Uncontrolled pain- how to approach the Doc?

[Sam J.]

We've all seen patients with uncontrolled pain, and many have stated the physician failed to act. Any insider tips that have worked to alleviate this issue, to advocate for the patient, even if the physician is obstinate?

Assuming the physician knows the patient personally (I'm not talking about calling anyone on call to ask for pain meds), and really is aware the patient is still in pain, and still the problem continues, what are some ways to get past this road block, without alienating the physician, of course? Begging? Pleading? Fresh-baked cookies? Suggest the family contact the doc? It can probably be tricky with some physicians, for a variety of reasons (liability claims, being offended by a nurse assuming to know more than the physician, personality differences, etc.).

Any unusual (or even simple, tried and true) success stories?

[GundeRN]

I think we as nurses need to get over our fear of offending the doctors. Sometimes we DO know better what is best for our patient because we are spending more time with them, or they are opening up to us more. Doctors make bad decisions and whether it stirs the pot or not it is our responsibility to advocate for our patients.

One idea though, and one that I have used is to find peer reviewed articles about the subject and place them in the dictation room or doctors lounge. I have had doctors that are afraid of morphine and won't give it to COPD patients, the ones who need it the most. I have found the case studies on morphine and SOB and spread them around.

[Sam J.]

I think we as nurses need to get over our fear of offending the doctors. Sometimes we DO know better what is best for our patient because we are spending more time with them, or they are opening up to us more. Doctors make bad decisions and whether it stirs the pot or not it is our responsibility to advocate for our patients.

One idea though, and one that I have used is to find peer reviewed articles about the subject and place them in the dictation room or doctors lounge. I have had doctors that are afraid of morphine and won't give it to COPD patients, the ones who need it the most. I have found the case studies on morphine and SOB and spread them around.

Good idea, AND anonymous.

As far as offending doctors, there will always be those that feel superior, and are difficult to work with.

Some of the worst offenders, maybe the most arrogant, might be the ones that really don't feel so confident in themselves or their abilities as a physician, and are a bit too touchy when any nurse might offer up suggestions- possibly it adds to their feelings of inferiority? Too bad this situation has to happen in health care, at all.

[wooh, BSN, RN]

Have you tried just calling the physician? I don't see where you even discussed it with the physician, so I assume you did not. How do you know the physician is really aware of the patient's continued pain?

[Sam J.]

I'll be glad to clarify: "Assuming the physician knows the patient personally, and is well aware that the patient is in pain, and has been notified repeatedly by nursing that the patient remains in pain, and that nursing has repeatedly requested a further review of the patient's pain by the physician, and the physician has still failed or refused to relieve the patient's pain, what are some ways to get past this road block, in order to advocate for the patient by receiving proper treatment orders by the physician that will alleviate the patient's suffering, without alienating the physician?".

[NC29mom, ASN, LPN, RN]

Pts have rights. ...including choosing their own doctors.

I've had similar situations with hospice patients. Not unheard of for our patient to decide they would rather have our medical director handle their care. Did it offend the attending? Probably. ...but at the end of the day our goal is pt comfort...whether the attending or medical director provides care. Once our medical director took over, our pt was finally able to have some quality left to his short life.

Doctors need to realize they are replaceable just as other professionals. If they aren't doing there job....time to move on.

[NC29mom, ASN, LPN, RN]

To add.....Medicare makes a BIG deal out of pain. Its the 5th vital sign and MUST be addressed.

Like I said.....find a doctor who will listen and treat pain accordingly. Its not that hard to do....

[Sam J.]

Pts have rights. ...including choosing their own doctors.

I've had similar situations with hospice patients. Not unheard of for our patient to decide they would rather have our medical director handle their care. Did it offend the attending? Probably. ...but at the end of the day our goal is pt comfort...whether the attending or medical director provides care. Once our medical director took over, our pt was finally able to have some quality left to his short life.

Doctors need to realize they are replaceable just as other professionals. If they aren't doing there job....time to move on.

Another great solution~

[Sam J.]

To add.....Medicare makes a BIG deal out of pain. Its the 5th vital sign and MUST be addressed.

Like I said.....find a doctor who will listen and treat pain accordingly. Its not that hard to do....

Well said...that it might affect the physcian's reputation (or more) if he becomes known as difficult to deal with, in any respect. Things are changing, for sure. Good point.

[wooh, BSN, RN]

Perhaps make a suggestion to the prescribing MD of what you want them to order. I've always found that more effective than. "X isn't working. [sILENCE]"

[Sam J.]

Perhaps make a suggestion to the prescribing MD of what you want them to order. I've always found that more effective than. "X isn't working. [sILENCE]"

Another good reply, and neutral.

[Sam J.]

Perhaps make a suggestion to the prescribing MD of what you want them to order. I've always found that more effective than. "X isn't working. [sILENCE]"

I stand corrected: Great idea to tell them what "isn't" working. I'll leave it at that point. Sorry I wasn't wearing my spectacles.