Seniors' Fault???

[ENTSteven]

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If your senior does something and you think he/she is outrageously wrong and you think is compromising patient care, what would you do?

I want honest answer not politically correct answer!

 

[Starflyr]

Well, it depends on the situation.

If it were a treatment decision, I would wait until I had a couple seconds and try to pull that person aside and ask politely "With Mr X's issue, and the thing you just ordered, isnt there a contraindication based on ........? Am I misunderstanding the reasons for this? Thanks" And if there IS a reason (whicn there can be in some situations), it might be explained to you. You might also have brought up a very good point in a respectful way. If it's something that if you dont speak up RIGHT THEN, speak up, but again, put it as a question so that the upper-level doesnt think you're overtly questioning his/her judgement obviously in front of the patient.

Star

 

[Winged Scapula]

I do as Star suggests: I phrase it so it sounds as if I don't understand (which I may very well not).

If the explanation still sounds bogus, I might comment about the action when rounding with the attending (ie, "so we did this..."), but would be very careful - obviously if the action was an error with significant impact on patient outcome then something needs to be said, BUT if mentioning it to the attending is required you need to do it carefully. You wanna protect the patient but not "rat out" your Chief/senior.

 

[ArrogantSurgeon]

The best advice is to make a huge scene out of it in front of the patient and the attending, preferably the departmental chief or residency director. That will ensure that the senior will be kept on his/her toes about correct patient management the next time around. Even if you are completely wrong that's OK since everybody will appreciate your honesty and proactive patient advocacy. This will undoubtedly do wonders for the working environment since everybody will try their hardest to provide optimal patient care in order to avoid another one of your outbursts.

 

[Rads Resident]

I agree with ArrogantSurgeon. I would also advise you to then turn to the patient and recommend a lawyer friend of yours.

 

[shag]

AS obviously knows the game well, but his effort will only get ya a B+. If you want the A, make sure to bring it up with consultants in the room. For ex, if on surg, make sure to bring it up when your surg team bumps into the medicine fleet in the pt's room. Also, make sure the pt has several family members in the room in case he/she is too out of it to remember the error. For bonus points, give the name of an attorney that has been successful in sueing your attending.

 

[Renovar]

Originally posted by shag
AS obviously knows the game well, but his effort will only get ya a B+. If you want the A, make sure to bring it up with consultants in the room. For ex, if on surg, make sure to bring it up when your surg team bumps into the medicine fleet in the pt's room. Also, make sure the pt has several family members in the room in case he/she is too out of it to remember the error. For bonus points, give the name of an attorney that has been successful in sueing your attending.

That's solid reasoning, but not quite the A material yet. To go that extra mile, make sure you photocopy every page of the chart and underline the pertinent error with a highlighter and the pertinent housestaff and attending name on the chart with a different color highlighter. If it is not clear, make it up, or write in your own interpretation of it. Since we are in an era where the patient should have the right to his medical record, make sure you gave the patient the whole set of photocopies, complete with the business card of an attorney, and offer the patient that you will be their witness should they appear on the court. You will certainly get an A+ on being organized, creative (as in writing your own interpretation), good to the patient, being the patient's advocate, as well as having good integrity. THose are the kind of comments you want on your Dean's letter. To make sure that the same mistake is not made ever again for good measure, go early to your next Morning Report / Grand Rounds and plaster each pertinent page with appropriate highlighting in the front board and/or make many copies of it for everyone to take at the door. Then, in the middle of the session, raise your hand and bring everyone, including the department chair or any visiting distinguished speakers to the attention of those lovely patient-chart handouts you made. Hopefully this will go to the end of furthering the quality of patient care.

 

[supercut]

.....And don't forget to add the error to the M&M schedule!