Patient's family being d!cks

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W222

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My experience last call. I am in the last hour of a 24 hours OB/LD call and I get called to place an epidural. Pt is a G1P0 in active labor with 10/10 pain. It has been a very busy call with a few serious cases and ton of run of the mill sections/epidurals. After starting at 6:45am I didn't eat or get a break until 3:00pm, but luckily I got a solid 3 hour nap. I wake up, splash water on my face and go see the patient. I walk in and introduce myself as the resident and patient decides to have husband leave and wants mom there for epidural...whatever. When going over her medical hx, patient keeps looking at her mother and mom has this disgruntled look on her face. Patient is the most cheerful person I have ever seen in 10/10 pain. I get setup and inject local, pt is squirming everywhere. I find a nice space, but patient keeps complaining of pain. Pain left, pain right.... no matter where I redirect. I try another space and can't get it. Pt keeps c/o pain. I infiltrate with more local, mind you this woman probably couldn't feel her entire back with the amount we had put in there. Person more senior than myself takes it and misses in first two spots. Gets it and we are out. I am out of the room two minutes and mom is walking down the hall with hubby saying..."That first guy didn't know what he was doing...I wanted someone who knew what they were doing...blah blah blha" She had to have known I was there, I was standing not a foot away.

Now my question is, do these people not f@cking realize that we have their family member's lives in our hands? Don't they realize the things we do are not easy and that we have their family members lives in our hands? Now, if I were to ever have a procedure I am certain that the first thing I would do would be to piss off the one person keeping me alive and comfortable. WTF?
 
Wait until you get in to private practice. When the patient goes home they will get in the mail a Press Ganey opinion survey. (Provides patient satisfaction surveys, management reports, and national comparative databases for the integrated health care delivery system.) They can fill it out and comment about how they felt about you. This is sent back to the hospital where it is often the measure used by administrators to determine the salaries of mid level administrators, thus more important than the quality of the patient care you deliver. It also is a convenient way to find a reason to fire you. If you treat a hundreds of patient a month and a ½ of a percent write something negative about you. Then the administrators will have three serous complains about you after six months, plenty of ammunition to fire you any time they want.

Almost every where I have been has a rule about the number of family members in the room when the epidural is placed. Unfortunately the rule is seldom enforced by nursing since they want Anesthesia to be the bad guy by forcing the family to leave the room which invariably gets you written up on the Press Ganey opinion survey, as mean and insensitive.
 
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Family should never be present in the room to watch an epidural.
It's simply not helpful and causes the patient to act more hysterical.
We do a delicate job at a very dire time when placing a labor epidural and we should not add family dynamics and emotional issues to that already crappy situation.
 
sonn said:
Wait until you get in to private practice. When the patient goes home they will get in the mail a Press Ganey opinion survey. (Provides patient satisfaction surveys, management reports, and national comparative databases for the integrated health care delivery system.) They can fill it out and comment about how they felt about you. This is sent back to the hospital where it is often the measure used by administrators to determine the salaries of mid level administrators, thus more important than the quality of the patient care you deliver. It also is a convenient way to find a reason to fire you. If you treat a hundreds of patient a month and a ½ of a percent write something negative about you. Then the administrators will have three serous complains about you after six months, plenty of ammunition to fire you any time they want.
Click to expand...

Sounds like you are speaking from experience. 😉

Our hospital prints the good reviews in the monthly newsletter. I'm sure they are keeping tabs of the poor ones as well but I've never seen any.

W222, don't worry about it. THe more you do these procedures the better you will be at handling these tougher cases (and their families).
 
50 or 100 mcg of fentanyl for mom goes a long way in helping her sit still. If she can't get it together to sit still, she's not getting an epidural. I've used the threat many times. Somehow, through the 10/10 pain, they all manage to sit still after that.👍
 
Not to mention the case I heard about awhile back about a husband who stayed in the room for moral support. He even helped hold his wife's hand. He had a vagal response and bumped his head and ended up dying from complications. Major lawsuit ensues due to the husband now being a
"de facto" employee since he was doing some hand holding. Long story short, less is more (when it comes to family). Keep out.
 
Thus is some good advice. In training we would limit family to one person "supporting/holding" the parturient during epidural placement. This was because the RN "had to chart" during the procedure. I call BS on a bad practice. We never had OR epidurals placed with a family member even if it was placed in preop before heading to OR. The labor epidural with family was also a part of the touchy-feely support thing. Now that I think about it, it really is a lawsuit waiting to happen.
 
sonn said:
Wait until you get in to private practice. When the patient goes home they will get in the mail a Press Ganey opinion survey.
Click to expand...

I'm in academics and we are subject to Press Ganey surveys too. We usually do pretty well.
 
I don't have a daughter, but I have a wife and two sons. I can feel your pain bro, but I also sympathize with the mother. During the delivery of my two boys I requested the supervising ca3 and the attending to do her epidural and spinal. Didn't want the jr resident for our first. For the second, I didn't want my co-resident (who was excellent) to see my wife's butt.
I had the pediatric plastics fellow stitch my younger kids eyebrow when he face planted.
It is a privilege to have had 1000s of willing pts allow me to learn anesthesia. Especially the 10/10 pain laboring pts when I did my first epidurals. Now that i can bang one in and not fumble like even the best residents do, I am even more thankful.
Sorry you had a rough call and bad experience. But put it in perspective. If you think you were under stress, imagine what it was like to be the patient and mom. Having a baby, and seeing one you love and have devoted your life to protecting suffering, can make good people say bad/stupid things. You'll see plenty of wives bitch their husbands out with each contraction--and 5 minutes later profess their love for you and your most recent epidural.
Cheers,
Tuck
 
urge said:
If it makes you feel better, chances are they are not paying their bill either.

😡
Click to expand...

That makes me furious! Patients that aren't paying for healthcare should get techs doing their procedures. Where the hell do people get off thinking that they are entitled to healthcare according to their preferences that intend NOT to finance! Obama sucks. Please unite in the vote against his reelection in 2012.
 
If you think the pain is legit give more local if as you say her whole back is numbed than push through the pain. If she moves tell her she has i big fat needle in her back ready to enter her spine and that you'll split if she can't hold still.

A good trick to know is if you have proximal bone contact (spinous process) redirect up/down if distal bone contact (lamina) redirect left/right.

OB is a nut house don't sweat it.
 
Now my question is, do these people not f@cking realize that we have their family member's lives in our hands? Don't they realize the things we do are not easy and that we have their family members lives in our hands? Now, if I were to ever have a procedure I am certain that the first thing I would do would be to piss off the one person keeping me alive and comfortable. WTF?
Click to expand...


Relax. They do not realize anything - those are stupid people, whose main guidance in life is TV and it's shows plus celebrity gossip.
 
I think the worst part about OB, in addition to what's being mentioned here, are the friggin' laboring teenagers, cursing and moaning. I don't care about "cultural sensitivity." Eighteen year olds should not be having kids. What say we pass a universal law: if you're under 21 and having kids, no epidural, and a free BTL? That'll make 'em think twice before getting knocked up by the local neighborhood hoodlum who's never around for the delivery anyway!
 
soorg said:
I think the worst part about OB, in addition to what's being mentioned here, are the friggin' laboring teenagers, cursing and moaning. I don't care about "cultural sensitivity." Eighteen year olds should not be having kids. What say we pass a universal law: if you're under 21 and having kids, no epidural, and a free BTL? That'll make 'em think twice before getting knocked up by the local neighborhood hoodlum who's never around for the delivery anyway!
Click to expand...

Won't work 😀

Teenagers will stop having babies if the government will stop rewarding them for that by taxpayer's money - plain and simple. You will be surprised how the teenage population wise up in a blink of an eye if there is no buck visible.
 
W222 said:
My experience last call. I am in the last hour of a 24 hours OB/LD call and I get called to place an epidural. Pt is a G1P0 in active labor with 10/10 pain. It has been a very busy call with a few serious cases and ton of run of the mill sections/epidurals. After starting at 6:45am I didn't eat or get a break until 3:00pm, but luckily I got a solid 3 hour nap. I wake up, splash water on my face and go see the patient. I walk in and introduce myself as the resident and patient decides to have husband leave and wants mom there for epidural...whatever. When going over her medical hx, patient keeps looking at her mother and mom has this disgruntled look on her face. Patient is the most cheerful person I have ever seen in 10/10 pain. I get setup and inject local, pt is squirming everywhere. I find a nice space, but patient keeps complaining of pain. Pain left, pain right.... no matter where I redirect. I try another space and can't get it. Pt keeps c/o pain. I infiltrate with more local, mind you this woman probably couldn't feel her entire back with the amount we had put in there. Person more senior than myself takes it and misses in first two spots. Gets it and we are out. I am out of the room two minutes and mom is walking down the hall with hubby saying..."That first guy didn't know what he was doing...I wanted someone who knew what they were doing...blah blah blha" She had to have known I was there, I was standing not a foot away.

Now my question is, do these people not f@cking realize that we have their family member's lives in our hands? Don't they realize the things we do are not easy and that we have their family members lives in our hands? Now, if I were to ever have a procedure I am certain that the first thing I would do would be to piss off the one person keeping me alive and comfortable. WTF?
Click to expand...

What you posted has happened to EVERYBODY. The advice I can give you is:
1) Since grandma had it out for you from the begining, I think you prolly showed weakness/ lack of confidence. Next time walk in there like you've done a thousand of them, dont use a high pitched cressendo voice when speaking, make it firm, confident, and to the point. Its a show, and youre the star, act like one.

2) Dont cuss and get angry when you cant get the space, make light of it with the family, frame it as a challenge, let them know you will win, you always do.

3) Remember those who contribute the least and are a negative influence in the world, are not only statistically more likely to be poping out babies, but even more likely to be at your (academic) hospital. You will find out that, on average, those who contribute the least always feel as though they are entitled to the best. Dont let it bother you. After the baby is delivered, they have to go back to their lives, when the call is over you go back to yours. And yours is MUCH better.

4) Most importantly, dont ever tell someone you need more practice, or you are practicing on them.
 
First thing I list in "risks" is failed or partially failed block. I tell patients that about 5% of people we can't get comfortable. When I get a patient for whom I can't get the space, or who gets a one sided block, "you are part of the 5% I told you about" My failure rate is lower than that, but I like underselling the epidural.
 
DreamMachine said:
One approach I occasionally use is to walk in there and play up the difficulty of the epidural.

"This is a blind procedure blah blah." "The epidural space is very narrow blah blah." "For some people it's impossible to get an epidural blah blah." "Many people get one sided blocks blah blah." Etc. Etc.

Then you do the epidural. Usually, I hit it first time and they think I'm a f*cking God. If it takes a while, they still think I'm the Bees Knees for doing something that is "clearly ridiculously difficult." The art is picking which customers to use this approach on. If the patient is an anesthesiologist, for example, they will think you are ******ed.
Click to expand...
👍👍
 
wow 12 posts in and we've dragged obama into yet another thread that he has nothing to do with.

I agree dreammachine on this one. The key to anesthesia and especially ob is to underpromise and overdeliver, that way you look like a rockstar for just doing your job. Whenever a patient moves i always stress that an epidural is an elective procedure and if she can't sit still, it will be too dangerous to proceed. Also make sure they realize how close your needle is to their spinal cord (even though its prolly a few levels below) that always seems to get em to sit still.
 
Planktonmd said:
Family should never be present in the room to watch an epidural.
It's simply not helpful and causes the patient to act more hysterical.
We do a delicate job at a very dire time when placing a labor epidural and we should not add family dynamics and emotional issues to that already crappy situation.
Click to expand...

I don't entirely disagree - but do you personally permit dad or grandma or that random friend in the room during epidural placement? What about in the OR during c-sections?

Epidurals are delicate, sure ... but are they really more delicate than a c-section?
  • "Oops I think that was a ureter ... and is that a hole in the bladder? Sterile milk please!"
  • Newborn needs resuscitation. Dad: "why isn't the baby crying? why isn't the baby crying? why isn't the baby crying? why isn't the baby crying? why isn't the baby crying? why isn't the baby crying? why isn't the baby crying? why isn't the baby crying?"
  • Suction goes ominously silent for a very long time ...
  • Dad: "what's that smell? are they burning her flesh?"
Family dynamics and emotional issues suck worse then, but everyone everywhere I've been permits another person in the OR for moral support.
 
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Narcotized said:
Who knows, maybe they overheard those insane views of yours that Obama has us on the right track with propping up failed companies, socializing losses, and bankrupting our way to prosperity. Heck, that would be enough to make me question if someone knew what they are doing. 🙂🙂
Click to expand...



😆
 
ssmallz said:
wow 12 posts in and we've dragged obama into yet another thread that he has nothing to do with.
Click to expand...
What was this guy thinking doing this right smack in the middle of the dawning of the age of hopequarius?

The OP failed to mention that dad was proudly wearing an Obama T shirt.

obey-obama-yes-we-did-tshirt-1.jpg
 
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They should not be allowed to watch the C section either but they are, and we can't change it because somehow it became the standard practice as you mentioned.
But If for some reason we need to convert to GA we kick them out.
As for epidural placement no one can force you to have family members watching since it's still acceptable to ask them to leave, so if you decide to keep them and they act crazy then this was your choice and you should not blame them.


pgg said:
I don't entirely disagree - but do you personally permit dad or grandma or that random friend in the room during epidural placement? What about in the OR during c-sections?

Epidurals are delicate, sure ... but are they really more delicate than a c-section?
  • "Oops I think that was a ureter ... and is that a hole in the bladder? Sterile milk please!"
  • Newborn needs resuscitation. Dad: "why isn't the baby crying? why isn't the baby crying? why isn't the baby crying? why isn't the baby crying? why isn't the baby crying? why isn't the baby crying? why isn't the baby crying? why isn't the baby crying?"
  • Suction goes ominously silent for a very long time ...
  • Dad: "what's that smell? are they burning her flesh?"
Family dynamics and emotional issues suck worse then, but everyone everywhere I've been permits another person in the OR for moral support.
Click to expand...
 
tucker27705 said:
I don't have a daughter, but I have a wife and two sons. I can feel your pain bro, but I also sympathize with the mother. During the delivery of my two boys I requested the supervising ca3 and the attending to do her epidural and spinal. Didn't want the jr resident for our first. For the second, I didn't want my co-resident (who was excellent) to see my wife's butt.
I had the pediatric plastics fellow stitch my younger kids eyebrow when he face planted.
It is a privilege to have had 1000s of willing pts allow me to learn anesthesia. Especially the 10/10 pain laboring pts when I did my first epidurals. Now that i can bang one in and not fumble like even the best residents do, I am even more thankful.
Sorry you had a rough call and bad experience. But put it in perspective. If you think you were under stress, imagine what it was like to be the patient and mom. Having a baby, and seeing one you love and have devoted your life to protecting suffering, can make good people say bad/stupid things. You'll see plenty of wives bitch their husbands out with each contraction--and 5 minutes later profess their love for you and your most recent epidural.
Cheers,
Tuck
Click to expand...

If you dont want "beginners" learning how to do procedures on you, there's an easy answer to that -- go to a private community non-teaching hospital. As a doc, you know where these places are.

You go to an academic hospital, you get no choice. You want access to the super subspecialists? You have to deal with residents. You dont like it? Have fun letting the general surgeon or ER doc at the private hospital do it instead of the pediatrics plastic surgeon sew up your kids' lacs.

You want subspecialized care, you are going to deal with residents, period.
 
DreamMachine said:
Lol. I remember being a surgery intern on plastics, sewing up lacs cause the ER consulted "plastic surgery."
Click to expand...

I did this also. Guy fell face first into a granite curb and he was on coumadin. Wife says,"I'm sure you are very good but shouldn't a plastic surgeon be doing this." Mind you I am at a very nice hospital in a very afluent area. So I say,"Actually, it would take the plastic surgeon about three or four hours to finally come in and that is if they even bother taking the consult." I then made this guys face look amazing, 30 odd stitches and bleeding like stink.
 
sonn said:
Wait until you get in to private practice. When the patient goes home they will get in the mail a Press Ganey opinion survey. (Provides patient satisfaction surveys, management reports, and national comparative databases for the integrated health care delivery system.
Click to expand...

I didn't know anything about these until my intern year, when several people apparently wrote me glowing reviews. Then this past year I found out that a complaint was filed against my team by a woman who was, along with her family, completely insane. She is now sueing both the anesthesia attending and surgeon for nerve injury, even though its documented she didn't follow the surgeons orders to wean a brace following her procedure and to attend rehab.
 
Are we hijaking this into a "stuff I probably had no business doing as an intern but did anyway" thread, 'cause I'm in.

I was the intern on call on the ENT service and it was our week for facial trauma call (we divide it with plastics). Get called by the Peds ED for kid vs. car. 11 y/o kid with eyelid and eyebrow both split from side to side and both parents in the room. I called the Sr. on back-up on the way in to ask "how do I sew up an eyelid". Don't ask, don't tell is my motto when it comes to learning on pt's (as long as I don't think I'll do more harm than good). Kid looked like a million bucks at the end.
 
DreamMachine said:
One approach I occasionally use is to walk in there and play up the difficulty of the epidural.

"This is a blind procedure blah blah." "The epidural space is very narrow blah blah." "For some people it's impossible to get an epidural blah blah." "Many people get one sided blocks blah blah." Etc. Etc.

Then you do the epidural. Usually, I hit it first time and they think I'm a god. If it takes a while, they still think I'm the Bees Knees for doing something that is "clearly ridiculously difficult." The art is picking which customers to use this approach on. If the patient is an anesthesiologist, for example, they will think you are ******ed.
Click to expand...

I have to try that. I love OB but I realize that there is a lot of social psycho interplay. Sometimes there are issues that we have no way of knowing about going on.

In general family members get in the way and are more disruptive than helpful.

Cambie
ps. If a pt is unable to sit still she cannot receive an epidural.
 
when interviewing the patient fasto tries to get a feel for the family, of course he introduces himself to them , makes eyecontact and shakes hands, should fasto feel that the family or friends are hostile /stupid/generally unhelpful or all of the above he will ask them politely to leave as the groupdynamics usually deterioriate as soon as the epidural is difficult to place or complications ensue. fasto feels that the key is to be determined but polite, should the family refuse to leave they are informed in a nonthreatening manner that fasto will be happy to return and place the epidural once his requests have been met...😀
fasto
 
I normally let the family stay, but if I sense they are gonna be jerks I will use the "slightly increased chance of infection with more people in the room" line. Probably should not be done if the nurse just told them that we always let the family stay though.
Also, if the patient is squirming I do my epidurals in the lateral position, then they can only move in one dimension. Not much to do about the pain with every move of the needle thing, except to try harder, use more local, or figure out if they are really feeling pressure they dont like.
 
not only was this guy in the room, he was allowed to record it.

[YOUTUBE]http://www.youtube.com/watch?v=AaG_fyseqDQ[/YOUTUBE]
 
You guys have got it rough! We routinely let one familt member stay on the non-operative side for moral support, though we are very clear about their role. Next step, Remifentanil, 10 mcg/mL given in 10-20 mcg boli until patient does not care how many times you stick. Works like magic, but you probably need a special deal with pharmacy.
 
Why would you have trouble with any procedure/diagnosis/medical issue? You're a doctor, aren't you? Doesn't that mean you can fix anything instantly?
 
Planktonmd said:
Family should never be present in the room to watch an epidural.
It's simply not helpful and causes the patient to act more hysterical.
We do a delicate job at a very dire time when placing a labor epidural and we should not add family dynamics and emotional issues to that already crappy situation.
Click to expand...

good pearl for many aspects of medicine
 
Sorry, but my opinion of the members of this forum has taken a substantial dive after reading this thread. You have all succeeded in sounding like the arrogant and insensitive windbags that most patients think you are. I know our jobs can be stressful, especially on OB with an awake pt, but seriously, wake up and smell the roses.
Before you post anything in an anonymous forum, read it and ask yourself if you would be comfortable allowing your parents and a jury to read it. If not, ask yourself why.
This thread is officially entitled "Patient's family being dicks." I think it ended up "Physicians being dicks."
Very sincerely,
Tuck
 
tucker27705 said:
Sorry, but my opinion of the members of this forum has taken a substantial dive after reading this thread. You have all succeeded in sounding like the arrogant and insensitive windbags that most patients think you are. I know our jobs can be stressful, especially on OB with an awake pt, but seriously, wake up and smell the roses.
Before you post anything in an anonymous forum, read it and ask yourself if you would be comfortable allowing your parents and a jury to read it. If not, ask yourself why.
This thread is officially entitled "Patient's family being dicks." I think it ended up "Physicians being dicks."
Very sincerely,
Tuck
Click to expand...

🙄

Biff
 
tucker27705 said:
I know our jobs can be stressful, especially on OB with an awake pt, but seriously, wake up and smell the roses
Click to expand...


I've never encountered roses to smell on OB.

Only placenta.

And meconium.

And occasionally stale stinkweed from the baby's daddy's clothing.
 
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