I love this!! Reality is so clearly described here!! It has been like this as long as I can remember--and I think that our answer may be some form of insistent electronic auto-delivery of results... With tracking and escalation up to ??? The problem is, doctors really don't have a "boss" so who will ultimately be responsible??
Calling with Critical Findings: Is Anybody Out There?
Calling with Critical Findings: Is Anybody Out There?
Blog | December 14, 2012
Ring-ring.
“Hello, this is Nurse Ratched.”
“Hi, Dr. X-ray here. Calling with critical CT findings on patient John Doe.”
“Oh… Critical findings? You’d better speak with the doctor.”
“But Nurse, you’re listed as ordering the study.”
“Yes, but I only ordered it because Dr. Hospitalist told me to. I wouldn’t know what to do with those results. You’d better call Dr. H.”
Ring-ring.
“*Yawn* This is Dr. Hospitalist.”
“Hi, Dr. X-ray here. Sorry to wake you, but I have critical CT findings on patient John Doe.”
“Doe? I don’t know anybody by that name. I don’t recall ordering any CTs recently.”
“I’m sorry, but Nurse Ratched says you did.”
“Um…I don’t think — wait! Yes, I remember now. I didn’t actually see him yet. The nurse told me one of the consults ordered by the ER before the patient got admitted said to get the scan, so I asked her to set it up. You should let the consultant know.”
“Okay, which consultant was it?”
“I don’t know. I’m sure the nurse does, though.”
Ring-ring.
“Hello, this is Nurse Ratched.”
“Hi, Dr. X-ray here. Dr. Hospitalist said that the study was requested by a consultant, but he doesn’t know which. Could you have a look and see which service I need to contact?”
“It’s very busy here. I don’t know where the chart is.”
“Well, I’m sorry to trouble you, but these are very abnormal findings. They really can’t wait.”
“[unintelligible growling/mumbling]”
“Hello? Nurse Ratched?”
[After prolonged pause] “Says it was Dr. Pulmonary.”
Ring-ring.
“Dr. Pulmonary. Who’s calling?”
“Hi, Dr. X-ray here. Calling with critical CT findings on patient John Doe.”
“Who the hell is that? I’m not even covering the service today!”
“I’m sorry, but Nurse Ratched said you were, and Dr. Hospitalist said you had wanted this scan done.”
“Well that’s bad news for them, because I know nothing about any of this, and I refuse to take results on someone else’s patient. Good luck.”
Ring-ring.
“Hello, Dr. X-ray here.”
“Yeah, this is Dr. ER. When are you going to read these trauma cases? I can’t move these patients till you do.”
Ring-ring.
“Hello, this is Nurse Ratched.”
“Hi, Dr. X — ”
“Oh, it’s you again. What do you want now?”
“Nurse, as the clinician who ordered his CT scan, you are hereby receiving these critical results on patient John Doe — ” *click*
Disclosures
FAMILIAR? ALL TO, UNFORTUNATELY. I think i was the patient doe on that one during one of the five attempts i made at going to the emergency room during that two week period of time in 2009 when the extreme pain in my leg and thigh and abdomin caused me to think i might have been dieing or something stupid like that. Fortunately, since they had spelled the name wrong and had an incorrect birthdate on the ct scan i finally was able to get on attempt number five, not too many of the horribly overeducated and/or too uneducated and busy to give a crap or know how employees had to be bothered about any of the really bizzarely abnormal results that somehow made one of them think rigor mortis was setting in. of course, since enough of them was using the correct spelling of the name and correct birthdate to assist me in obtaining pharmaceuticals i was being provided with for free, at least i am still living proof i existed at all, during that critical moment of crisis i was refused medical treatment for--five times in two weeks. ...
there was one part of reality left out of this descriptive tale of this typical day... with the computerized methods they use now with the auto signitures of all involved at the push of a button and maybe the entering of a pin or code, it is actually more typical and common for the "lower downs" who actually have much work in progress training, sometimes for many years, to know in most situations, what needs to be started, ordered, asked for, written in the records, and if it needs done quicker than usual or is normal enough to wait on the doc to show up for thier twenty minutes of glory to justify their name being placed on the billing end of the story. most of these times when the lower downs have ordered what ever they have and used the electronic signitures of the docs since of course, lower downs have zero authority to do such thing and even if they were allowed, lower downs are never given consideration for knowledge, and experiance and too many people are alwys forced to make things appear to be said or ordered or done by someone else... its the way it is... all you gotta do is read a typical medical record for a six month period of time to start getting an eery feeling doctors seem to have multiple personalities or something, or other people are the ones doing all of it, including recording all that is maybe in a doctors name, giving an assumption that they may know what is going on and may know who you are and recognize the name and remember the ongoing illness and care you are seeing them for,,, when they dont have a clue... except that you look like half dozen others who also have bothered their busy glorious selves by expecting them to be in the room with them for ten ....er i mean twenty minutes,, though the only thing remembered is the wondering if that thing you are complaining about is contagious or not.... do a reality check and see who know most and does most of everything in health care facilities.. including the constant protecting of and covering for their beloved doctors....who let them play doctor also...
A nurse can only "order" a study in our state if he/she has prescriptive authority. Otherwise, the nurse is merely entering the request for an ordering provider. Therefor, the critical result is provided to the ordering provider (whether he knows the patient or not) with he/she understanding that action is immediately required...and follow this with a rapid written interpretation to him,/her with the note that the critical result has been communicated to the (doctor or whoever). As a safety net, copy to the ER supervisor. More work but better for patient care and less time than portrayed in the above interchange of calls.
Escalate EVERY time to CEO level.
Let them explain the care path to your local TV news crew....
Let them explain the care path to your local TV news crew....
I love this!! Reality is so clearly described here!! It has been like this as long as I can remember--and I think that our answer may be some form of insistent electronic auto-delivery of results... With tracking and escalation up to ??? The problem is, doctors really don't have a "boss" so who will ultimately be responsible??
FAMILIAR? ALL TO, UNFORTUNATELY. I think i was the patient doe on that one during one of the five attempts i made at going to the emergency room during that two week period of time in 2009 when the extreme pain in my leg and thigh and abdomin caused me to think i might have been dieing or something stupid like that. Fortunately, since they had spelled the name wrong and had an incorrect birthdate on the ct scan i finally was able to get on attempt number five, not too many of the horribly overeducated and/or too uneducated and busy to give a crap or know how employees had to be bothered about any of the really bizzarely abnormal results that somehow made one of them think rigor mortis was setting in. of course, since enough of them was using the correct spelling of the name and correct birthdate to assist me in obtaining pharmaceuticals i was being provided with for free, at least i am still living proof i existed at all, during that critical moment of crisis i was refused medical treatment for--five times in two weeks. ...
there was one part of reality left out of this descriptive tale of this typical day... with the computerized methods they use now with the auto signitures of all involved at the push of a button and maybe the entering of a pin or code, it is actually more typical and common for the "lower downs" who actually have much work in progress training, sometimes for many years, to know in most situations, what needs to be started, ordered, asked for, written in the records, and if it needs done quicker than usual or is normal enough to wait on the doc to show up for thier twenty minutes of glory to justify their name being placed on the billing end of the story. most of these times when the lower downs have ordered what ever they have and used the electronic signitures of the docs since of course, lower downs have zero authority to do such thing and even if they were allowed, lower downs are never given consideration for knowledge, and experiance and too many people are alwys forced to make things appear to be said or ordered or done by someone else... its the way it is... all you gotta do is read a typical medical record for a six month period of time to start getting an eery feeling doctors seem to have multiple personalities or something, or other people are the ones doing all of it, including recording all that is maybe in a doctors name, giving an assumption that they may know what is going on and may know who you are and recognize the name and remember the ongoing illness and care you are seeing them for,,, when they dont have a clue... except that you look like half dozen others who also have bothered their busy glorious selves by expecting them to be in the room with them for ten ....er i mean twenty minutes,, though the only thing remembered is the wondering if that thing you are complaining about is contagious or not.... do a reality check and see who know most and does most of everything in health care facilities.. including the constant protecting of and covering for their beloved doctors....who let them play doctor also...
A nurse can only "order" a study in our state if he/she has prescriptive authority. Otherwise, the nurse is merely entering the request for an ordering provider. Therefor, the critical result is provided to the ordering provider (whether he knows the patient or not) with he/she understanding that action is immediately required...and follow this with a rapid written interpretation to him,/her with the note that the critical result has been communicated to the (doctor or whoever). As a safety net, copy to the ER supervisor. More work but better for patient care and less time than portrayed in the above interchange of calls.
Escalate EVERY time to CEO level.
Let them explain the care path to your local TV news crew....
Let them explain the care path to your local TV news crew....