Vent: MD visitors who are NOT intensivists

Specialties MICU

Published

:madface: This has happened to me so many times, but today I nearly lost it. I absolutely hate it when an ICU patient has a visitor who is a doctor but not an intensivist and who grills me on the patient's condition, makes stupid comments, and expects me to carry out ridiculous and often dangerous interventions at their behest. Often these MD visitors are so old that they probably can't remember their ICU rotations (if they even had them). I am sorry, but being an opthamologist for 40 years in a private office does not give you much if any insight into how to care for vented patients, titrate vaso-active drips, run CRRT, etc...

Today I had a pretty good shift until one of these idiots interrupted my report to the oncoming nurse (24 hour visitation at its finest) to tell me that my patient needed to be NT suctioned. The patient was extubated yesterday and has a history of being reintubated within a week of each extubation. I know he sounded awful (like he was gargling phlegm), and I had been suctioning him with the Yankauer pretty much every hour all day with little result. Really I think he needs a trach, but the family cannot accept that he is not improving. Normally I would have no problem NT suctioning someone like that, BUT in my facility you need an order to NT suction AND the guy was on a heparin drip so one nick to his mucuous membrane, and I'd have a throat full of blood as well as phlegm.

I told the visitor that I could not NT suction the patient for the reasons I just mentioned. He basically accused me of letting him choke on his secretions. I told him that the sats were 100% all day on 2 L NC, he was coughing up and swallowing most of his secretions, and that I had been suctioning every 15 minutes (could not leave the room; thank god he was CRRT/drips 1:1!) for the past hour (after wife gave him "sip" of water!), and that I could not do more. Then he started grilling me about the most recent lab results with questions like, "Is he still anemic?" Well, DUH. The patient has had a hemoglobin of 8 for the past MONTH, and this visitor was here yesterday, so I hardly think he has miraculously bounced up into the normal range overnight! Gah. The questions went on and on, each dumber than the last. At least he did not TASTE the patient's oral secretions (that's right folks) like the last annoying MD visitor I had issues with.

Ugh. You had to be there to see how annoying this guy was and how he was totally showing off for the family members who were there. Usually he insists on talking to one of the attendings when he visits (they are equally annoyed by him), but today I clocked out before he escalated to that.

Sorry, just had to vent. This has happened to me at least four times in the last month. Sometimes they merely phone the unit, and I have to spend 15 precious minutes explaining IABP to an oncologist from Iran or something equally ridiculous. Bah!!!!!

Specializes in ICU.

Right now at the LTACH I am the nurse manager at, there is a patients daughter who "works" at a nursing home. I believe she is a LPN, but never mentions. She come sin with an attitude, demanding certain labs, demanding certain feedings, dressing changes, the list goes on. She actually says something and expects US to write an order. She drives me insane. i almsot told her why don't you take her home and be her Dr?

It's frustrating. I dealt with it alot int he MICU I worked in with open visiting hours. Nurse and Dr relatives drive you nuts. And yes, it's mostly the nurse ones I have a problem with. When I am a patient, I don't let them know I am a nurse and I never interfere with their care. I was always very friendly with myd aughters NICU nurses, When I was across the country and my dad had an AMI on his vacation, I talked with the nurses with respect on the phone.

I don't get it.

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Specializes in ER, ARNP, MSN, FNP-BC.

but, lets not forget that there are some real quacks out there and some nurses we wouldn't want to touch our dog. Those of us who are "in the field" get paranoid sometimes when it comes to our loved ones

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Specializes in ICU, ER, EP,.
but, lets not forget that there are some real quacks out there and some nurses we wouldn't want to touch our dog. Those of us who are "in the field" get paranoid sometimes when it comes to our loved ones

Agreed, but not what the OP is venting about. I have my own do not ever touch me list written down at home:lol2:

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If we get a patient's family doc (from within our system) in and they are pleasant and want some simple questions answered, I don't mind, but if they bust out detailed questions I just point them to our covering doctor. I don't have time for that garbage.

The WORST doctors are the foreign docs who are family members of patients whose medical degree is comparable to a patient care tech certificate here in the states. I swear I don't know where some of the people went to school but they come up with the worst and craziest suggestions and can't seem to grasp simple things. It's like our medicine is a completely foreign concept to how they practice.

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Specializes in Surgery, Trauma, Medicine, Neuro ICU.

I had a trauma patient one day (that was all I could stand his family for) and the family marched in a retired endocrinologist family friend from California to ask me questions. First he wanted to see the chart and scans and blood work, to which I said no. Then he has the unit secretaries paging me overhead "Physician holding on 8934" trying to give me orders AND insulting MY trauma docs and residents when I asked him if he worked for our hospital ("Oh, God No. I wouldn't work HERE. I worked for a PRIVATE hospital, not county.")

We ended up having to get our NeuroSurgeon to speak privately with him, our House Supervisor had to have a very clear and frank talk/smack down with him and the family about how he doesn't have priviliges here, how he can't be misrepresenting himself as a doctor with priviliges and how anyway he's an endocrinologist and not a trama surgeon so butt out already.

This particular family ended up being a NIGHTMARE that 95% of the nursing staff and 2/3 of the attendings and resdients refused to deal with.

We get the regular parade of Med/Surg nurses and CNAs from nursing homes 20 years ago as well trying to tell us what's up.

My FAVORITE is the family members who watch House and then warn us that they know what is going on and how this is all supposed to happen because they watch House and they'll be watching us too.

My response is generally "Well, House misdiagnoses his patients about 3 times an episode, plus there are no nurses on the show and it's full of medical errors. Also, it's a work of fiction, kinda like Harry Potter. But Hugh Laurie is great."

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Specializes in Critical Care.

One word...HIPPA!! If they are not in the direct care of the patient I would not get into specifics. Especially if the doctor is not even on the case. Where I work the pulmonologist are pretty territorial and if a non critical care MD is pushing too hard we let them know and they will take them to the side :) They stay on the side of nurses... especially us night RN's ;)

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My answer: They're in critical condition, you'll have to get any and all info from the family d/t FEDERAL HIPPA LAWS. Sorry..............

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Specializes in ICU.

I took care of a young Dentistry student who had the flu. She was crazy sick and of course it would be my luck that her Dad was this big shot oromaxillofacial surgeon in our hospital. He was very nice, but because he worked for the hospital, he always insisted on checking his daughter's chart. To make matters worse, her brother from out of state comes and STAYS with her in the hospital. Well he was a GI resident somewhere and his wife was OB resident too. They wanted to look at her chart all the time too and constantly second guessed every order that was written for her. They never left her side thanks to 24 hr visitation and even went so far as to SLEEP ON THE FLOOR EVERY NIGHT!!!!!!! I'm sorry, but it doesn't take a genius to know how FILTHY the floor is. But because of who her Dad was, this was tolerated. There were a bunch of us nurses complaining that we had not a second's peace in that room ever and it was getting to be too difficult to maneuver around all those people and actually get to the patient. But unfortunately, the same rules just don't apply to certain people. Management didn't want to make waves and back up all our concerns.

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I don't care who you are, if I cannot care for MY patient appropriately with you there

You will leave. Because if something goes wrong it will be MY license there going after. And who's to say the pt wants them there. Maybe they don't know how to tell their family to get out

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Specializes in ICU.

I had a hospice aide sister of a patient once think she should dictate her brothers care in the ICU. She made soooo much trouble for me, reporting me to everyone and anyone that had to listen to her. Finally the nursing supervisor put an end to it by talking to the patient himself asking him if he was satisfied with the care I was giving him and if he had any concerns about his care. Thank god he was still oriented at that point! He asked if his sister was causing trouble again and when it was confirmed, he asked that she not be allowed in anymore. I was grateful to them both. While it was not difficult to justify my every action to superiors as I comply with standards of care, it would have been difficult trying to prove I did not 'threaten' my patient verbally as she accused me of, had the patient not been able to deny it.

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