So I'm not trying to step on any toes here, but I am just a little shocked at two experiences I've recently had and I want to know if this is normal or just two bad cases...
First, I worked at a small critical access hospital and we had to call a rapid response on a patient. All of the nurses rushed in and worked their magic while I watched over the floor since I was the only PCT and all of the nurses were busy. 20 minutes after the rapid was over, the physician came calmly and slowly walking down the hall and asked our nurses about the rapid. She was two months pregnant and took frequent hour long naps throughout the day and really just didn't seem at all concerned about the rapid response (if being 20 minutes late didn't say enough, IMO).
Now I've transferred to another hospital in the same network but it's a bigger hospital with all of your expected units. So last night I was watching our telemetry monitor and a patients heart rate dropped to 40, 30, 17... I alerted my nurse and we ran in. The woman was gray, not breathing, and by that time had no pulse. We called a code blue and I started compressions while the nurse got her oxygen. In a matter of minutes the code team was there and took over and once again I found myself monitoring the floor because the nurses were in the room working on this patient. About 10 minutes after the code started, the physician came walking up like he had no care in the world, stopped outside of the room and looked in for a whole maybe 8 seconds, and then left! He didn't ask a single question, walk in the room, hell, he probably didn't even know the patients name!
I've just found myself really outraged both times that the physicians did NOTHING. Is this how it normally goes? To me it just seems like doctors prescribe the meds and the nurses do, well, everything.
And to the OP, I was very lucky with the doctors I worked with. The vast majority of our OBs were very responsive to our concerns, and very respectful our judgments. It was not at all uncommon for them to order a patient to the OR for a stat c-section just based on our judgment. They didn't mosey on over, look at the strip, and then tell us to move them. I adored the last group of physicians I spent my work hours with. Now I have very little contact with docs, and I miss it. Well, I miss the private MDs. I do not miss residents and attendings.
I think this just depends on the hospital. I work nights in surgical/trauma ICU at a large teaching facility. There is always a doctor on the floor and typically our patients don't get to the point where they code because every step of the way, we've been informing the doc of any changes and getting new orders. It makes for really busy nights, but out patients do really well.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I think this just depends on the hospital. I work nights in surgical/trauma ICU at a large teaching facility. There is always a doctor on the floor and typically our patients don't get to the point where they code because every step of the way, we've been informing the doc of any changes and getting new orders. It makes for really busy nights, but out patients do really well.
*** That must be nice. I "grew up" in a large and busy surgical / trauma ICU and we almost never had physicians on the unit except during morning rounds. The resident who was on call for the unit also was responsible for emergency surgery and trauma so sometimes there was no fast way of getting a physician to the bedside. We had a ton of standing orders and protocols and it made for very independent RNs.
As mentioned before MDs do not have to be present for a code, just the orders. I have found if there is more than one MD present egos get in the way of patient care.. Sometimes it's best when they no show.
What do doctors do? I wonder how many Americans are wondering WHERE WERE THE MDs when that woman in Oklahoma was laboring in the middle of an EF5 TORNADO and her attendants were FOUR INCREDIBLE NURSES!?
WELL DONE, LADIES!!!
(Back to the thread - I've just been almost desperate to post that somewhere!)
What do doctors do? I wonder how many Americans are wondering WHERE WERE THE MDs when that woman in Oklahoma was laboring in the middle of an EF5 TORNADO and her attendants were FOUR INCREDIBLE NURSES!?
WELL DONE, LADIES!!!
(Back to the thread - I've just been almost desperate to post that somewhere!)
Agree - hats off to those nurses! :)
But it is not typical in the US for a physician to remain with a laboring patient through hours of labor, so I'm not sure what to make of the implication in your post that - why wasn't a physician there? You seem to imply some kind of deficiency of care there, and I don't think that's fair. While I have not worked in an L&D environment ... certainly the bulk of discussion that I read about that specialty area advocates for a trend toward less medical intervention, not more. And yet you seem to want to find some kind of fault that there was not a physician present for a laboring patient, when a tornado just happened to touch down.
There is little to no warning for tornadoes - it's not like a hurricane or even a snowstorm situation in which there is often 24 hours or longer to plan and make preparations.
Specializes in Oncology; medical specialty website.
I wonder how much bailing will actually happen, though? I bailed out the residents I liked. If they were jerks, I'd sit back and watch them drown with a sense of extreme satisfaction. I do see a lot of 3 am Tylenol and urine output update phone calls in his/her future, though. We had an attending who would bring the interns around and introduce us, and he'd usually tell them to be kind to the nurses because we'd either save them or make their life a living hell, whichever they deserved.
Unprofessional. It's about the patient, not you. That kind of behavior is a great way to foster hostility. Suck it up and do the right thing.
But it is not typical in the US for a physician to remain with a laboring patient through hours of labor, so I'm not sure what to make of the implication in your post that - why wasn't a physician there? You seem to imply some kind of deficiency of care there, and I don't think that's fair. While I have not worked in an L&D environment ... certainly the bulk of discussion that I read about that specialty area advocates for a trend toward less medical intervention, not more. And yet you seem to want to find some kind of fault that there was not a physician present for a laboring patient, when a tornado just happened to touch down.
There is little to no warning for tornadoes - it's not like a hurricane or even a snowstorm situation in which there is often 24 hours or longer to plan and make preparations.
I know - I lived in Oklahoma for five years and was living there when the F5 hit Moore in 1999 (3 May - I will never, ever forget it), and I'm as American as they come. I was part of a rescue-recovery team from a nearby Air Force Base as I was a military working dog handler on active duty in the USAF at the time. I also spent my formative years in Hurricane Alley and have lived in San Francisco and Hawaii. The only natural disaster I've not dealt with is brush fires, thank God.
There's actually much more warning for supercells now than there was in 1999. While you can't predict the path, you can come damn close to predicting what systems might drop a twister or two. And some Okies are better predictors than any weatherman.
Considering the woman had had an epidural already, I'd say some MD should've been in the vicinity. In my limited L&D experience, if a woman was laboring, there was usually an MD or PA/NP somewhere on the floor in the event all hell broke loose. I realize facilities differ, but Moore's hospital as I remember was fairly small, since the big med center is in OKC just up I44/I35, depending on which way you go.
And no, I'm not finding fault at all (well, yeah, I am a bit - someone should've been there) - just wondering how many of my fellow countrymen are wondering that, right now, even as they think all we do is eat bonbons during shift and check a few temperatures.
Specializes in Oncology; medical specialty website.
There are many ways of doing the right thing by the patient and allowing a resident to dig his or her own grave.
I do not believe in letting someone dig his/her own grave. What is the point of doing so, other that getting feeling of self-satisfaction? Why not be a professional and be helpful? If the resident doesn't want the help, then fine, you've done what you could, but this idea of "I'm going to sit back and watch them drown" is petty, juvenile and unprofessional. Who knows...that resident/doctor who's a jerk could become your biggest ally, all because you chose to take the higher ground.
Don't get me started on bomb paging interns/residents at 0300 for Tylenol, Colace, etc.
.thumb.gif.09f7460d3e1ff8d6732564d77b5465cb.gif){kind=avatar}
monkeybug
716 Posts
And to the OP, I was very lucky with the doctors I worked with. The vast majority of our OBs were very responsive to our concerns, and very respectful our judgments. It was not at all uncommon for them to order a patient to the OR for a stat c-section just based on our judgment. They didn't mosey on over, look at the strip, and then tell us to move them. I adored the last group of physicians I spent my work hours with. Now I have very little contact with docs, and I miss it. Well, I miss the private MDs. I do not miss residents and attendings.