What would you have said to this??

[DebRN06]

This afternoon I called to inform a doc that pt whose urine has been amber now has gross hematuria. Doc asks if pt has foley, I say yes and he says "well, d/c it. Maybe it will stop." I start to reply with, "Ok, and if it doesn't stop...." Doc then takes over and says, "If it doesn't stop, I'll care...Hmmm...Maybe when hell freezes over."

I can't wait until I have more experience!!! :chair:

[matchstickxx]

We have to read back all verbal and telephone orders to the physician. So I guess I would read back...

1. Discontinue foley catheter due to hematuria.

2. If hematuria continues, call when Hell freezes over.

Anything else, doctor?

Why does the patient have a foley in the first place? If she is post op, did she have a surgery where there was a potential for bladder or ureter trauma/laceration?

[withasmilelpn]

I write it word for word, exactly as the horse's a** , I mean MD states. While I have the MD on the phone, I also ask for what he should've ordered in the first place- CBC, UA C&S etc and document that I asked for such and his response to that request. If I really think that something needs immediate attention I call the family in order to update them with their loved ones condition. They express concern, I innocently encourage them to discuss their concerns with the MD and give them his #. This has gotten me results often. Some doctors feel like they can just dismiss nurses, but when they are dealing with families I think they think possible 'lawsuit', if they don't act like they are taking them seriously. Shame its gotta be that way, but there you go!

[UM Review RN, ASN, RN]

Why does the patient have a foley in the first place? If she is post op, did she have a surgery where there was a potential for bladder or ureter trauma/laceration?

I don't know how, but I sorta pictured this as an elderly gent with BPH. Poor guys tend to retain urine and then when the Foley's inserted, it causes some urethral trauma and some bleeding.

Since OP said that the patient developed the bleeding later, I pictured an elderly gent who was also a tad demented and might've had some physical trauma due to pulling on the cath somehow, in addition to the BPH.

If the patient was demented and had a high probability of disturbing the cath and causing self-trauma, that could also explain the doc's blase attitude.

Doesn't excuse it, though. Just because a patient is confused doesn't mean that they shouldn't get the appropriate care. A better doc might've said, "Is it possible that he caused the bleeding by pulling on the cath? If so, then leave it in. If it doesn't clear up overnight....blah, blah, blah."

This doc? His attitude just makes you wanna slap him silly. With a fish. :trout:

[luv your nurse, RN]

"how would you like that order written?" ha! that Dr. is going to learn the hard way that you dont want to piss off your nurses.

[LilRedRN1973]

I had a patient come back to the ICU after a Whipple with an epidural infusing Dilaudid. Pain was obviously uncontrolled as patient was screaming and writhing around in pain. I called the anesthesiologist that had been responsible for managing the epidural, thinking either it needed to be changed to a different medication or possibly the epidural was not in the correct space. With my patient screaming cuss words every 5 seconds in the background (and the MD could hear him, no doubt), I received this response, "The PACU nurse already called me to complain about his pain level and I upped the rate on the epidural. If you keep calling me about his pain, I'm just going to stop his drip altogether and then he'll have nothing". Shocked into not being able to speak, I gathered up as much courage as I could muster and meekly said, "How do you spell your name again so I can write a verbal order?". He was very quite and then came back, telling me to

DC the epidural, start a PCA (with very liberal settings) and call him back if pain continued to be uncontrolled. I would have said the same thing to the MD in your situation as well....insinuate that you will be writing it up as an order and most docs will respond with a bit more sense after that! Of course, there are those who won't and an incident report can be filled out.

Melanie = )

[TrudyRN]

in all honesty, i probably would have just said, "okay thank you." then i would have gone straight to my nurses noted immediately and charted what he said, using direct quotes.

what a jerk.

And you'd have been wrong to do so. Never chart dumb stuff like that in the permanent record that could go to court. First, it wastes time. Next, as a juror, I'd be wondering what you, the nurse did to follow up. Yeah, I'd be amazed at the doc's words but I'd be looking for you to follow through and get proper care for your patient.

[TrudyRN]

We had a doctor make similar statements one time, something to the effect of accusing the nurses and facility of "just wanting to cover your a****" along with other choice sentences. The nurse on our end of the phone con, documented his statements in the nurses' notes, word for word, using quotation marks.

And of course it is somehow wrong for nurses to want to cover their backsides while docs and facilities do it all the freaking time.

[anniev]

May I read that order back to you Dr?

[perfectbluebuildings, BSN, RN]

My favorite so far has been, on a cellulitis pt there for IV antbx, "I don't want to get three or four calls on this patient all night [this was at about 9 p.m.], just call me if she's actively dying!!"

[ckben]

And you'd have been wrong to do so. Never chart dumb stuff like that in the permanent record that could go to court. First, it wastes time. Next, as a juror, I'd be wondering what you, the nurse did to follow up. Yeah, I'd be amazed at the doc's words but I'd be looking for you to follow through and get proper care for your patient.

thing is, i've had a similar situation like this come up lots of times. upon asking other nurses/charge nurses what to do, they usually just say, "chart exactly what the doctor said in your nurses notes, watch the patient real carefully, and call him back anyway if you need to."

i'm not saying i would just forget about the patient, but i, like many other people, am pretty non-confrontational and would probably not be able to muster the nerve to get into a pissing contest with the doc at will.

[DebRN06]

Since OP said that the patient developed the bleeding later, I pictured an elderly gent who was also a tad demented and might've had some physical trauma due to pulling on the cath somehow, in addition to the BPH.

Elderly gent, tad demented...yes.

I wimped out and pretty much went with..."okay, thank you...goodbye." Even if I had more experience under my belt, I think I would've still been too shocked to say much more than that. My preceptor did tell me I should've asked if that was an order.

Here's the really "funny" part though...He is MY doctor, too. So...guess who's gonna be looking for a new doc!!!:roll :roll :roll

[UM Review RN, ASN, RN]

Elderly gent, tad demented...yes.

I wimped out and pretty much went with..."okay, thank you...goodbye." Even if I had more experience under my belt, I think I would've still been too shocked to say much more than that. My preceptor did tell me I should've asked if that was an order.

Here's the really "funny" part though...He is MY doctor, too. So...guess who's gonna be looking for a new doc!!!:roll :roll :roll

Oh honey, make sure that you tell him why, too. Because that patient could've been anyone--you or a family member.

Not forgetting the fact that as a nurse, you were entitled to respect from him.

I wouldn't be able to have a doc that doesn't get along with the nurses for my PCP, because communications are harder and things are less apt to get done in a timely manner with this type of doc.

So please, give him a head's up about this. In a nice, non-confrontational way.