Nurse and Doctor and their interaction

I have just finished another tour of duty, and I am sitting back contemplating what transpired during those past 44 hrs. Lots happened some funny some not so funny. Before I start I want to tell you what got me thinking about this. The other day I was doing my blog thing and I connected to a site of a doctor in Australia,"Jellybean". In one of her blogs she talks about nurses being terrible patients. I felt compelled to leave a comment. Well, the nice doctor did respond to my comment and was very gracious and apologetic for her comments. She recognized that she made the comments out of haste and frustration. We all get frustrated sometimes, that's ok, it's recognizing that frustration and trying to channel it in a positive manner. Nobody is perfect, doctors, nurses, lawyers, moms dads and so on. We are all human and try to do the best we can.

So here is something that upset me the other day at work with an interaction I had with a doctor.

I was tending to my patients and along comes the doctor to do her rounds. This doctor is covering for the regular GP. The doctor went in to do her assessment on the patient and came out, I was able to give the doctor my observations of the patient over the past 22 hrs I had spent with the patient. I mentioned that I felt it was not cardiac pain but rather muscle/skeletal and that our current medication regime we were using for her was inadequate. At that point a patient called and I had to leave. By the time I got back from tending to the patient's need the doctor had left and had left some orders. I processed those orders as always and told the patient that the doctor had changed her pain medication and that I was just waiting for the medication to come from pharmacy. Time passed and no medication. I contacted the pharmacist, she told me she didn't' get the order so send it again, I do. The pharmacist calls me back and says that we don't carry the medication the doctor order and that they do an "autosubstitute" I said that the patient was already on that medication and the doctor specifically wanted the medication she had ordered. The pharmacists tells me I have to call the doctor and see what else she would like. At this point one of my colleagues over hears this conversation and tells me that she told the doctor that we had that medication on formulary, and that she forgot to tell me that she had spoken to the doctor. Great I say to myself. The doctor is going to be pleased with this one. So I call the doctors office only to get an answering machine. Getting frustrated here. I call the doctor's cell, the doctor answers I tell her what happened. She was mad at me. I apologized as I had not realized that she was given that information from the other nurse in the morning. The doctor was abrupt said she was busy and said she would call me back. She called back, she was mad, said she only had 10 mins. left in the clinic that she had been there for 4 hrs and wanted to go into town to shop. I said "are you not on call for Dr. So and So's patients" " yes" she said, but that she didn't want to be disturbed while she was shopping. Oh how lovely for you I think to myself, you are on call but don't want to be disturbed while you are shopping. If I need something for the patients I am going to call you whether you are shopping or not. If you don't want to be on call then you shouldn't be on call. Anyhow, as I said she calls back. Then it is a matter of getting someone in pharmacy to talk to her. I call pharmacy overhead to get them to call me while I have the doctor on hold. The pharmacist calls gives me a number that she can be reached at. I dial the number to connect the doctor. Oooops the pharmacist calls me back to tell me she gave me the wrong number. I say to late I already transferred doctor grumpy to that number and that she will have to call the doctor herself.
Oh my goodness. You know I was just trying to do my job and to be a patient advocate. It took me a couple of hours to get that all straightened out and it did get straightens out in the end. You know that is only one of the things I have to deal with in a 12 hr. shift.

Here's another one. We get this patient unexpectedly to the unit. The doors fly open and in comes the recovery nurse with the a doctor pushing the patient....the doctor gives the bed one last good push through the door and leaves. The recovery nurse is so upset. She says you are not going to believe what just transpired. Apparently, this patient we got was a post op hip but went into rapid atrial fibrillation post op. The anesthesiologist wants to treat the rhythm and stabilize the patient before he sends the patient to ICU. The surgeon and the anesthesiologist get into a pissing match because the surgeon wanted to do the trauma patient in emergency department and they needed to get rid of the post op hip. Well tempers flew, thank goodness the patient was sedated and extremely hard of hearing as this went on all around the patient. Oh how unprofessional is that. Normally what would have happened the patient would have been connected to a monitor for transport and everything that goes along with it but in this case nothing like that happened. She came with the doctor she didn't even have time to get the patients records to relay information to the ICU nurse. It was awful. The nurse was caught in the middle of the doctors pissing match and the patients needs as far as I am concerned were ignored. Anyhow, we got the patient settled, the internist came and gave us orders and things worked out for the patient in the end.
That same evening we get the trauma, accompanied this time with a doctor as the patient is on a ventilator. Lots of complications. This patient was still bleeding. Very low hemoglobin needed blood. Low BP, tachycardic and in pain. He needs to be medicate, and given volume and monitor chest for fld overload. The nurse try as she might can't get a hold of the surgeon. So call the internist on call to get orders. No such luck. The internist won't see the patient even though he is on call because he was not consulted. So try as she might she can't get a hold of the surgeon. So what does she do, she gives the patient volume, medicates him and , listens and hopes for the best and that the doctor if she ever hears from him won't be mad that she took those actions. She was able to stabilize the patient. She didn't hear back from the doctor for almost 4 hrs. He had fallen asleep, didn't hear his pager and his cell was in his car. Wow!!! If the surgeon wasn't so pig headed and rushed out of the department as quickly as he did, he could have consulted the internist oncall who could have tended to this patient and the surgeon could have had his sleep.
As nurses in the ICU we work as a team. If one of our colleagues needs help we are there for them and do whatever we can, as we see it is all about what is best for the patient. I just don't know why the surgeons and the GP's and the internist can't communicate it would make our lives so much easier and that of the patients.

Oh just another day in the life an RN......hope you all have a good one ...cheers......