Pt. in persistent AF c RVR. Had two doses of Diltiazem, was on a Dilt gtt, got 0.5 of Dig. Slowed down for a little while after each med, but after a bit was back to his old tricks in the 140s-150s. Totally asymptomatic, but yes I do understand the importance of rate control despite lack of symptoms. In fact, I explained this concept to the patient when he asked why he couldn't just go home and live in a rapid rate, since he didn't feel anything.
Hospitalist comes in, sees rate on monitor, says to me "So he's at a rapid rate and we're not doing anything for him?".
I dunno, maybe look at the chart. Maybe talk to the ER doc. Maybe ask me the question in a different way, in a different tone of voice?
Totally unnecessary to come in here and flip me attitude, like it's my fault the guy is refractory to everything we've done.
I know in hindsight that I should have calmly and methodically reviewed the chart with the hospitalist and told her everything I had done so far and what the results had been, but I was pretty taken aback by her attitude, had stayed an hour late because things were so busy, and really felt attacked. I'll do better next time.
Generally, if the hospitalist gets attitudinal on me regarding medical therapeutics, I try not to engage at all and simply remind them who is the ED doc placing orders... and offer to immediately implement any new (relevant) interventions that the hospitalist would care to order.
Reminds me of an incident I had a few weeks ago while sending a patient upstairs. College age girl with SOB x5 days. Chest CT reveals multiple PEs... described by the radiologist as "significant" clot burden. As I'm waiting for her bed to be ready I give her the heparin bolus & start the drip, as well as do a lot of teaching. Talk to the nurse that will be getting her and when I ask her if she as any questions, she says in this really snotty tone, "well it doesn't look like we've DONE ANYTHING for her." To which I ask her if she means have we started her heparin & bolused her? She says yes. I respond as politely as I can, that yes, in fact I had done all of that and if she had looked at the MAR, she would have seen that. Gah.[/quote']
I've had them call back asking what meds we gave...the ones I listed for you and that have been charted in the MAR. So wasn't worthy of a phone call. I guess they don't actually listen to phone reports sometimes.
I've totally stopped having those conversations -- "Dr. ER Resident - could you come to room 18 please?" If the hospitalist wants to beat up on his/her fellow resident buddy ... go for it. I'm not playing.
Off topic, but I've been using the same approach on those Discharged Patients Who Just Won't Leave, too. No more "but she said she was going to give me a script for pain pills" ... I call the resident to the room & we deal with it right there. Totally their call whether they want to cave and give the patient a goodie bag of pills, scripts, and a work excuse ... but I don't have time to play messenger and mediator.
Off topic, but I've been using the same approach on those Discharged Patients Who Just Won't Leave, too. No more "but she said she was going to give me a script for pain pills" ... I call the resident to the room & we deal with it right there. Totally their call whether they want to cave and give the patient a goodie bag of pills, scripts, and a work excuse ... but I don't have time to play messenger and mediator.
Ugh! This is a good one to add to the pet peeves list. I haaaaaate when this happens.
We have a very VERY condescending hospitalist resident right now, but he always seems to be the worst when he's not directly with the hospitalist that he's shadowing-who happens to be the sweetest person on earth.
The resident will leave with the chart for hours, literally hours, on end, not bother asking for the nursing notes or for any thoughts on the patient at all, and then leave a whole pile of orders tucked away for us to hopefully find some time later. Also completely not approachable. Like don't even bother trying to ask for anything. He will get his comeuppance once he's crossed enough staff, I'm sure.
Off topic, but I've been using the same approach on those Discharged Patients Who Just Won't Leave, too. No more "but she said she was going to give me a script for pain pills" ... I call the resident to the room & we deal with it right there. Totally their call whether they want to cave and give the patient a goodie bag of pills, scripts, and a work excuse ... but I don't have time to play messenger and mediator.
Oooh, I *HATE* when that happens. It's like nails on a blackboard. So often, I'd ask the patient "Did you ask the doctor about that while they were in here?", which the vast majority of the time, they hadn't. They'd only assumed. And by that time, the doc has moved on and is busy with someone else, and I have to track them down in whichever of five different zones they could possibly be in, or just interrupt whatever they might be in the middle of by calling their phone, only to have the doc say no, but they won't go talk to the patient, *I* have to be the messenger. Ugh. Fortunately, in my small ED it doesn't happen much. It happened all the time in the big ED I worked in.
Oooh, I *HATE* when that happens. It's like nails on a blackboard. So often, I'd ask the patient "Did you ask the doctor about that while they were in here?", which the vast majority of the time, they hadn't. They'd only assumed. And by that time, the doc has moved on and is busy with someone else, and I have to track them down in whichever of five different zones they could possibly be in, or just interrupt whatever they might be in the middle of by calling their phone, only to have the doc say no, but they won't go talk to the patient, *I* have to be the messenger. Ugh. Fortunately, in my small ED it doesn't happen much. It happened all the time in the big ED I worked in.
Wouldn't you just like to tell "you've had your time and it is up!!" and send them on their merry way?
Wouldn't you just like to tell "you've had your time and it is up!!" and send them on their merry way?
Oh yeah!
I'll do an imperceptible intake of my breath to keep my game face on until I'm out of the room, trudge to the doc, find out from horse's mouth final verdict, go back with news to pt.
Do-over, ASN, RN
1,085 Posts
I've learned, the hard way, that if it felt good saying it... I can expect a call from HR in the near future.