Monday, January 12, 2015

Well my throat hurts too!

Page: "Doctor, Mr. R is complaining that his throat hurts."
Me: "Okay, we'll see him on rounds and we'll take a look at his throat."

Nurse: "Doctor, Mr. R says that his throat hurts."
Me: "Well, we're rounding now and we'll see him very soon."

Me: "How are you feeling, Mr. R?"
Mr. R: "Oh, I'm fine."
Me: "The nurse told me that your throat hurts."
Mr. R: "Oh yes, well.. ever since the surgery, it's been hurting a little bit. But it's not bothering me that much."
Me: (after looking in this throat) "Do you want anything for it?"
Mr. R: "No no, I'm fine."
Me: (shrugs) "Okay."

The next day, 7AM:
Nurse: "Doctor, Mr. R says his throat hurts."


  1. Perhaps the patient is too embarrassed to bother you with such a minor issue?

  2. As a nurse I will tell you this, pain documentation is a bitch. For example I work in the ICU so I have to assess for pain every hour. If the patient even complains about 1/10 pain I have to document accordingly and implement an intervention. It can be "guided imagery" (I'm not kidding), massage therapy (do I look like a masseuse?), giving them medication, telling the doctor, and so forth. At my hospital there is an area where I can document "patient declines intervention at this time" but then I have to type in explanation of why they declined.

    I've also had patients tell me they want pain medication but once the doctor comes to the bedside to assess them they CHANGE THEIR MIND. I swear, patients make liars out of nurses.

    I don't think doctors really know how much crap we divert from them. I've had family members demand that I call the doctor because the patient had hiccups and wanted the doctor to give them something NOW.

    We know you MDs are busy and all but with medical system catering to patient satisfaction we really are put between a rock and hard place.

    1. I am aware that you filter a LOT of insignificant issues in addition to taking care of the more important aspects of your job. Am very grateful for this.

      As an ICU nurse, surely you have all the time in the world to perform and document guided imagery and massage interventions for a 1/10 pain level. Documentation requirements have ballooned to tragicomical levels for everyone on the health care team. When I read PT/OT notes I wonder if/when the therapist had time to teach and monitor the patient.

      Patients do change their minds all the time, often after they've had a chance to discuss and think about the issue. Other times, the patient feels more comfortable complaining to the nurse he sees all day than the doctor he sees for just a few minutes. But sometimes the disparity makes no obvious logical sense.

    2. To the ICU nurse and PGYx, I'm not surprised. Regarding patient satisfaction, I received a survey after my short visit to the ER.
      On principle, I wouldn't fill it out. Guess what? They sent me a
      second one! Really? You want me to evaluate physicians and
      staff, eh? These corporate "persons" should have to sit in on
      ONE COURSE that physicians and allied health professionals are
      required to pass in order to practice their profession. I doubt that
      they would be able to pronounce some of the course titles, let alone
      pass a single exam. It galls me to no end. By the way, forgive my
      ignorance: what is guided imagery? - Paul

    3. Never mind. I just "googled" it.
      Now that I know, you've got to be kidding me!

    4. Well, I think it can actually help as our mind-body connection is powerful -- as an example, consider the efficacy of sexual fantasy. But none of the nurses I've known have had sufficient "free" time to add this to their already long list of tasks, nor have they had any training.

      It might actually be nice to provide a mp3 of a soothing guided imagery track (Cleveland Clinic has a great 20 min version aimed at clinicians but it's great for anyone). For patients with smartphones and earbuds this would be a simple intervention, though impractical for many more patients.

    5. You finished my thought, PGYx and did so better than I could do so myself!
      Absolutely agree. I'm all in favor of any modality that can help alleviate
      a patient's discomfort. However, "you've got to be kidding me" was with
      respect to the time element. Thank you, PGYx. - Paul

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