MD Whistleblower

Does any living, breathing human believe that there is not enough paperwork in our lives?  While we are all burdened, I believe that the medical profession is uniquely deluged with an absurd volume of documentation requirements, most of which should be filed under ‘N’ for nonsense.  Ask any physician or nurse about this and have antacids on hand as you will soon see some sizzling smoke emerging from the medical professional’s nostrils. Each hospitalized patient has a tremendous amount of recorded data which nurses painstakingly document.  This requirement fails on two fronts.  It takes nurses away from time at the bedside.  Additionally, most of the stuff they document is not viewed by physicians or others on the care team.  For example, I rarely read the nurses’ notes.   Is this because I do not value the nurses’ opinions on my patients?  Hardly.  Instead or perusing their written descriptions of my patients’ progress, I use a soph...

On the day that I penned this post, I rounded at our community hospital.   My first patient was in the step-down unit, which houses patients who are too ill for the regular hospital floor.   I spoke to the nurse in order to be briefed on my patient’s status.  I learned that this nurse was assigned 6 patients to care for – an absurd patient volume for a step-down unit.  “Why so many patients?” I asked.  She explained that some nurses called off work and the patients had to be spread around among the existing nurses. This occurs every day in every hospital in the country.  Nurses are routinely required to care for more patients than they should because there is a nursing shortage on a particular day.  Why do hospital administrators allow this to happen?  If any are reading this post, I invite your response.  Enlighten us.  When a nurse is overburdened, how do you think this affects quality of care and nursing morale? I s...

I work with nurses every day.  Anyone who doesn’t realize how hard these professionals work, has never been in a hospital.  Their job descriptions have expanded along with their work load.  This is not your father’s hospital ward.  Hospitalized patients today are older and sicker than ever before.  It takes a seasoned nursing professional to manage the care of these complex patients.   Their work days are full simply managing the expected tasks of dispensing medications, coordinating diagnostic tests and assessing their patients.  There is no time scheduled for unexpected events, which are expected as sick people’s conditions may change at any moment.  In other words, if a nurse must attend immediately to a patient with chest pain, then his or her other more mundane tasks are delayed or shifted over to another busy nurse. I believe that the most potent barrier that is separating nurses from their patients today is the ferocious documenta...

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.                        ...

Physicians and patients collaborate to treat symptoms.   This is not newsworthy and even sounds appropriate.  Isn’t that what doctors are trained to do?   It is but I’m not sure this should be a central focus of our healing mission.  Treating a symptom is not the same as treating a disease.  For example,  if an individual is having abdominal discomfort, pain medicine should not be the first responder, even if this would bring the patient relief.  Physicians try to understand the cause of the pain which would then guide our therapeutic response. The treatment would differ substantially if the cause of the pain were appendicitis or an ulcer or a kidney stone. Is Fever the Enemy? Often symptoms are regarded as diseases themselves that need to be treated.   Over the years, I have been called by nurses hundreds of times to prescribe medicine for patients who were nauseated.  Nurses are exceptional professionals, but ...

All of us have been to fast food establishments. We go there because we are in a hurry and it’s cheap. We love the convenience. We expect that the quality of the cuisine will be several rungs lower than fine dining. We now have a fast medicine option available to us. Across the country, there are over 1000 ‘minute-clinics’ that are being set up in pharmacies, supermarkets and other retail store chains. These clinics are staffed by nurse practitioners who have prescribing authority, under the loose oversight of a physician who is likely off sight. These nurses will see patients with simple medical issues and will adhere to strict guidelines so they will not treat beyond their medical knowledge. For example, if a man comes in clutching his chest and gasping, the nurse will know not to just give him some Rolaids and wish him well. At least, that’s the plan. Primary care physicians are concerned over the metastases of ‘minute-clinics’ nationwide. Of course, they argue from a patient...