unsafe MD

TazziRN, RN · Oct 15, 2007

Why not go to both? The fact that others have written him up tells us that you are not spoiled or overreacting. If write-ups haven't worked then it's time to go higher up the food chain. Not to hospital admin, unless they're backed into a corner they will support the docs.

trethern · Oct 15, 2007

I totally agree. I have had to work with a doctor who told me that I was overreacting when I told him his patient's wound had eviscerated. Luckily I was able to go to this doctor's senior partner who took care of the situation. Does this MD have a competent partner that you could talk to? If he does, they will generally get right on it because they don't want their practice involved in a malpractice case.

**canoehead, BSN, RN** · Oct 15, 2007

Page him every 15 minutes until you get an answer, if it takes more than 4 pages go up the chain of command. Document all pages.

If his decisions are inappropriate express your concerns to him. If he doesn't respond appropriately, go up the chain of command. Document your conversations.

If he says he's coming right over and doesn't show up page him again just to make sure he wasn't in a car wreck ( ) If he still doesn't show up, go up the chain of command.

There has to be a medical head of the department, or hospital, and that's part of their job- to make sure the docs on staff don't kill anyone. If you need to contact the department head leave a message for your manager as an FYI. Likely someone will complain to her about what mouthy employees she has, and she'll appreciate the heads up.

Keep a copy of documentation about the issues you called about and the responses in case nothing changes and you choose to report him to the medical board. It gives you more credibility if you can show them how you addressed the problem internally before going to them.

bagladyrn, RN · Oct 15, 2007

A heads up! As a new traveler you need to do one more step - before taking any action above the unit level and/or addressing the immediate problem as it arises (i.e. repeated pages, instituting chain of command) and certainly after taking these actions, be sure to talk to your company, asking to discuss it with the clinical liason for your area.

It's really important to keep them aware of what is occuring and the actions you are taking so that they are not blindsided by a complaint about you (in which the facts may be twisted). If they already know about an issue over a period of time, they are less likely to respond negatively to you if, for instance, they are notified of a physician complaint about you.

rn undisclosed name · Oct 15, 2007

I agree it is so frustrating and I think the hospitals need to stop putting up with this. I work with a doctor who is terrible. One day another nurse counted how long he was in a pt room. 17 seconds. I just think that is terrible. I realize docs don't spend as much time as nurses. This particular doc will keep patients in the hospital until all consults sign off. Some consults don't sign off and will just continue to follow until they are discharged. So with this particular doc I make sure to tell the consults this pt will not go home as long as you are still on the case. It's frustrating when you have other docs ask you why is this patient still here.

Also, with this particular doc I have to tell him which orders are needed and will have a list on the front of the chart. I feel like I am playing doctor and doing his job for him. I have noticed a lot of other people don't question anything he does. Some of the things I have gotten on him for (1) pt comes in with high K and there are no labs for 3 days - don't you want to know if his K is WNL (2) same pt is getting dialysis and is acute but we are just ordering dialysis and don't have any labs - I thought dialysis was based upon a patient labs. There are more.

One time we told him we needed him to spend more time than he was. He said he had to go because time is money. Give me a break. The hospital backs this doctor. I have no idea why because they are losing money because his patients stay in the hospital forever!

Makes me appreciate the docs who are really thorough and want to help their patients. I am glad that most of the docs I work with are good and not of the caliber of this particular doc.

Kelly

lindarn · Oct 15, 2007

Page him every 15 minutes until you get an answer, if it takes more than 4 pages go up the chain of command. Document all pages.
If his decisions are inappropriate express your concerns to him. If he doesn't respond appropriately, go up the chain of command. Document your conversations.
If he says he's coming right over and doesn't show up page him again just to make sure he wasn't in a car wreck ( ) If he still doesn't show up, go up the chain of command.
There has to be a medical head of the department, or hospital, and that's part of their job- to make sure the docs on staff don't kill anyone. If you need to contact the department head leave a message for your manager as an FYI. Likely someone will complain to her about what mouthy employees she has, and she'll appreciate the heads up.
Keep a copy of documentation about the issues you called about and the responses in case nothing changes and you choose to report him to the medical board. It gives you more credibility if you can show them how you addressed the problem internally before going to them.

And don't forget to make and keep copies of every piece of documentation that you write. I would also make copies of my nurses notes in case they also "disappear misteriously", if you know what I mean.

Lindarn, RN, BSN, CCRN

Spokane, Washington

leslymill · Oct 16, 2007

We had an ophthalmic surgeon who would fly all over rural Texas gathering patients to perform Surgeries on a decade or so ago. These were primarily Hispanic non-English folks who were told we would accommodate their families and give them private rooms. What a mess.

The reason I say Hispanic is because what causes eye problems in the Hispanic population? HIGH BLOOD PRESSURE AND DIABETES. These folks come in not getting a private room like promised. Families sleeping all over the floors. Their blood pressures and blood sugars are SKY HIGH and have never been diagnosed with those problems. This MD only fixed their eyes. He ignored over half the calls of high pre-op and post-op blood pressures and blood sugars and to get anything done was like pulling teeth. He made a lucrative killing$$ with his little Cessna and private Spanish speaking nurse.

He wasn't unsafe when it came to eye surgery, but how long are they gonna see if their B/P is >200/100 all the time.

blueheaven · Nov 17, 2007

Page him every 15 minutes until you get an answer, if it takes more than 4 pages go up the chain of command. Document all pages.
If his decisions are inappropriate express your concerns to him. If he doesn't respond appropriately, go up the chain of command. Document your conversations.
If he says he's coming right over and doesn't show up page him again just to make sure he wasn't in a car wreck ( ) If he still doesn't show up, go up the chain of command.
There has to be a medical head of the department, or hospital, and that's part of their job- to make sure the docs on staff don't kill anyone. If you need to contact the department head leave a message for your manager as an FYI. Likely someone will complain to her about what mouthy employees she has, and she'll appreciate the heads up.
Keep a copy of documentation about the issues you called about and the responses in case nothing changes and you choose to report him to the medical board. It gives you more credibility if you can show them how you addressed the problem internally before going to them.

Yes the nurse manager will hear about it!! LOL It all gets back to CYA.

This exactly what I did when I worked in a small community hospital. I had no qualms about going up the food chain when I needed to. There was one incident where I reported a particular doctor for writing things about me in the chart like Mz. Nancy Nurse has oversedated the patient so he wouldn't bother her...etc. Needless to say that was inappropriate. I wrote him up numerous times. Administration did nothing to address his behavior. He almost came over the desk after me one day when his patient didn't get extubated exactly when he wanted (RT extubated patients at that facility) Administration finally did something after I went and had copies of everything I had written up and copies of inappropriate chart entries and statements from my coworkers about his harrassment of me and contacted an attorney. They dealt with him quickly after that.

TiredMD · Nov 17, 2007

This MD only fixed their eyes. He ignored over half the calls of high pre-op and post-op blood pressures and blood sugars and to get anything done was like pulling teeth. He made a lucrative killing$$ with his little Cessna and private Spanish speaking nurse.
He wasn't unsafe when it came to eye surgery, but how long are they gonna see if their B/P is >200/100 all the time.

Ophtamologists are eye surgeons, not primary care practitioners. They were referred to him for a specific reason: eye care. It is neither expected nor appropriate for an ophthamologist to initiate blood pressure treatment on a patient they will not be following as an outpatient. While a blood pressure of 200/100 is disconcerting, it's not really a problem that can or should be fixed during a brief hospitalization for eye surgery.

Probably the better way to deal with these patients is to encourage them to follow-up with their PCP (after all, someone had to refer them to the ophthamologist), or provide them with the phone numbers of local Medicine docs who don't mind taking low-income patients.

Giving meds for hypertension during a surgical hospitalization sounds like a good idea, but once the pain and stress of surgery wears off, these meds can make people hypotensive, orthostatic, or even syncopal. Surgeons need to do what they were trained to do, and not try to fix every problem on a patient's problem list.

morte, LPN, LVN · Nov 17, 2007

Ophtamologists are eye surgeons, not primary care practitioners. They were referred to him for a specific reason: eye care. It is neither expected nor appropriate for an ophthamologist to initiate blood pressure treatment on a patient they will not be following as an outpatient. While a blood pressure of 200/100 is disconcerting, it's not really a problem that can or should be fixed during a brief hospitalization for eye surgery.
Probably the better way to deal with these patients is to encourage them to follow-up with their PCP (after all, someone had to refer them to the ophthamologist), or provide them with the phone numbers of local Medicine docs who don't mind taking low-income patients.
Giving meds for hypertension during a surgical hospitalization sounds like a good idea, but once the pain and stress of surgery wears off, these meds can make people hypotensive, orthostatic, or even syncopal. Surgeons need to do what they were trained to do, and not try to fix every problem on a patient's problem list.

did you miss the part about him flying around gathering up patients?

TiredMD · Nov 17, 2007

did you miss the part about him flying around gathering up patients?

First of all, surgeons don't "gather up patients". Patients are referred to them for specific concerns, usually by a primary care physician/NP/PA. It's not like this guy puts an ad in the paper that says, "Think you need eye surgery? Come see me!" and patients call him up to schedule a procedure.

Second, in rural areas it is not uncommon for a physician to fly around (or drive, or whatever) to areas that do not have a local surgeon in that specialty, spend a week operating on prescreened patients, and move on. These docs provide a valuable service, because then patients don't have to drive hundred or thousands of miles to larger centers to have their operations performed.

Regardless, my point was simply that ophthamologists shouldn't shouldn't manage blood pressure, especially when they're only seeing patients briefly for a specific operation. Would you want your ophthamologist managing your hypertension?