A Conundrum

[NJWxMan]

Only my third week in IM and I had to play middle man between what an attending wanted (less pain meds for chronic issue) and what the patient wanted (more meds for chronic issue). Despite his wife asking me in front of him if they could "take him home" the next day, I was accused of "pushing the patient out" by the patient and will be "reported" by the patient. I tried to tell him that I wasn't the one who decreased his Dilaudid, and yet I get threatened. He's the one that told me several days prior that they should d/c him because all he was getting was pain meds. What happens if he does report me? Do I get a warning from the hospital, from the state board? It makes you realize real fast how much of a selfless job medicine can be. You try to help, and all you get is crap sometimes.

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[2tall]

Hope you have malpractice insure...

 

[NJWxMan]

I remember my attending on the Psych floor always getting threatened by patients that they would report him to the state medical board. I don't think he ever thought anything of it. For some reason, I think my situation on a medicine floor is a bit different. Who's responsible for such false reports from a patient, especially when the attending has backed me up? Does a report to the hospital or board get dispelled promptly? I think the claim that someone "pushed" you out of the hospital is vague and has a lack of credibility.

 

[billypilgrim37]

Welcome to the occupation.

That won't be the first or last time (possibly this month) that someone threatens to "report" you. It happens in all "service" industries. If you hung around a McDonald's or an animal shelter or the Salvation Army, you'd hear these threats constantly. The only way many people know how to get what they want is to let their amygdalas do the talking. Threats are a last resort, and many people don't mind jumping straight to the last resort to get what they want.

I'd suggest you do a little reading on malpractice to comfort yourself.

 

[OldPsychDoc]

Just document, document, DOCUMENT that you were doing what was appropriate vis a vis the patient's situation. Talk about it with your attending and see how he describes his rationale in his notes. (Hopefully he is doing a job worth emulating!)

Difficult patients ("talking with their amygdalas"--love it, Billy) are a daily occupational hazard.

 

[NJWxMan]

I noted in the chart that we were attempting to wean the patient from Dilaudid 8 mg SQ Q3HR to 6 mg and that he was not happy with out rationale. I looked it up after the fact and didn't realize how large of a dose that was to begin with. It should have been more like 4 mg max Q4HR.

 

[billypilgrim37]

Dilaudid 8 mg SQ Q3HR

I just splurt (new verb!) Coke Zero all over my laptop screen as I crapped my pants. That is the most amazing dose I've ever seen. Most community emergency departments don't use this dude's daily supply in a week during motorcycle season.

 

[kugel]

I just splurt

I have a splurt-guard on my keyboard. It came in handy when I read that dose.
A dose that high maybe should have been considered for a PCA pump - at least that would have gotten an anesthesia-consult on board.

"That won't be the first or last time (possibly this month) that someone threatens to "report" you."
I've quit responding, "Just make sure you spell my name right."
Frankly, it only aggravated the situation.

I do, however, either give the pt a grievance form, and/or offer to dial Patients' Rights for him/her, and/or ask a supervisor to come listen to his/her complaint (and document all of it - including the pt's response). That way, the chart shows I heard/understood the complaint and attempted to assist the pt is getting it documented.

 

[fMRI]

Document every interaction, get nurses comments as well.

I try to keep in mind that most patients feel stressed out about the situation they are in (hey, who likes being in a hospital, feeling unwell and having huge bills looming??) and sometimes (way too often ) project that onto somebody on the medical staff. And yet again others seem to have a dominant complaining-and-bitching gene. It's on the short-p of...

BTW, what's the policy at your place about "handing the patient on" to a different team?

If everything else fails, print out this thread and hand it to him.

 

[michaelrack]

so someone is going to complain to the state board because you didn't give him as much dilaudid as he wanted. I doubt the state board will do anything to you.

Hospitals are more concerned about patient satisfaction; just put the blame on your attending and you should be ok

 

[whopper]

Based on what you're telling me I wouldn't worry about it.

#1-the attending is legally responsible, not the resident. If an attending ever tried to blame a resident on something where the resident kept the attending fully informed, and the resident did what the attending told him/her to do, then that attending is unethical & shouldn't be teaching a resident.

#2-plenty of patients make bogus accusations like this to scare people into doing what they want you to do. Don't fall for it. You need to treat the person correctly, not give them as much opioids or Xanax as they want.

#3 even if the patient tried to do something against you, from what you're saying, it appears you didn't do anything wrong.

And if you are in NJ--the NJ state board is notorious for lack of action against doctors. I don't mean that as a compliment either because some doctors IMHO needed action to be taken against them, but in this case their lack of action should make you worry less.