What would you have done?

[MsSocalRN]

Pt comes in c/o dizziness n/v, pt is paced. Md orders for CM to set up pacer check appt made for 11/14. Telemetry calls and asked CN what type of pacer does the pt have? Asked pt he does not know, tele tech stated the pacer may be malfunctioning, CN advised MD of this, MD talks over CN he is rude and condescending told CN pt has pacer check on OP basis. MD orders for pt to be DC'd, nurse went to dc pt he c/o dizziness again. CN calls MD he yells and states I ordered pt to be DC'd, CN recommended for pacer to be checked stat, MD being condescending and stated well if you can get it checked faster then do it. Which CN could call pacemaker company in the area for stat interrogation, so CN received orders for a stat pacer check. The patient is 98 yrs old. Would you have insisted on an inpatient pacer check or would you have DC'd the patient and had him wait 13 more days? Just curious. I thought I was doing the MD a favor because I don't think he knew we could get pacers checked inpatient and stat but he thought I was questioning his judgement. Which in a way I was because of the s/s the patient was c/o he also stated he felt his heart was beating out of his chest. The MD has been written up many times for his behavior with nurses I.e. rude, calls some nurses stupid. I thought he and I had a decent rapport but I think I'm writing him up for his behavior this evening, or maybe just talking to him and explaining why I was insistent on getting it checked inpatient because with his age the pt might not have made it the next 13 days if it is malfunctioning. Thanks for reading and for any advice! I know we all have different opinions so I was wondering "What would you do" lol like the show!

[Esme12, ASN, BSN, RN]

Let him scream...why in heavens name would you make a 98 year old patient wait for a pacer check, make them travel in possible bad weather when they are in the hospital?

Let the MD yell.

[martymoose, BSN, RN]

I'm not understanding. The pt came in for dizziness, n/v, Were these things resolved? B/p was stable? was pt sick otherwise? Was there anything obvious on telemetry , like not capturing, or hr too fast (afib?) Labs ok? If pt vomiting, was their K+ low? Are they in renal failure? Wow, there just seems like there would be more to this than a mere pacer check.

Yes Docs can be jerks. One could hope that the pt will refuse to sign the d/c :)

[registerednutrn, BSN, RN]

I would have done just what you did advocate for my patient. I had a patient to be discharged but complained of leg pain so I called to doc I was yelled at and cussed at by the doc.. My charge told me if the doc said to discharge then I had to so made sure I documented every word the doc said. Patient came back 2 days later and had to have a BKA due to blockage. Wish I had tried to advocate for them more maybe would not have lost their leg.

[MunoRN, RN]

While the Physicians behavior is unacceptable, in my experience these reactions are less likely when the Nursing staff is able to more clearly communicate their concerns. Informing the MD that something might be wrong with pacer isn't very helpful, is it a sensing issue, capture issue, PMT?

[ChristineN, BSN, RN]

While the Physicians behavior is unacceptable in my experience these reactions are less likely when the Nursing staff is able to more clearly communicate their concerns. Informing the MD that something might be wrong with pacer isn't very helpful, is it a sensing issue, capture issue, PMT?[/quote']

Not to excuse it if the nurse wasn't providing the correct info, but some hospitals, like mine, get very few cardiac pts and very few pts with pacers, so I do not feel comfortable knowing when it is "off.". I can tell "normal" but otherwise, I am like a fish out of water

[Anna Flaxis, BSN, RN]

I would have advocated for my patient, and if I felt the physician was missing some info, I would have filled him in. Some docs can be asses and act out, but that shouldn't prevent you from providing good nursing care.

[MsSocalRN]

Pacer was checked, it was failing to pace. Pt requested to be sent to SNF because he lived alone and only had a caregiver 3 hours a day. He has a follow up with Cardio. He stated he is 98 yrs old he probably won't pursue anything drastic just didn't want to be alone when he dies. Md came in and DC'd pt to SNF. So everything worked out for the best for him. Md actually said to CN I wasn't upset I was driving. Thank you to everyone for reading and posting. I just had to get it off my chest.

[jadelpn, LPN, EMT-B]

Pacers are interesting things. They make sure that the heart rate doesn't fall below a certain "paced" rate, however, most I have dealt with do not regulate when a heart rate increases. I made the assumption that the pacer was off on a patient and had an equally as rude MD tell me that "unless the heart rate is low, like for instance 30, the pacer is doing its job...." Doctors can be difficult to communicate with to say the least.

Hopefully the SNF will follow up with Cardio for this patient, and that he will be made comfortable with cardiac meds. And equally as comfortable with meds that can control his other symptoms.