me a lesson one day: A good doctor is one who if you will wakeup him in the middle of the night (dosen't matter why), he will listean the nurse, asking and responding togheter on patient medical issues, is a doctor that YOU want to be your family physician because YOU have trust in him! We need to respect these type of doctors and say them thank you that they are here (FEW but still they are here.....looooool).

Thank you!

I agree... to a point. I don't expect anyone I wake up in the middle of the night to be cordial and pleasant---but that doesn't mean I expect them to be nasty. I do expect a doctor to listen to what I have to report and act upon it.

While what you describe above makes a good person, they aren't necessarily what makes a good doctor. A good doc will possess those qualities, but there's far more to it than that; I've encountered too many who are the nicest people you'd ever want to meet, however when it comes to medicine they're dumb as a post.

Then there are those who are sharp as a tack, but lack any personality at all.

The true gems are the ones who combine the best of both :)

[Ruby Vee, BSN]

don't you just love those dters?!

working in a cardiac surgery icu, i took care of a patient who admitted to drinking a gallon (gallon!) of vodka every other day. at least he thought it was vodka -- it more closely resembled vodka than any other liquor he could think of. he was 32, found in an alley, covered with bug bites and with a murmer you could hear from the doorway. after he got his new valve, there was a little problem with agitation. the cardiac surgery fellow, whose name i've forgotten so we'll call him joe, wanted to extubate.

what i said was something to the effect of "are you crazy? we can't give him enough drugs to get over this hump with this sternotomy intact and his lines still in and still have him breath!"

joe said something to the effect of "sure we can. we'll just do a "ninja extubation" (where you let them wake up until they're absolutely wild then you yank out the et tube on the theory that since that's what's bugging them the most, they'll immediately calm down and cooperate as soon as it's out) and then give him enough benzos to keep him calm. it'll be fine."

and i responded something like "you are crazy. i have another patient in the next bed who is trying to die, and i don't have time to wrestle with your patient until you give up and re-intubate him so you can paralyze him."

"it'll be fine," joe said. "and i promise. if it doesn't work, i'll come wrestle with him."

we did the "ninja extubation" with predictable results. the patient, who was 'satan's nephew' intubated and on drugs became satan himself, growling, spitting, hitting, kicking, biting, headbutting and just generally carrying on like the evil fool he was. joe, of course, was in the or. i paged him and had the circulator put me on speaker phone.

"you know that dting patient you wanted to extubate because you're so sure he'll be calm once his et tube is out? well he just sent two techs and a security guard to the er and i'm pretty sure my charge nurse will have to go too, once we pry her out of his grasp. i've already given him about three times as much ativan as you ordered, and pharmacy won't give me more until you call them personally. i expect that to change once the pharmacist actually gets here to scope out the situation, but in the mean time, you promised you'd wrestle with him."

there was a moment of dead silence on the phone. then i heard the attending's voice: "joe will be right there." and damned if he wasn't! he must have run up the stairs from the or, because he was there almost by the time i hung up the phone. he personally wrestled with the patient until the anesthesiologist got there to re-intubate. he personally pushed the paralytics, he personally pushed ativan, and he apologized to everyone sincerely, profusely and in specific detail. and the next time we even thought about extubating, joe was there holding the biggest danged syringe of ativan i've ever seen!

things i wish i could tell joe? "thanks again, for the hundredth time, and i really miss you sometimes!"

[ahsweeney]

Way back when, while on the med-surg floor, I had a patient 'circling the drain'. She needed to go the the unit - quickly. I called her surgeon at 11:15pm (which I didn't think was that bad) and was promptly chewed out by him for having the gall to call him. I had to listen to him complain about the babies who were sick and not sleeping - hence he & wifey weren't sleeping. I very calmly told him "If you don't want these phone calls you should have gone into dermatology. You are her surgeon and she is failing fast. I need orders from you to transfer her to the unit - now!" That brat didn't speak to me for a week!!! The charge nurse almost swallowed her teeth when I said that - but I was ticked.

[Warpster]

AhSweeny wrote, ""If you don't want these phone calls you should have gone into dermatology. You are her surgeon and she is failing fast. I need orders from you to transfer her to the unit - now!" That brat didn't speak to me for a week!!! The charge nurse almost swallowed her teeth when I said that - but I was ticked."

I overheard one of my fellow nurses sweetly ask a doctor if he wanted to be called before, during or after the code on a particular patient who was circling the drain. She also informed him she'd write it as an order.

He got his worthless ass in there in record time.

[nanacarol]

Some of the responses I have made out loud over the past 20+years, #1 I'll be finished in a few", I lost my, pen, report sheet, CPOE slip, if you find extras, let me know, oh, you intended to discontinue the order to call you with the blood sugar elevation, sorry, I didn't find a written or CPOE order, do you want to give the order now?, My goodness, did the ER doc. not realize we get the patients you can handle, do you want me to let them know of your new orders? You would be amazed at the silence these well spoken retorts have garnered. I am never rude, nor can anyone say I am insurbordinate, I am always, merely asking for clarification, always the "helpful handmaiden", yea, right!! I believe if we all took this approach every day the doctor nonsense would stop and doctors would respond at a professional level. Seeing us as equals. nana

[Simba&NalasMom, LPN]

don't you just love those dters?!

working in a cardiac surgery icu, i took care of a patient who admitted to drinking a gallon (gallon!) of vodka every other day. at least he thought it was vodka -- it more closely resembled vodka than any other liquor he could think of. he was 32, found in an alley, covered with bug bites and with a murmer you could hear from the doorway. after he got his new valve, there was a little problem with agitation. the cardiac surgery fellow, whose name i've forgotten so we'll call him joe, wanted to extubate.

what i said was something to the effect of "are you crazy? we can't give him enough drugs to get over this hump with this sternotomy intact and his lines still in and still have him breath!"

joe said something to the effect of "sure we can. we'll just do a "ninja extubation" (where you let them wake up until they're absolutely wild then you yank out the et tube on the theory that since that's what's bugging them the most, they'll immediately calm down and cooperate as soon as it's out) and then give him enough benzos to keep him calm. it'll be fine."

and i responded something like "you are crazy. i have another patient in the next bed who is trying to die, and i don't have time to wrestle with your patient until you give up and re-intubate him so you can paralyze him."

"it'll be fine," joe said. "and i promise. if it doesn't work, i'll come wrestle with him."

we did the "ninja extubation" with predictable results. the patient, who was 'satan's nephew' intubated and on drugs became satan himself, growling, spitting, hitting, kicking, biting, headbutting and just generally carrying on like the evil fool he was. joe, of course, was in the or. i paged him and had the circulator put me on speaker phone.

"you know that dting patient you wanted to extubate because you're so sure he'll be calm once his et tube is out? well he just sent two techs and a security guard to the er and i'm pretty sure my charge nurse will have to go too, once we pry her out of his grasp. i've already given him about three times as much ativan as you ordered, and pharmacy won't give me more until you call them personally. i expect that to change once the pharmacist actually gets here to scope out the situation, but in the mean time, you promised you'd wrestle with him."

there was a moment of dead silence on the phone. then i heard the attending's voice: "joe will be right there." and damned if he wasn't! he must have run up the stairs from the or, because he was there almost by the time i hung up the phone. he personally wrestled with the patient until the anesthesiologist got there to re-intubate. he personally pushed the paralytics, he personally pushed ativan, and he apologized to everyone sincerely, profusely and in specific detail. and the next time we even thought about extubating, joe was there holding the biggest danged syringe of ativan i've ever seen!

things i wish i could tell joe? "thanks again, for the hundredth time, and i really miss you sometimes!"

awesome story (well not all of it but you know what i mean).

[buggal1989]

I was touched by the two "thank yous". There was one doc who ALWAYS came in when one of his pts came into the ER. He KNEW the pts family - mom, father, siblings, grandmother and father, etc back to the Mayflower (JK), their financial situation (and ordered and prescribed in light of this), and just about everything you can think of knowing about a pt. While at the time I was annoyed because he insisted (I think one scank had implied that he was "friendly" with her) a nurse be in the room no matter what hell was breaking loose in the ER. But when I found out he had died and now I wish that I had hugged him and told him how much I honored him as a doctor because he was an A1 diagnostician and threat-er :caduceus:, and how much I loved him . I hope that when we get to heaven I can hug him, kiss him and tell him this. I am so sorry I did not tell him when I worked there when I was leaving. So if you have a doc you truly appreciate tell him/her as soon as possible - you don't know how much time you have left to tell them!

[ASSEDO]

Document in a legible handwrite and kill less patients.