British Residents Face "The Noctor"

[Coastie]

EDIT: Must see picture is not coming up. Can anyone help me? I only see a box.

Found this link browsing through twitter. Hilarious and informative that the UK guys have this problem too, although we are farther down the road.

http://www.drrant.net/2008/01/lets-play-at-being-noctors.html

Dr Rant encounters many tales from his medical colleagues around the country. A lot of them are regarding the gathering rise of the 'Noctor'. A 'Noctor' is a portmanteau term to describe a nurse acting as a doctor, but can represent any speciality who does not have a medical degree attempting to do the job of someone who should have one.

Here is a tale from one of Dr Rant's colleagues who describes a typical night on call, and a phone call from such a noctor:

While at the out-of-hours clinic, I got a phone call from an 'Emergency Care Practitioner' nurse at 2 am. The conversation went something like this:

Noctor: Eh, doctor, where can I get some Fluconazole at this time?

Me: Fluconazole-why at this time?

Noctor: Need urgently for this poor lady, she is not very well.

Me: Fluconazole!!?? What is wrong with her?

Noctor: She is 10 days post-partum and has swelling over one breast, red, hot, painful. She also has fever and chills. I have made a diagnosis of Mastitis (lot of pride in voice-well done mate!) and I need Fluconazole urgently for her as I do not want to admit her.

(They are on a mission not to admit, so that PCT can prove nurses do better than doctors. Sometimes it means asking patients to call-as they are in no condition to visit-their doctors early next morning.)

Me: Fluconazole!!!???

Noctor: (in complete confident flow now) Yes, can you tell me how to access emergency chemist? And oh-you'll also have to sign the prescription, as I don't have the Directive for it. (Impatient now), will you help me? (Threatening tone now as "helping and supporting" them is part of our contract.)

Me: But why Fluconazole???

Noctor: (very patronizing and mocking tone now-I am, after all, only a GP; he has done all the courses.) Is that not the first choice for mastitis?

Me: Fluconazole??!!??!!

Noctor: Yes, yes, we always use it for skin infections. Isn't it the first drug on protocol?

Me: What Protocol?

Noctor: I know doctors don't use the protocols,(mocking, insulting) but we have one (proud) and it says fluconazole for skin infections, have you not seen that?

Me: (Like a broken record, in disbelief, and by now, just a niggle of doubt about my 20 year training and experience creeping in!) Fluconazole???###!!!??/###???###!!! Er, have you got this protocol with you?

Noctor: No, but I can show you next week, we were given it at our prescribing course. Look, we are all very busy professionals here, are you going to help me or should I call the night duty manager? (Patronizing, threatening, arrogant or just full of s**t-could not decide.)

Me: (Penny suddenly dropping now.) Do you, er, by any chance, eh, mean Flucloxacillin??

Noctor: (Silence for a long 15 seconds-----)

Me: Hello?? Are you there?

Noctor: Oh! Em , I mean, eh, yes, Eh, I think you may be correct.

Me: (thinking-yes you f*****g idiot, I am correct!) OK, so you need some fluclox?

Noctor: (Not admitting defeat, got confidence and arrogance back by now-is that taught on a course?) Yes I think we can try Fluclox, but I am sure Fluconazole is first choice!!

Me: Try drug box in car, you may find some.

Noctor: I'll show you the protocol next week.

It is three weeks, and I am still waiting to meet this noctor, or to see the 'protocol'.


Rather than see someone who has been trained in medicine (including microbiology, breast disease and pharmacology) for five years, and has at least five years post-graduate experience dealing with these fields, the above patient was dealt with by someone who had been on a short course. Rather than use their brain to think about the pathogenesis of a breast infection, the most likely micro-organisms, and the class of antibiotic, they had followed the protocol 'mastitis = give drug beginning with F'.

For what it is worth, Fluconazole is secreted in high levels in breast milk, and is not a drug that should be given to a breastfeeding woman. Many cases of mastitis do not require antibiotics, either.

Dr Rant is aware that some doctors will act in a fashion similar to the above, but he hasn't met very many like this, and those that he has met would have backed down and apologised profusely as soon as the word 'flucloxacillin' was mentioned.

These noctors will be increasing in number. They will be seeing your families and friends in the middle of the night. They have minimal training in drugs, and can prescribe only a handful of them. How much do they know about other drugs your lil' ol' granny is on, at 3 am, while she is on the floor, or SOB, or confused, is any one's guess.

There is a colossal shortfall in quality manpower of nurses out there, and taking nurses from the wards, and training them to be low quality GPs is neither wise nor productive. And in some cases will poison a newborn with an antifungal overdose.

Welcome to cost saving.

---

Members don't see this ad.

 

[peppy]

There is a colossal shortfall in quality manpower of nurses out there, and taking nurses from the wards, and training them to be low quality GPs is neither wise nor productive.

That is well said. If every reasonably intelligent nurse becomes a midlevel/noctor/whatever, then who is actually going to be left to do nursing duties?

 

[Coastie]

British noctor vid also found via twitter. This is beyond hilarious.

http://www.xtranormal.com/watch/4406081/


Who knew they had the same trouble we do?

 

[ChiDO]

 

[chocomorsel]

British noctor vid also found via twitter. This is beyond hilarious.

http://www.xtranormal.com/watch/4406081/


Who knew they had the same trouble we do?

Hilarious. Except it's in an American Accent and not a British accent.

 

[Ashers]

Excellent. I was actually just in England while the health care bill passed, so everyone asked my opinion on it... including all my doctor friends. I wish I had known about this issue too, to ask them about it.

 

[JelloBrain]

The biggest difference I have seen so far between UK (where I trained) and USA (where I am now) systems is that USA has a much wider variety of midlevels than UK, so the problem is compounded.

In UK, as we only have one government run NHS, our midlevels are mostly (almost exclusively) NPs, with the occasional surgical assistants in some surgical departments (usually cardiac surgery).

In USA, due to both academic and private practice set-ups, there are NPs/PAs/Medical Assistants/Surgical Assistants/Nurse Anesthesiologists, and who knows how many others. USA already has DOs to compete with MDs (not so in UK), and the addition of all the other midlevels just really adds more confusion-Too many chiefs and not enough Indians kind of situation!

I dread to be one of the uninformed patients out there who has to decide whether to be seen by a doctor or a nurse or a noctor or a.....

 

[Eta Carinae]

The biggest difference I have seen so far between UK (where I trained) and USA (where I am now) systems is that USA has a much wider variety of midlevels than UK, so the problem is compounded.

In UK, as we only have one government run NHS, our midlevels are mostly (almost exclusively) NPs, with the occasional surgical assistants in some surgical departments (usually cardiac surgery).

In USA, due to both academic and private practice set-ups, there are NPs/PAs/Medical Assistants/Surgical Assistants/Nurse Anesthesiologists, and who knows how many others. USA already has DOs to compete with MDs (not so in UK),

and the addition of all the other midlevels just really adds more confusion-Too many chiefs and not enough Indians kind of situation!

I dread to be one of the uninformed patients out there who has to decide whether to be seen by a doctor or a nurse or a noctor or a.....

QFT. Totally agree. I insist on overseeing all of my friends' and family members' contact with the healthcare industry. I can't possibly accompany them to every visit but I make sure they use MDs/DOs and the appropriate subspecialists when needed. It takes an insider to navigate them through this discombobulating labyrinth we've created

 

[bioman2006]

.

 

[JelloBrain]

QFT. Totally agree. I insist on overseeing all of my friends' and family members' contact with the healthcare industry. I can't possibly accompany them to every visit but I make sure they use MDs and the appropriate subspecialists when needed. It takes an insider to navigate them through this discombobulating labyrinth we've created

So do I. Actually I have told my husband that if he ever sees anyone other than an MD for any health issues, I'll leave him,

 

[Southpaw]

In USA, due to both academic and private practice set-ups, there are NPs/PAs/Medical Assistants/Surgical Assistants/Nurse Anesthesiologists

You are correct in the wide variety, but there is no such thing as a 'Nurse Anesthesiologist'. An anesthesiologist is a physician, whereas a nurse anesthetist is a nurse. And you should inform your uninformed patients, for the sake of safety and simplicity, to always request a physician.

 

[JelloBrain]

You are correct in the wide variety, but there is no such thing as a 'Nurse Anesthesiologist'. An anesthesiologist is a physician, whereas a nurse anesthetist is a nurse. And you should inform your uninformed patients, for the sake of safety and simplicity, to always request a physician.

I meant a CRNA, who are quite autonomous in a lot of places in terms of delivering anesthesia during surgery. As the AANA website proclaims, nurse anesthetists are anesthesia specialists, and they deliver 2/3rds of all anesthesia in rural areas and inner city areas with no medical supervision. That should definitely be a scary thought, and that does not define the scope/boundaries of "nursing" to me. Again I speak from my UK experience, where anesthetists (MDs) have more scope of practice than in USA, where the specialty is further diluted by CRNAs.

Anesthesia is one of the most challenging specialties out there. When I was running my large animal neurotrauma project in USA, I was usually more worried about the anesthesia issues of keeping my animals safely under for 22-24 hours at a stretch, and recovering them safely, than I ever was about the surgical portions.

Any one who is/will be my patient will of course be seeing a physician, and I also guide family and friends through their choices to always see a physician, but not everyone in this country will have a physician friend/advocate to guide them. I feel worried on their behalf. Facing too many choices is not good at any time, but especially when you are not well-mistakes are bound to happen in who you pick for your care.

 

[bassstimme1]

QFT. Totally agree. I insist on overseeing all of my friends' and family members' contact with the healthcare industry. I can't possibly accompany them to every visit but I make sure they use MDs and the appropriate subspecialists when needed. It takes an insider to navigate them through this discombobulating labyrinth we've created [/QUOTE]


After all, if any of yer friends n' family went to one of them thar DO cardiooligists with a hurt in the chest, he'd just crack yer back and give y'all some snake oil....

 

[Eta Carinae]

Originally Posted by Eta Carinae

QFT. Totally agree. I insist on overseeing all of my friends' and family members' contact with the healthcare industry. I can't possibly accompany them to every visit but I make sure they use MDs and the appropriate subspecialists when needed. It takes an insider to navigate them through this discombobulating labyrinth we've created

After all, if any of yer friends n' family went to one of them thar DO cardiooligists with a hurt in the chest, he'd just crack yer back and give y'all some snake oil....

Pardon me, my friend. That should have read MD/DOs.

While I find the statement amusing that DOs represent competition to MDs, I'm certainly confident in the capabilities of my DO, ACGME-accredited residency-trained colleagues.

 

[Coastie]

Unfortunately, your information is incorrect.

Whilst CRNAs are involved in 2/3 of anesthetics in this country, MDs head 90% of all anesthetics. 10% are solo CRNA, in rural areas, and ASA 1/2 patients.

There just aren't enough people, but with CRNAs being pumped out like crazy, and the market for their services getting tighter, I believe we will see fewer and fewer solo CRNAs.

Anesthesiologists have the full scope that they do in the UK.

I meant a CRNA, who are quite autonomous in a lot of places in terms of delivering anesthesia during surgery. As the AANA website proclaims, nurse anesthetists are anesthesia specialists, and they deliver 2/3rds of all anesthesia in rural areas and inner city areas with no medical supervision. That should definitely be a scary thought, and that does not define the scope/boundaries of "nursing" to me. Again I speak from my UK experience, where anesthetists (MDs) have more scope of practice than in USA, where the specialty is further diluted by CRNAs.

Anesthesia is one of the most challenging specialties out there. When I was running my large animal neurotrauma project in USA, I was usually more worried about the anesthesia issues of keeping my animals safely under for 22-24 hours at a stretch, and recovering them safely, than I ever was about the surgical portions.

Any one who is/will be my patient will of course be seeing a physician, and I also guide family and friends through their choices to always see a physician, but not everyone in this country will have a physician friend/advocate to guide them. I feel worried on their behalf. Facing too many choices is not good at any time, but especially when you are not well-mistakes are bound to happen in who you pick for your care.

 

[JelloBrain]

Pardon me, my friend. That should have read MD/DOs.

While I find the statement amusing that DOs represent competition to MDs, I'm certainly confident in the capabilities of my DO, ACGME-accredited residency-trained colleagues.

The way I meant DOs as competition is that they can apply to MD residencies, but there is no reciprocity AFAIK, thus increasing competition. What about your confidence in DOs who are not ACGME accreditied, but train in a DO residency-OGME/AOA accredited? I am genuinely asking as they are an unknown quantity to me.

In UK, as there are no parallel medical tracks, there is only one group of physicians-MBBS or MBChB, and so far only one level of midlevels-NPs or Nurse Managers. I heard the first batch of PAs graduated last year though. Not sure how widespread they are in the NHS already. There were none when I moved to USA in 2006.

 

[Integrity]

@ the OP: You obviously have empathy and recognized the need of this wish of this nurse to both feel important and to impress others. There is little gratitude in daily work, and on top of that, nurses struggle with their positions in the hierarchy.

Why did you simply repeat fluconazole to address the ridiculous drug suggestion? What did you gain by it? Wouldn't it have been more tactically sound to give the nurse credit for her assessment, but merely suggest that she had gotten the staph drug and the fungal drug confused?

I understand everything provocative about the situation, and her defense by making not-so-subtle sarcastic comments back at you, but that is actually how people react normally. I hope you ain't gotten all that frustrated that you demand superhuman insight from all colleagues.

I think you did a bad job here. Been there, done that. I understood by your first sentence that we were talking about flucloxacillin, and I seriously think you did as well, as I am a douche when it comes to antibiotics, and I don't know much about mastitis. Now you have a nurse with hurt feelings, who realizes she said something stupid, but in her mind, she will find a way to blame you for it, and that ain't helping you jack.

 

[JelloBrain]

Unfortunately, your information is incorrect.

Whilst CRNAs are involved in 2/3 of anesthetics in this country, MDs head 90% of all anesthetics. 10% are solo CRNA, in rural areas, and ASA 1/2 patients.

There just aren't enough people, but with CRNAs being pumped out like crazy, and the market for their services getting tighter, I believe we will see fewer and fewer solo CRNAs.

Anesthesiologists have the full scope that they do in the UK.

I am quoting from the AANA website:

What Is the Role of the Individual CRNA?
Nurse anesthetists, pioneers in anesthesia, have been administering anesthesia for more than 100 years.
As anesthesia specialists, CRNAs take care of patients before, during and after surgical or obstetrical procedures. Nurse anesthetists stay with their patients for the entire procedure, constantly monitoring every important body function and individually modifying the anesthetic to ensure maximum safety and comfort.
How do CRNAs Impact Healthcare?
CRNAs are the sole anesthesia providers in more than two-thirds of all rural hospitals in the United States, affording some 70 million rural Americans access to anesthesia. CRNAs provide a significant amount of the anesthesia in inner cities as well.
CRNAs are qualified and permitted by state law or regulations to practice in every state of the nation.
Meeting the Needs of Tomorrow
CRNAs have a proud history of meeting the challenges of changing healthcare trends. The recent acceleration of managed healthcare services will provide additional opportunities and new challenges for these advanced practice nurses. CRNAs will continue to be recognized as anesthesia specialists providing safe patient care.
CRNAs Fully Use Their Training
During surgery, the patient’s life often rests in the hands of the anesthesia provider. This awesome responsibility requires CRNAs to fully utilize every aspect of their anesthesia education, nursing skills, and scientific knowledge. CRNAs vigilantly monitor the patient’s vital signs, regulate the anesthetic as necessary, analyze situations, make decisions, communicate clearly with the other members of the surgical team, and respond quickly and appropriately in an emergency.
"The future looks bright for CRNAs," according to 1999 AANA President Linda R. Williams, CRNA, JD. "CRNAs are a glowing example of how advanced practice nurses can be used to provide affordable, high-quality healthcare to the citizens of this country."
The shortage of CRNAs in the marketplace spells job opportunities. With hospitals and other healthcare facilities scrutinizing their bottom lines, CRNAs offer an attractive option for providing anesthesia care. Also of interest is the fact that approximately eight nurse anesthetists can be educated for the cost of one anesthesiologist. Competitively, this gives CRNAs an advantage over anesthesiologists in a scenario where manpower supply and costs to the government and society are issues.

 

[nowooftickets]

Oh god that video is hilarious.

 

[Coastie]

Let me repeat what I posted to you before:

Unfortunately, your information is incorrect.

Whilst CRNAs are involved in 2/3 of anesthetics in this country, MDs head 90% of all anesthetics. 10% are solo CRNA, in rural areas, and ASA 1/2 patients.

There just aren't enough people, but with CRNAs being pumped out like crazy, and the market for their services getting tighter, I believe we will see fewer and fewer solo CRNAs.

Anesthesiologists have the full scope that they do in the UK.

You seem oddly familiar..

I am quoting from the AANA website:

What Is the Role of the Individual CRNA?
Nurse anesthetists, pioneers in anesthesia, have been administering anesthesia for more than 100 years.
As anesthesia specialists, CRNAs take care of patients before, during and after surgical or obstetrical procedures. Nurse anesthetists stay with their patients for the entire procedure, constantly monitoring every important body function and individually modifying the anesthetic to ensure maximum safety and comfort.
How do CRNAs Impact Healthcare?
CRNAs are the sole anesthesia providers in more than two-thirds of all rural hospitals in the United States, affording some 70 million rural Americans access to anesthesia. CRNAs provide a significant amount of the anesthesia in inner cities as well.
CRNAs are qualified and permitted by state law or regulations to practice in every state of the nation.
Meeting the Needs of Tomorrow
CRNAs have a proud history of meeting the challenges of changing healthcare trends. The recent acceleration of managed healthcare services will provide additional opportunities and new challenges for these advanced practice nurses. CRNAs will continue to be recognized as anesthesia specialists providing safe patient care.
CRNAs Fully Use Their Training
During surgery, the patient's life often rests in the hands of the anesthesia provider. This awesome responsibility requires CRNAs to fully utilize every aspect of their anesthesia education, nursing skills, and scientific knowledge. CRNAs vigilantly monitor the patient's vital signs, regulate the anesthetic as necessary, analyze situations, make decisions, communicate clearly with the other members of the surgical team, and respond quickly and appropriately in an emergency.
"The future looks bright for CRNAs," according to 1999 AANA President Linda R. Williams, CRNA, JD. "CRNAs are a glowing example of how advanced practice nurses can be used to provide affordable, high-quality healthcare to the citizens of this country."
The shortage of CRNAs in the marketplace spells job opportunities. With hospitals and other healthcare facilities scrutinizing their bottom lines, CRNAs offer an attractive option for providing anesthesia care. Also of interest is the fact that approximately eight nurse anesthetists can be educated for the cost of one anesthesiologist. Competitively, this gives CRNAs an advantage over anesthesiologists in a scenario where manpower supply and costs to the government and society are issues.

 

[JelloBrain]

Let me repeat what I posted to you before:

Unfortunately, your information is incorrect.

Whilst CRNAs are involved in 2/3 of anesthetics in this country, MDs head 90% of all anesthetics. 10% are solo CRNA, in rural areas, and ASA 1/2 patients.

There just aren't enough people, but with CRNAs being pumped out like crazy, and the market for their services getting tighter, I believe we will see fewer and fewer solo CRNAs.

Anesthesiologists have the full scope that they do in the UK.

You seem oddly familiar..

I hope the AANA website it wrong. I sure hope that CRNAS remain few and far between. I don't know any anesthesiology resident on any coast as far as my memory goes, so I am not sure why you would think so. But I am happy to learn about you and if I do know you, I shall give out my info too, how about that?

 

[Parietal Lobe]

USA already has DOs to compete with MDs (not so in UK)

Not in terms of residency, but US-trained DO's can be licensed to practice medicine in the UK so they do have DO physicians as well.

 

[maceo]

I am quoting from the AANA website:

What Is the Role of the Individual CRNA?
Nurse anesthetists, pioneers in anesthesia, have been administering anesthesia for more than 100 years.
As anesthesia specialists, CRNAs take care of patients before, during and after surgical or obstetrical procedures. Nurse anesthetists stay with their patients for the entire procedure, constantly monitoring every important body function and individually modifying the anesthetic to ensure maximum safety and comfort.
How do CRNAs Impact Healthcare?
CRNAs are the sole anesthesia providers in more than two-thirds of all rural hospitals in the United States, affording some 70 million rural Americans access to anesthesia. CRNAs provide a significant amount of the anesthesia in inner cities as well.
CRNAs are qualified and permitted by state law or regulations to practice in every state of the nation.
Meeting the Needs of Tomorrow
CRNAs have a proud history of meeting the challenges of changing healthcare trends. The recent acceleration of managed healthcare services will provide additional opportunities and new challenges for these advanced practice nurses. CRNAs will continue to be recognized as anesthesia specialists providing safe patient care.
CRNAs Fully Use Their Training
During surgery, the patient’s life often rests in the hands of the anesthesia provider. This awesome responsibility requires CRNAs to fully utilize every aspect of their anesthesia education, nursing skills, and scientific knowledge. CRNAs vigilantly monitor the patient’s vital signs, regulate the anesthetic as necessary, analyze situations, make decisions, communicate clearly with the other members of the surgical team, and respond quickly and appropriately in an emergency.
"The future looks bright for CRNAs," according to 1999 AANA President Linda R. Williams, CRNA, JD. "CRNAs are a glowing example of how advanced practice nurses can be used to provide affordable, high-quality healthcare to the citizens of this country."
The shortage of CRNAs in the marketplace spells job opportunities. With hospitals and other healthcare facilities scrutinizing their bottom lines, CRNAs offer an attractive option for providing anesthesia care. Also of interest is the fact that approximately eight nurse anesthetists can be educated for the cost of one anesthesiologist. Competitively, this gives CRNAs an advantage over anesthesiologists in a scenario where manpower supply and costs to the government and society are issues.

wait until we hire PAs to be our assistants in the OR. Put the CRNAs on the defensive. Not to mention all the AA schools that can and will be opened soon as legislation is passed

 

[JaggerPlate]

In UK, there are no parallel medical tracks, there is only one group of physicians-MBBS or MBChB, and so far only one level of midlevels-NPs or Nurse Managers. I heard the first batch of PAs graduated last year though. Not sure how widespread they are in the NHS already. There were none when I moved to USA in 2006.

Huh???

My head keeps hurting more and more with every post you write.

Or???

Kinda like one group of physicians in the US, MD or DO???

 

[bluealiendoctor]

@ the OP: You obviously have empathy and recognized the need of this wish of this nurse to both feel important and to impress others. There is little gratitude in daily work, and on top of that, nurses struggle with their positions in the hierarchy.

Why did you simply repeat fluconazole to address the ridiculous drug suggestion? What did you gain by it? Wouldn't it have been more tactically sound to give the nurse credit for her assessment, but merely suggest that she had gotten the staph drug and the fungal drug confused?

I understand everything provocative about the situation, and her defense by making not-so-subtle sarcastic comments back at you, but that is actually how people react normally. I hope you ain't gotten all that frustrated that you demand superhuman insight from all colleagues.

I think you did a bad job here. Been there, done that. I understood by your first sentence that we were talking about flucloxacillin, and I seriously think you did as well, as I am a douche when it comes to antibiotics, and I don't know much about mastitis. Now you have a nurse with hurt feelings, who realizes she said something stupid, but in her mind, she will find a way to blame you for it, and that ain't helping you jack.

That is what nurses do and that's why handling it your way would've only augmented the NP's delusion of grandeur.

 

[Siggy]

Huh???

My head keeps hurting more and more with every post you write.

From looking at Wikipedia, it looks like it's just a name difference, like DMD vs DDS.

 

[JaggerPlate]

From looking at Wikipedia, it looks like it's just a name difference, like DMD vs DDS.

Then the grammar/phrasing of the posts is odd.

There is only one type of ____. A or B.


Huh?

There is only one type of ____. A/B

Shrug?? Dunno.

It really doesn't matter, just a lot of fallacies in that member's last few statements.

 

[chocomorsel]

@ the OP: You obviously have empathy and recognized the need of this wish of this nurse to both feel important and to impress others. There is little gratitude in daily work, and on top of that, nurses struggle with their positions in the hierarchy.

Why did you simply repeat fluconazole to address the ridiculous drug suggestion? What did you gain by it? Wouldn't it have been more tactically sound to give the nurse credit for her assessment, but merely suggest that she had gotten the staph drug and the fungal drug confused?

I understand everything provocative about the situation, and her defense by making not-so-subtle sarcastic comments back at you, but that is actually how people react normally. I hope you ain't gotten all that frustrated that you demand superhuman insight from all colleagues.

I think you did a bad job here. Been there, done that. I understood by your first sentence that we were talking about flucloxacillin, and I seriously think you did as well, as I am a douche when it comes to antibiotics, and I don't know much about mastitis. Now you have a nurse with hurt feelings, who realizes she said something stupid, but in her mind, she will find a way to blame you for it, and that ain't helping you jack.

Actually if you go back and re-read the post you'll see that the OP is not the one who had the conversation. It was some physician out in the UK as it was reported in the paper/blog/wherever. And it was 3am or so and the physician was just confused as he was likely tired and couldn't figure out the nurses request but knew that it didn't make sense. So he kept kept repeating "fluconazole". Later in the conversation it came to him as to what the nurse must have meant as you read later in the article and he realizes that the nurse was clearly confusing two drugs that sound alike. Anyway dude, just read the post.

 

[Eta Carinae]

Actually if you go back and re-read the post you'll see that the OP is not the one who had the conversation. It was some physician out in the UK as it was reported in the paper/blog/wherever. And it was 3am or so and the physician was just confused as he was likely tired and couldn't figure out the nurses request but knew that it didn't make sense. So he kept kept repeating "fluconazole". Later in the conversation it came to him as to what the nurse must have meant as you read later in the article and he realizes that the nurse was clearly confusing two drugs that sound alike. Anyway dude, just read the post.

I dunno, half the spats that occur wouldn't take place if people actually read posts or, God forbid, an entire thread before inserting mindless and out-of-the-way comments.

 

[Rendar5]

That is what nurses do and that's why handling it your way would've only augmented the NP's delusion of grandeur.

This is what people do. Doctors are people as are nurses, and they all have natural ways of feeling good about themselves, including getting defensive, sarcastic, uppity, etc. when challenged and realizing they shouldn't feel good about something. If you have a positive response towards a mistake, then the other person doesn't get as uppity.