Monday, May 28, 2012

On-call medicine jerk

One of my previous posts indicated I had a run in with a doctor so here's the post that explains it...

It was on a weekend and so the reg doctors mainly were covered by other non regular doctors. We also had an admit from another hospital with whom the covering doctor accepted. Unfortunately he's not used to the policies and procedures of accepting other pt's from other hospitals and as such, this pt was due to arrive during the evening shift.

Now, these doctors get off at 1800hrs and after that we're expected to call the on-call medicine for orders. And this particular doctor swung by our unit before heading out. As such, I asked him about this particular pt and whether he was going to write orders before he left. He stated that since he didn't get a chance to assess the pt with his own eyes and hands, that he didn't feel comfortable writing orders... ok, fair enough. And off he went to spend the evening with his family.

The pt arrived after 1800 of course with a PICC line and a few other things going on. When the pt arrived I called the on-call medicine doctor for orders. I explained the situation and was told that he would NOT write orders for this pt and that I had to contact the covering doctor that accepted the pt. In response, I told the doctor that it was HIS responsibility NOT the covering doctor as it was after 1800hrs. Well that of course did not go over well. He got REALLY snotty with me, full of attitude and told me that I had to page the covering doctor and have him RETURN to the unit to write orders!!! I told him that I would not do that as it was HIS responsibility to write the admission orders, so this doctor said that HE would page the covering doctor and speak with him. OK, that's YOUR porogative (exactly what I told him) and 2 min later the covering doctor called me to say that he was going to come back to the unit to write the orders.

I could NOT believe that he would come back!!! IMO it just goes to show you the type of person and doctor that he is! Seriously wish that he was a more frequent doctor on our unit. And I don't believe that this doctor is used to writing admission orders as he asked for guidance and of course I offered. Tho several hours later, when I was putting together the admission package and making sure that everything was put into place, I realized that diet orders were forgotten.

As such, I had to again call the on-call doc - to get an order for an IV fluid as it was better to leave this head injury pt NPO unit speech pathologist could do a swallowing assessment on this pt. But when I asked for it, I was told that I had to AGAIN page the covering doc since "he didn't finish his admission orders". Of course I said that I wouldn't do it, and that I was only asking for a simple IV order, D5W or 2/3 & 1/3 just until morning when the covering doc would be back. He of course wasn't talking respectfully to me and when you disrespect me, don't expect me to be the kindest back. In the end he again said that he would speak to the covering doc again. My response, "that's your choice", "I'll be here".

Again the covering doc called and told me "if you need ANYTHING else for this pt, regardless of what time, just have me paged. Don't call the on-call doc for anything regarding this pt, I'll do it." and gave me orders for my IV and said that he would come in the AM to see if anything else needs to be done.

I followed up this event by emailing a couple of people above me and was told that the covering doc should have written orders before the pt arrived based on information in the admission packet we get from the other hospital.

NOW, I don't know of ANY doctors/nurse practitioners/dieticians/heck even nurses, who would write ADMISSION orders without setting eyes or hands on a pt. I understand on-call docs do this sort of thing all the time without setting eyes or hands on pt's, tho they are only writing orders for the interim til the regular doc can do something about the issue (as in a PRN analgesic order for a pt in pain), not writing admission orders. And they ask questions about why the order is req and any applicable information. And normally the on-call doc will swing by the unit when they're not busy so that they can write in the pt's chart and do the whole eyes/hands on assessment, and talk with the pt normally.

When I spoke with the chief doctor in charge of the other doctors (he's a reg doc on our unit), I was informed that I was correct in my thinking that it's the on-call responsibility to write the orders should the pt come to us after 1800hrs. I also sent an email and the response I got from my charge nurse was that no, the covering doc should have written orders. Such conflicting info!!! Was told that the doc was wrong with how he spoke to me but that's about it. The covering doc emailed me later and indicated that the jerk on-call doc apologized to him but did I get an apology for the way he spoke to me?! NOT A CHANCE!!! UGH!

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