DRshooter

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Hello all,
I'm a Surgical intern rotating on vascular surgery this month. Something happend while I was on call this friday.
There is an 87 year old female patient with PVD that has foot gangrene. She had her right leg amputated in 2002 and this one in going to go for an amputation soon, her WBC are rising and atempts to revascularize the foot failed....it's dead...
When I rounded in the evening I noticed that the Daughter was a little uncomfortable with me, even though I go out of my way to be extra nice to my patients. I D/C'd her vanko b/c of a rash and gave her some benadryl..everything fine so far. In my rounding in the morning, I did a quick physical and then told the patient that I would discuss my findings with staff(WBC 23, temp rising). The daughter then interferes and says that the patient has her own doctors and that I don't have to discuss anything. The patient, who is not confused and seems pretty sharp to me tells me that she wants to know whats going on and what her treatment options are. Tha daughter interferes in a rude way and doesn't let me answer.
I took her out of the room and told her that the patient has a right to know.
I then got told off by this person and told to mind my own business, etc.
I left, wrote a note about this and told my fellow.
My question is this...should I have told the patient (I didn't)?
Nursing is fed up with the daughter who seems to have some sort of personality disorder. What can be done about this? Will staff stand up for me or be pissed at me for standing up for this nice old lady?
 

docB

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As the intern you are totally justified in kicking this one up the chain of command and having your seniors/attending deal with this. This is one of those situations that can get really ugly and (if you have them) should also have social work and risk mgmt involved.
 

Faebinder

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docB said:
As the intern you are totally justified in kicking this one up the chain of command and having your seniors/attending deal with this. This is one of those situations that can get really ugly and (if you have them) should also have social work and risk mgmt involved.

Absolutely... send it up the chain of command... this is way too risky for an intern to risk his/her neck on. Tell them the story in detail from your side, make a note in the chart on exactly what happened.
 
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DRshooter

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Faebinder said:
Absolutely... send it up the chain of command... this is way too risky for an intern to risk his/her neck on. Tell them the story in detail from your side, make a note in the chart on exactly what happened.
That's what I did. But I can't stop feeling rotten about being told off by this person. I'm always respectful of everyone, being disrespected really gets under my skin. I guess I'll have to learn to deal with it.
This woman is even interfering with Doctors Orders...telling the nurses.."give her half of the metoprolol instead..." and then complaining when the mother's BP shoots up. A real piece of work this lady.
 

ekydrd

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DRshooter said:
That's what I did. But I can't stop feeling rotten about being told off by this person. I'm always respectful of everyone, being disrespected really gets under my skin. I guess I'll have to learn to deal with it.
This woman is even interfering with Doctors Orders...telling the nurses.."give her half of the metoprolol instead..." and then complaining when the mother's BP shoots up. A real piece of work this lady.
Nursing should be instructed to follow the doctor's orders, not the daughter's... unless she has completed 4 yrs med school and a residency that makes her more qualified than the attending she should not have the say as to med administration.

As for disrespectful people... expect them at all levels... patients, family, staff, and (gasp) even other doctors. Document... document... document. Just remember that your notes are fair game for the court room. Be sure your notes are truthful, non-judgemental, written in proper grammer, and accurately depicts the events, without name-calling or character bashing.
 

docB

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DRshooter said:
That's what I did. But I can't stop feeling rotten about being told off by this person. I'm always respectful of everyone, being disrespected really gets under my skin. I guess I'll have to learn to deal with it.
This woman is even interfering with Doctors Orders...telling the nurses.."give her half of the metoprolol instead..." and then complaining when the mother's BP shoots up. A real piece of work this lady.
You'll get used to people treating you like crap. That sounds bad but it's true. There are lots of people with axes to grind against the medical system, people who are frustrated about their problems (health and otherwise) and people who are just insane who like to lash out at who ever is nearby.
 

PainDr

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Agree with all of the above. However, I recommend a more proactive and protective strategy. Your institution should have a patient advocate available 24/7. It is their job to intervene in such a situation. I've even called them in late at night or on the weekend (two or three times during 5 yrs of post grad training). It is their job to get the daughter under control and ensure that the patient gets the care she needs. Once we (they) even had to threaten a family with expulsion from the facility (forcibly if necessary) if they continued to interfere with treatment.

DO NOT get involved in this situation any more than you already have. If you haven't done so already, write a DETAILED note in the morning. Date it currrently and state that the note reflects the events of (fill in the date). I would call the charge nurse RIGHT NOW and have them page patient advocacy (or risk management, or whatever term your facility uses) so they can be aware of the situation. They won't have anyone inhouse, but will have someone on call who can call you back or come in if necessary. In addition to protecting both the patient and the staff, they're very good at letting people vent and getting to the bottom of any problems (real or percieved).

Every time I was faced with this type of situation, I was proactive and immediately called our patient advocate. They were always glad I called and always took control. Also, my attending was always relieved that I'd taken control of the situation in the appropriate way. I would usually inform them the next day, however, as an intern, you should probably call your senior and make them aware of the situation. PROTECT THE PATIENT AND PROTECT YOURSELF!

EDIT: I reread your post and noticed that you've already informed your fellow. I hope he/she called risk mgmt. It's NEVER wrong to call them and if nothing else, give them a heads up.
 

Jocomama

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I concur with all the posts on this thread, except one note on PainDr - focus on his last statement.

Do NOT do anything - do not engage daughter. Just say, "yes, ma'am"
Your chief will instruct
I do NOT suggest you personally get patient advocate, risk management nor anyone involved. It is 110% up to your Sr Resident/attending.
Support your nurses in any and all ways possible
And like all post - document,
Leave OUT any and all adjectives, emotions. Just data.

There are crazy people in this world. Accept them, pray for them, and move onto next patient.

DRshooter said:
That's what I did. But I can't stop feeling rotten about being told off by this person. I'm always respectful of everyone, being disrespected really gets under my skin. I guess I'll have to learn to deal with it.
This woman is even interfering with Doctors Orders...telling the nurses.."give her half of the metoprolol instead..." and then complaining when the mother's BP shoots up. A real piece of work this lady.
 

PainDr

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Just to clarify, it really does depend on your program. The way my training (residency and fellowship) was structured, we didn't have a senior, other than our attending. We had a great deal of autonomy and were expected to function at a high level.

However, the above poster is certainly correct...one should ALWAYS follow the designated chain of command.
 
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