Balls and Walnuts
more than you ever wanted to know
MD aware
That’s what we used to call it in residency . . . so named because it would punctuate the ubiquitous comment in the nursing notes. As in,
Mr. Ramirez’s IV infiltrated and had to be removed. Unable to give 2 AM dose of labetalol. Current blood pressure 224/110. MD aware.
It’s the ultimate ass-cover. The doctor knows about all this and no orders were forthcoming. And if the 1:50 AM phone call was only, “Doctor, Mr. Ramirez’s IV doesn’t seem to be working,” the note in the chart makes it a he-said she-said situation. Worse: the nurse’s note is in black and white, and if the doc tries to correct things the next morning, it looks like fighting in the chart — a classic “gimme” for the malpractice lawyers.
We had another saying in residency: “They can always hurt you more.” Applies to patients, ERs, nurses, call centers. Sometimes it makes me long for the bad old days when we were truly resident in the hospital. If you were there, you could assess the situation firsthand. You didn’t have to depend on someone else’s report. Reminds me of how in med school, on an internal medicine rotation, we’d sometimes make ICU pee rounds, checking folks for their urine output.
There were good reasons for this, but they escape me at the moment.
But you know, you have to have a life, too, which means you have to trust other people to do the right thing. And by and large they do.
D.
(No, nothing bad happened . . . but calls in the middle of the night always make me think about this issue.)
I think most of us folks hope/ believe our docs are as conscientious as you.
Seems like a possible use for some sort of video calling. The nurse calls/Skypes you, shows you a picture of the problematic IV, a picture of the blood pressure readout, and a picture of the patient. You say, hmmm, can I see his whatever more closely? Hmmm, you ask, could you check the thingamajig? Then you make your decision. I know it wouldn’t be as good as being there, but I bet it would be a lot better than what you get now.