We had some good stories yesterday, but most of them were more "oh shit" stories. Like you were doing your job and then realized that "oh shit" you made some horrible mistake.
I don't think that's shameful though. I mean, to err is human, right?
I'm not sure whether this is a particularly saintly group or people are just scared, even though this is entirely anonymous. But I used to see on a regular basis residents doing things that I thought were pretty shameful.
One thing that I saw residents do a lot in residency was handle things on homecall from home that should have been handled by coming in to evaluate the patient. And I worked with several residents who used to lie about having seen a patient if they were short for time. I worked with a med student who was told to go out and rescrub, and he was so pissed off that he rescrubbed with the sponge he'd thrown in the garbage, then went back in.
That's the kind of shameful stuff I'm talking about. But nobody here would do anything like that, huh?
No - because doing something like that would be IDIOTIC and shows no judgement whatsoever.
ReplyDeleteRight. And no doctor (in training) would ever act that way. Except for the bunch of people I actually saw do it. But nobody else.
DeleteSeriously?
ReplyDeleteOk, here's one. At an appointment with my child's doctor, the doctor sent my child out of the room so we could discuss a sensitive subject. He started asked me about my marriage. Then for a hug. So I gave him a hug, and then he looked at me and asked, "and maybe more, like a kiss?"
And I stammered and backed the hell out of there, but he still does it every time we have an appointment. And he's a specialist, the kind its super hard to find another of. And 30 years older than me.
Creepy enough for you, Fizzy?
It's creepy all right. But it would be better if the story was:
DeleteThere's this woman who brings her kid to my pediatric practice. She's very attractive, and whenever she comes to see me, I always ask her for a kiss. I act like I'm joking, but I'm really into her.
That's not only creepy, it's immoral and unethical. You are likely not the only one he is doing this to. Report him immediately to the State Medical Board.
DeleteToo bad I'm speaking from the wrong side, Fizzy. Trust me, I'd be a lot happier if I were the all-important specialist harassing a mom, instead of the mom being harassed by an all-important specialist.
DeleteGlad to know it's amusing to you, though, but sorry my story isn't "good enough" for you.
Actually, several people emailed me saying that they wished they could have shared their stories, but felt bad about themselves that nobody else could come up with anything. I thought this was a great opportunity for people to be honest and get something off their chest, and also for people to learn that doctors are human too.
DeletePlaying the blame game about doctors you've seen doesn't fall into that vein and wasn't the purpose of the post. There are zillions of blogs from angry patients who didn't like what their doctors did. This post was trying to do something different, to ask doctors to *own up* to what they did wrong.
Don't blame me that you missed the point.
Yes, because sexual harassment is "playing the blame game". And doesn't fit into the idea of doctors behaving "shamefully" at all.
DeleteYou are right, Fizzy, I must have missed the point. Completely.
Right, you missed the point, which was that I asked people to *own up to your own mistakes*. Not tell about someone else's. It was an exercise in being honest about yourself.
DeleteMaybe you do no wrong though.
A guy at my institution wants to study "shirking" behavior induced by shift work. For instance, when you know that something needs to be done for a patient, but your shift is about to end, so you don't do it. Not in an obvious way, like signing out a bunch of procedures or labs or anything. More like, the doctor/nurse justifies to her/himself that the work doesn't really need to be done. This can be conscious or subconscious. And yeah, it's crappy patient care.
ReplyDeleteShare your own if you want people to open up and be honest.
ReplyDeleteI 100% will. But I think I'm entitled to the same cloak of anonymity that I'm offering all of you, right?
DeleteJust post comments yourself as anonymous.
DeleteRight. So how am I supposed to set an example as the commenter requested if I'm posting anonymously?
DeleteI've seen an OB resident almost simultaneously deliver the baby and the placenta.
ReplyDeleteCan you explain why this is bad? I honestly don't know.
DeleteWell normally you deliver the baby, cut the cord and then wait a few minutes before you can deliver the placenta. The placenta will usually come down on its own but you have to be gentle with it or else the patient may hemorrhage. In this case, Dr. A delivered the baby and cut the cord. But not even ten seconds later he was trying to pull the placenta out. It just seemed very unorthodox and dangerous. It can take up to 20 minutes for the placenta to come down on its own so maybe he couldn't afford to wait but Labor &Delivery wasn't even that busy.
DeleteIt can cause involution of the uterus, or for the cord to break due to excessive traction.
DeleteSimilarly you asked on MIM to share how people are bad to their kids and said you would not tell what it is you did that was bad and caused you distress.
ReplyDeleteI think 1)people who read your blog have high moral standards and 2)may not have done anything bad knowingly 3) maybe bad doctors do not care enough about their profession to read medical blogs
What are you talking about? In the MiM, I said in the post that I'd put my bad mom moment in the comments, and the very first comment was from me, talking about how I bought a big box of neon cupcakes.
Deletehttp://www.mothersinmedicine.com/2012/04/bad-mom.html
You can't expect me to openly divulge EVERY detail of my life.
I feel bad that one time I gave not so good evaluation to a brand new med student who was very shy, also very slow, inefficient, etc. At the time I thought it will help the person to correct all of these and I have to be "honest". But now I think I should have stressed that this student was sincere and showed promise to become good kind of thing. I hope it did not emotionally affect this student.
ReplyDeleteYou probably made her cry :P
DeleteI used to work at a hospital that required the RNs to do vitals every 4 hrs on every patient. Including overnight. Even the ones waiting for a nursing home. Even the ones waiting for rehab. If the patient was asleep, RR fine, and first set of vitals fine, and l would skip doing some/all of the overnight ones. Sometimes I would make them up. Sometimes I would say they refused. Sometimes I would just leave the space blank. Sometimes I would do then at 0630hrs instead of 0400hrs.
ReplyDeleteFaking the vitals isn't ethical, but then again, I was just discussing with my roommate this morning how wrong it is to order frequent overnight vitals and labs on completely stable patients (look in and make sure they're breathing and not crying out in pain, sure; but let the patient sleep!). Same thing with rounding on patients at 5:30 AM (which we did on ob... Yeah, let's make the woman who just spent many hours in labor or undergoing surgery get up to answer a list of ridiculous questions). They are in the hospital for a reason... and it's difficult to get better when someone is coming in to check your vitals every 2-4 hours.
DeleteI hide the Dynamaps so I can have one when I need it.
ReplyDeleteEveryone does that :) Dynamap wars are vicious.
DeleteThe kind of stuff you mentioned is the kind of stuff I still see all the time. Visit notes written and visits charged for when the physician is out of state (or, in one case, out of the country), not coming in to see patients when on call, letting orders and VS slip - happens all the time. What I did on occasion (back to calling the doc in the middle of the night) was to give something the patient needed without an order. The docs always covered me in the morning.
ReplyDelete"Back in the day" in the ER when a patient died, some docs used to let med students and this nurse practice intubation skills. I guess that is frowned on now.
I very intentionally and unprofessionally lost it with a patient once. One of our street denizens was found in a snowbank. I don't recall now what his temperature was, but I remember that it was too low to register on a standard rectal thermometer. He was completely unconscious and the neurons thought he was a goner. I took such good care of him for 3 days in the ICU and I told the neurons that I thought he was lightening up. They told me that I was crazy - his brain damage is permanent. Oh, yes, he woke up and he was a miserable, nasty human being, and yes, he was completely oriented. He called me vile names and spit at me, but when he threw excrement at me, I lost it. I turned on him and said, "I just spent the last 3 days trying to save your sorry ass; I shouldn't have bothered." I stormed out of the room and refused to go back in. (Kind of unheard of to refuse an ICU assignment mid shift.) I went back in at the end of the shift to give report and he was as meek as a lamb to me!
Boring, I know, but I spent most of my career protecting the arses of new residents ....
Wow -- that patient sounded like he deserved it though. A lot of the times, I try to hold back with these types of patients, not because they don't have it coming (a lot of them really do), but because of professional pride -- it's unseemly for health care professionals to yell at patients. But, yeah, I think with excrements, all bets are off! Besides, if a patient is well enough to be an ass, then they're well enough to be discharged from the ICU.
DeleteAs for handling things over the phone, as a med student/first year resident, I would always go and see the patient, even for a tylenol order, but now I realize how many things can really be fairly safely dealt with over the phone -- I don't feel particularly guilty about that.
ER MD
To be honest, that behaviour sounds like severe delirium, not surprising given how he was found. Unless, of course, you've met him before and that's how he is. Lots of homeless people also have schizophrenia. I guess what I'm saying is he may not have been doing this intentionally.
DeleteThat said, sometimes it's important to speak up, and words can have a stronger effect if said right than meds. I'd probably have reacted the same way if it got to poop-throwing. Although I'm in Peds, so we're not unfamiliar with that...
Aeris: Thanks for the laugh; yeah, in peds you have your share of poop events. Once he woke up, this guy stayed oriented to name, place, and somewhat to date. He knew he was an ICU patient and I was his nurse. Beyond that, I cannot speak for his baseline, but I just don't think he was a teddy bear. I never had that happen to me before or since. I have had scared, confused patients pinch - oh, those old ladies are great with the pinch - or punch or lash out some way, especially in the ER, but he was not behaving like he was scared or confused, or even belligerent; he was just nasty. He did not oomplain of hallucinations (rather, he did not speak of hearing or seeing things that I could not see or hear), but who knows?
DeleteFine, I'll bite.
ReplyDeleteYes, I've written notes on patients i didn't really round on. There have been times when I walked in the room, the patient was sleeping, I tried to wake the patient up but he/she was sleeping really soundly, and I fudged a note based on physical exam findings from the day before and what the nurse told me, so I could have my notes done before rounds.
One time I was supposed to do a dressing change on a patient and once I finished, I could leave. The patient was insistent that she get fentanyl before that so I had to order the fentanyl and then wait for it to work. I changed the dressing, or so I thought. Turns out there was packing in the wound that I was supposed to change, but I didn't realize that until I read a note later. by that time I really wanted to leave so I lied and said I changed the packing so I didn't have to wait to give her fentanyl again...
There have been one or two times i said the patient was refusing a postop dressing change when what really happened was, I didn't have time to do it in the morning and I needed an excuse for why I hadn't looked at the incision before rounds.
When I was a med student and patients asked me to let their nurse know they wanted pain meds, I would always say I would find the nurse and let him/her know. I never did that because i didn't know any of the nurse's names and they used to yell at me for bothering them. (the hospital I was a med student in had the meanest nurses on the planet. One of them called me "b*tch with boobs")
I like to think I'm not the only one who's done these sorts of things.
You're definitely not the only one. Thanks for having the courage to be honest.
DeleteI've eaten hi-cal nutrition puddings out of the patient's fridge on a night shift having been awake for 27 hours with no food.
ReplyDeleteThat is pretty shameful.
Ah, c'mon ... really? Damn, I always thought it was survival, not shameful.
DeleteYou monster.
DeleteI suspected I had the A-flu on the year when we were all so worried about it (pandemics and all). That is, 3 years ago. So, well, it was my first practice at the hospital ever, and I wanted to go so very bad. I even had a fever. I went to the hospital. I even passed out (at an ecography, shame on me, I felt so awful). I didn't tell anyone or felt compelled to use a mask. I just paraded up and down the hospital, me and my viruses.
ReplyDeleteOk, happened this weekend. As a Pt. I was waiting for appointment and the two docs in the office were having a quick lunch break and a discuaaion of the one told the other that he had several calls to local hospital.
ReplyDeleteDoc 2 asked if he had to admit anyone.
"No, Ativan cures everything," said Doc 1.
All medical personnel are allowed to scream now.
This really wasn't me, but it's so epic I had to tell it. One of the neurosurgeons once told me that his orders would be "PPBBB." "Put pine box by bedside." Apparently, and this may be an urban legend, once someone actually said this loud enough for a family to hear and, well, something hit a fan.
ReplyDeleteOkay. Not me. Witnessed. Intoxicated trauma patient behaving violently. Our team couldn't clear his c-spine. Surgery chief resident had the patient intubated. So far, so good. Next he let the patient wake up from the initial sedative, administered an additional paralytic so the patient was completely awake and dependent on the ventilator, kicked the nurse out of the room, and then switched off the ventilator for 30 seconds, leaned down to the patient's ear, and said quietly to the patient, "I want you to understand something. I am in control here; whether or not you breathe is up to me. Do not forget this." He waited another 10-15 seconds before turning the ventilator back on. After the patient was extubated, he wouldn't say anything other than "yes, sir/ma'am" or "no sir/ma'am" for the rest of his admission.
ReplyDeleteWhoa.
Deleteyeah. Super whoa.
DeleteI'm totally creeped out by this one. Of course, your shame is that you did nothing about this. Hard to have that on your conscious.
DeleteI am a female doctor. I get called "nurse!!" all. the. time by patients, and depending on my mood, I either ignore them, gently correct them, or not so gently correct them. We had a particularly belligerent patient in the ER last night. He had just been seen and evaluated by one of the other ER docs, so he was definitely not wanting in attention. I was standing at the charting station, gathering the chart and papers of another patient I was about to see, and there happened to be two male nurses rig next to me.
ReplyDelete"Hey, there's a nurse!" he said really loudly, and pointed at me as if a was an endangered species. "Nurse! Nurse! Hey, nurse!"
"No, actually, I'm a doctor, " I said in an obviously annoyed voice.
"Really??!!" he answered, as if I said I could levitate or crap sunbeams.
At this point his wife intervened and said something about him being rude and not knowing any better, and apologized, and said something funny about having to live with him and his sorry ass ignorance. He made some sort of sarcastic response response about how he made a mistake but didn't apologize.
I said to the patient, loudly enough for all of the other patients in the crowds ER to hear, "Yes, they actually let women become doctors now."
His wife laughed and told him "Yes, she's a doctor. And I bet she knows what CBI is."
I do. It's continuous bladder irrigation. It involves the penis and it's not comfortable.
I answered "Yes, I do, and it couldn't happen to a nicer guy
1/2
ReplyDeleteOK, I have one. It's too long so I split it in two.
When I was in residency, my very recently-an-ex boyfriend called me to tell me that he was at the hospital where I worked with his new girlfriend. I was pretty bitter about their new relationship.
He called to say she was admitted for "chest pain" and had been there for a whole day, all of her results were negative, but no one was giving them the time of day and he wanted to know when she would go home.
I knew the ways of the hospital. She was admitted after midnight and it was a Saturday. I know the day team took one look at her EKG, labs, age, and lack of risk factors, and knew it was a BS admission and didn't even see her since she had already technically been seen that day. I knew the day team was way overworked, and it was not just a Saturday, but it was during the holidays. It was also the evening by this point, and I knew the day team was done rounding for the day by several hours and would not be available, and the night team would only respond to emergencies and wouldn't discharge a patient unless there was already orders from the attending physician, who was gone and wouldn't take to kindly to a phone call about this.
I was working the night team at the time and had narrowly avoided running into them and admitting her, actually. That would have been awkward. I was off the next day, which was when he finally called me.
He swore she was feeling fine, just had a headache now, and had no risk factors, and everyone told them all of her results were negative. So, I told him he should probably tell her to sign out AMA, or she'd likely be stuck until the next day. I was very considerate. As jealous as I was, I am a nice person. I had not looked at any of her results. He hung up, and I felt guilty, thinking, what if she really has something wrong with her and I told her to leave the hospital. I technically was on the team that admitted her, but I was not involved in her care, and there was obviously a personal conflict kind of situation there.
Well, I tried contacting him again and couldn't get through. I decided to look up her results at home, to make sure that she wasn't really having a heart attack. Well, I found out her admission diagnosis was chest pain, acute alcohol intoxication. Her alcohol level was critical, like, seriously a critical value, and she was on a banana bag and seizure precautions, and her liver profile was one of a chronic alcoholic. She also had his name on her admit papers as a contact person in regards to her admission.
My ex contacted me the next day, and told me that she signed out and everything was fine. I told him that I needed to talk to him. I told him I was probably violating privacy rules (probably? no, definitely) and asked him how much her knew about her admission. I asked him if he was OK with us having a conversation about it, and he said yes. I told him about her results, and he said yes, the ER doc came in and asked how much she had to drink and asked her about her liver function. She apparently told them that she only had half a beer (uh, no) and that she always had elevated liver enzymes due to some familial liver condition, and that condition led her to seem to have high blood alcohol.
We talked about it a little bit. I told him that, as far as I knew, there was no congenital liver disease that would make your blood alcohol content above 300 if you only had half a beer. I also told him that someone who wasn't a chronic drinker would be comatose with that high a level, even if it was a liver processing issue. I told him she might be hiding her drinking from him. I did believe all of these things. I also thought they just started dating, he didn't know her very well, and was, again, really jealous and pissy about the whole thing.
2/2
ReplyDeleteWell, it turns out she had moved into his house. She was driving his car and two kids that night, her daughter and her daughter's friend (!!!) I told him if she got pulled over, she would have been arrested. He called me back later, after I really knew I shouldn't be continuing the conversation, and told me she had "fatty liver disease". I said, unlikely. That is a diagnosis of exclusion, and the number one excluder is a BAC of 300 and someone sitting there able to have a conversation as if they're not that drunk. And, that disease does not falsely way elevate your BAC, as far as I know, especially not to a critical value. There is a lot of literature on alcohol and fatty liver, mostly that it is an exclusion criteria for the diagnosis. Nowhere is there a mention that one drink will make your BAC 5 times the legal driving limit. And even IF she had that to begin with, she should not be drinking heavily, because she had an increased risk of cirrhosis.
And he makes some sort of comment about how maybe that's why she can't get a job and needed to move in with him. And he asks me how he can get her medical records for himself to see.
This whole time I am telling myself that I am doing this in the name of all that's good and well in medical care and telling the truth. But I was already feeling icky about it, and at this point I am feeling super icky about it. Yes, I was on her admitting team. Yes, she did give his name on her admit forms as someone who could be contacted about her care. But, Jesus, we were obviously over the line by like a mile by this point. Oh, and I had also asked the ER doc about her, and he said something along the lines about him knowing she was completely full of shit, and him being clueless about the whole thing, and the ER doc thought she was probably cheating on him and hiding the drinking. Not sure where the cheating part came in. I didn't mention any of this conversation to my ex.
At this point I told him I needed to excuse myself from talking about her health anymore, that I wasn't her doctor, and I had never met her, and I obviously had a conflict of interest. He said he knew me really well, trusted me, and that he knew I was a good doctor, and wasn't making any of this up. I told him he should 1. trust her if he invited her into his life and home 2. talk to her 3. ask for her medical records together and go over them together. And I never communicated with him about it again.
Wow, what an amazing story. Thank you for sharing.
DeleteP.S. I am dying to hear Part 3, but I guess you don't know it....
DeleteYou know, Fizzy, these aren't just stories made up for your amusement. The vast majority of them are real, true stories.
DeleteMaybe you might think that the world is here to give you interesting crap to read, but maybe, just maybe, you might want to have a smidgen of compassion and actually think about the fact that all of these things actually happened and had incredible (and negative) impacts on everyone involved.
You know, just maybe.