Monday, July 21, 2003
KEEP THE CARDS AND LETTERS COMING.....
My pet peeves post has certainly generated alot of traffic....
Dr. Smith sent along this gem...
Same pet peeves. But I don't feel so insulted by the phone/television issue ever since I saw a patient do the same thing to her priest.
She was in the ICU, so I had a full view of her room from the nursing station where I was writing her transfer orders to send her to the floor. She was talking on the phone and watching television while the priest gave her the bread and wine of the Eucharist - on Easter Sunday. And as he walked away from the room, she was still chewing on the Host as she talked on the phone. Unbelievable.
This led to an interesting comment on another site about the theological problems can can be brought on by tele-communing (heh). I think you get to spent eternity in an exam room. With only a paper gown. With the thermostat at 60 degrees.
Dr.Rangel also expands on the pet peeves...
For many patients you would never have thought that they had ever had the modern convince of having a personal phone (to say nothing of a cellular phone). To a certain extent this is understandable since hospitalization is often a very stressful and lonely experience but considering that fact that they have almost nothing to do for hours out of the day it is always astounding that at the exact moment I walk into a patient's room they are engaged in a personal conversation that just cannot be interrupted, even by their physician! Then you are faced with an uncomfortable situation. How long to you stand at the head of the bed waiting for the patient to grant you an audience as if they were the King of Siam? Often I will wait about 30 - 60 seconds and then start talking. If they missed what I said then too bad. I'll be back in the morning. Maybe then they will be off the phone.
even better....
The most dangerous family member is the one with just enough medical training or background to be annoying and not enough knowledge or understanding of the care of the medical patient to completely grasp and appreciate the complexities and limitations of modern health care. In my experience this usually involves family members who are ancillary medical professionals such as physical therapists, respitory technologists, LVNs, lab techs, or anyone who has spent too much time looking up medical information on the internet. They often appear to feel that they are qualified enough to critique every detail of the patient's medical care. It's not that I don't appreciate the attention and concern that they have for their family member but when they become confrontational it can undermine the trust and security of the doctor-patient relationship. Ironically I have never had a problem with family members who are themselves physicians. I think that this is because we are on the same level and they understand these issues involved.
The GruntDoc sent this in.....
1) The Holiday Nursing Home Dump: concerned relatives visit granny/uncle Whoever in the Home and are Shocked! Shocked! how bad they look; it's only been about 6 months since they saw them last. The NH staff cannot stand in the way, and the NH doc isn't coming in for any reason. To the ER! Huge, pointless workup = back to the NH, after the family goes home.
2) We have TV's in some rooms. I just turn them off, tell them I cannot stand the extra noise. Nobody has complained yet. I turn them back on when I leave, cuts down on the nurse calls.
3)My biggest peeve: "Do you have any samples"? What I hear: I can't pay for the meds, why should I pay you? (No samples).
4) Back in the Resident days, on Trauma, we'd tell them: elect a Spokesperson, give them a list of questions, we're not going to have 15 briefs a day (which they all get something different out of, compare notes, and decide you're giving different stories to different people).
I did some moonlighting in a small ER about 45 minutes from where I trained. It was the scene of many a Sunday nursing home dump. Same circumstances as above. But I found it really hard to send them back when they came with a packed suitcase. I worked as a unit clerk in an ED while in college and the nurses hated the televisions in the room because the patients would come in and "camp out".
Even the paramedics had something to say.
So with great fanfare I CONTINUE THE LIST.....
6. THE NINTENDO/PLAYSTATION/X-BOX: Same as THE TELEPHONE but with a different age group. Just pause the game!!
7. THE ABSENT PARENT/GAURDIAN/MPOA: I try to get to see a consult within an hour or two of my being called. If I am going to be late I call the nurse's station. I go up to see a minor or a patient who cannot make a medical decision themselves and there is NO ONE THERE. This involves a trip back to the hospital room when someone shows up. Under a very limited set of circumstances (emergency, great distance) I will handle this over the phone. Most often I set up a time to meet someone and discuss it.
8. SURPRISE!!! I'M YOUR SURGEON: I go see a consult...and the patient has no idea I am coming to see them. Really bad when I am consulted for operative management of a malignancy, and their primary care MD has not told them of the diagnosis. I have to deliver enough of my own bad news, I'm not going to be the heavy for someone else.
Thanks for all the feedback!! |
My pet peeves post has certainly generated alot of traffic....
Dr. Smith sent along this gem...
Same pet peeves. But I don't feel so insulted by the phone/television issue ever since I saw a patient do the same thing to her priest.
She was in the ICU, so I had a full view of her room from the nursing station where I was writing her transfer orders to send her to the floor. She was talking on the phone and watching television while the priest gave her the bread and wine of the Eucharist - on Easter Sunday. And as he walked away from the room, she was still chewing on the Host as she talked on the phone. Unbelievable.
This led to an interesting comment on another site about the theological problems can can be brought on by tele-communing (heh). I think you get to spent eternity in an exam room. With only a paper gown. With the thermostat at 60 degrees.
Dr.Rangel also expands on the pet peeves...
For many patients you would never have thought that they had ever had the modern convince of having a personal phone (to say nothing of a cellular phone). To a certain extent this is understandable since hospitalization is often a very stressful and lonely experience but considering that fact that they have almost nothing to do for hours out of the day it is always astounding that at the exact moment I walk into a patient's room they are engaged in a personal conversation that just cannot be interrupted, even by their physician! Then you are faced with an uncomfortable situation. How long to you stand at the head of the bed waiting for the patient to grant you an audience as if they were the King of Siam? Often I will wait about 30 - 60 seconds and then start talking. If they missed what I said then too bad. I'll be back in the morning. Maybe then they will be off the phone.
even better....
The most dangerous family member is the one with just enough medical training or background to be annoying and not enough knowledge or understanding of the care of the medical patient to completely grasp and appreciate the complexities and limitations of modern health care. In my experience this usually involves family members who are ancillary medical professionals such as physical therapists, respitory technologists, LVNs, lab techs, or anyone who has spent too much time looking up medical information on the internet. They often appear to feel that they are qualified enough to critique every detail of the patient's medical care. It's not that I don't appreciate the attention and concern that they have for their family member but when they become confrontational it can undermine the trust and security of the doctor-patient relationship. Ironically I have never had a problem with family members who are themselves physicians. I think that this is because we are on the same level and they understand these issues involved.
The GruntDoc sent this in.....
1) The Holiday Nursing Home Dump: concerned relatives visit granny/uncle Whoever in the Home and are Shocked! Shocked! how bad they look; it's only been about 6 months since they saw them last. The NH staff cannot stand in the way, and the NH doc isn't coming in for any reason. To the ER! Huge, pointless workup = back to the NH, after the family goes home.
2) We have TV's in some rooms. I just turn them off, tell them I cannot stand the extra noise. Nobody has complained yet. I turn them back on when I leave, cuts down on the nurse calls.
3)My biggest peeve: "Do you have any samples"? What I hear: I can't pay for the meds, why should I pay you? (No samples).
4) Back in the Resident days, on Trauma, we'd tell them: elect a Spokesperson, give them a list of questions, we're not going to have 15 briefs a day (which they all get something different out of, compare notes, and decide you're giving different stories to different people).
I did some moonlighting in a small ER about 45 minutes from where I trained. It was the scene of many a Sunday nursing home dump. Same circumstances as above. But I found it really hard to send them back when they came with a packed suitcase. I worked as a unit clerk in an ED while in college and the nurses hated the televisions in the room because the patients would come in and "camp out".
Even the paramedics had something to say.
So with great fanfare I CONTINUE THE LIST.....
6. THE NINTENDO/PLAYSTATION/X-BOX: Same as THE TELEPHONE but with a different age group. Just pause the game!!
7. THE ABSENT PARENT/GAURDIAN/MPOA: I try to get to see a consult within an hour or two of my being called. If I am going to be late I call the nurse's station. I go up to see a minor or a patient who cannot make a medical decision themselves and there is NO ONE THERE. This involves a trip back to the hospital room when someone shows up. Under a very limited set of circumstances (emergency, great distance) I will handle this over the phone. Most often I set up a time to meet someone and discuss it.
8. SURPRISE!!! I'M YOUR SURGEON: I go see a consult...and the patient has no idea I am coming to see them. Really bad when I am consulted for operative management of a malignancy, and their primary care MD has not told them of the diagnosis. I have to deliver enough of my own bad news, I'm not going to be the heavy for someone else.
Thanks for all the feedback!! |
