Sunday, February 15, 2015

Is Your Doctor 'Aware'?

Every doctor understands what the phrase, doctor aware’, means.  This is the phrase that hospital nurses record in their nurses notes when they have notified the doctor, usually by phone, on a patient’s issue.   Once the ‘doctor is aware’, the nurse is in the clear and has transferred responsibility for the issue to the physician.
Here are some samples of doctor awareness.

Phone Call Notification                                           Nursing Record

Doctor, Mrs. Leadbelly just vomited.                       Doctor aware!
Doctor, Mr. Wobbly is dizzy.                                        Doctor aware!
Doctor, the ultrasound showed a gallstone.         Doctor aware!
Doctor, Mrs. Hothead has a fever.                             Doctor aware!

Physicians often roll our eyes over these conversations.  Some of these notifications are communicated in the middle of the night about patients we do not know.   Although we can’t usually address the abnormal finding directly at that time, nor do we often need to, once we have been made ‘aware’, the responsibility of the entire case is now ours.   For example, if we are awakened by a nurse asking if she can give antacids to quell a patient’s heartburn, we are likely to agree with this seemingly reasonable recommendation. The chart will record that we are ‘aware’.  If that ‘heartburn’ turns out to be a harbinger of a more serious condition, then the physician will be liable for his action.

If  it's more than heartburn, will we end up in the dock?
Before you pounce on this doctor accusing him of haste and sloppiness, keep in mind that we handle hundreds of these calls every year.  If we were to run to the hospital on every one of these calls to see the patients personally, we’d have to live in the hospital like a medical intern. 

A standing joke between physicians and nurses is after a nurse reports an abnormality to the doctor, the physician wryly responds, ‘I am not aware!’

One particular vexing example of this is when a nurse calls me at 8 pm as the attending physician wants me to approve that the patient can be discharged home.   Often, one of my partners has seen this hospitalized patient during daylight hours.  As I have no knowledge of the particular patient, I am reluctant to sign off on the after-hours hospital discharge, which would force me to accept enormous responsibility on the appropriateness of sending the patient home.  In the most recent example of this, I told the nurse that I cannot clear the patient as I was not involved in the case.  The attending physician must make his own independent decision if his patient can be sent home.  Of course, the attending doctor who is asking me to approve hospital discharge is engaging in the same ‘Dr.Aware’ procedure at the physician level.   Familiar with the concept of CYA?

We do the same thing with our patients.   When patients reject our medical advice, guess what phrase we enter into the record.

1 comment:

Anonymous said...

In Australia it goes a step further.
If they want an empty bed in a hospital they are likely to burst into the ward/room with the statement "I hear you want to go home' - how 'aware can you get.
You then are aware how tenuous your stay in hospital is.
YThis happened when I was visiting my wife who , unforunately , is old - as I am. So we are expendible.

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