Nurse Kelly asks a good question

How do you tell a doc when it’s time to go?


What do you do when you know a doctor needs to retire: A long drawn-out tale of woe

We have a doctor that, without going into major detail, has a neurological disorder which affects his concentration and ability to stay on task, among other things. He’s the one who will allow charts to be “in the rack” for many hours while he places seemingly useless phone calls at 3 in the morning to on-call physicians on convenience care patients who aren’t sick to let them know he is discharging the patient. He’ll call specialists before doing a workup to ask what work-up he should do on seemingly straightforward patients.

Read the rest, and wonder.  And, I don’t know how that conversation would go, and who should be the one to do it.  Oh, and it’s not Nurse Kelly.


Comments

  1. CHenry says:

    This is not a puzzle. If the doctor is truly impaired, there are procedures established by most hospital medical staff bylaws that define exactly what needs to be done and how a concern about staff physician impairment is to be addressed. State laws also define procedures to deal with practicing physicians who are suspected of impairment.

    The hospital medical staff director is the person to whom these concerns should be directed, not a blog page. Needless to say, there should be consistent evidence to justify any kind of intervention, something more than irritation at slow chartwork or the occasional odd-houred phone call to an on-call specialist (as an on-call specialist myself, I get more annoying calls from the ED than from staff doctors taking care of inpatients.)

    And even if the doctor may be ill or have less stamina, that shouldn’t mean it is automatically time to retire. Of course if there is evidence of cognitive defecits in the course of patient care, then it does merit inquiry and probably a medical assessment.

  2. I’m with Chenry. This seems like a nobrainer. You find out whatever the procedure is at your hospital–and you start the process of evaluation.

    Sad to see though.

  3. You wanna see what happens if a staff nurse starts publically bad mouthing an ER physician to medical directors singlehandedly? No, me neither. I like my paycheck, thanks.

    I talk to my nurse-manager when I have a concern about him or anything else that affects patient care. I try to keep it sparse and egregious when I complain. If I complained about every forgotton troponin or every chest CT ordered on a patient allergic to IVP dye or every patient that got a perplexing workup, I’d be yapping nonstop (this is why I have a blog, people). I’m not really asking what I should do personally. I think the medical director of the ER is trying some things, such as reducing his shifts to 8 hrs instead of 12; encouraging him to avoid the critically ill patients whenever possible and assigning someone to personally help him with the computer (hand-holder).

    I’m just wondering, mainly…

    1) How slow is too slow?
    2) In a situation where the place is packed, there are sick people everywhere and the doctor is unable to function (he has meltdowns where nothing is accomplished at all when it’s really busy), are nurses expected to provide life-saving treatments to the best of out ability (outside the realm of pre-printed protocols and ACLS) and risk our licenses or should we stay within our license and just report the really bad stuff, attempt to assign everyone to a protocol, and hope the doctor can get it together enough to order something?
    3) Is it okay to cry on the job?

  4. Jim in Texas says:

    My wife was an OB-GYN nurse in a large hospital in So. Cal. I routinely heard stories about monstrous screw-ups by doctors and nurses alike but was always frustrated about how all of them, including my wife, “covered up” for the offenders. As a criminal investigator it made my blood boil so much that I finally told her to stop telling me the stories.

    Some of the offenses weren’t even borderline as when an Indian trained nurse “prescribed” Pitocin drip to hurry up a delivery for a favorite doctor without consulting any physicians. That one I told her that if she didn’t report it I would. She did and the nurse was fired and two other nurses (who had covered for the offender) asked to leave.

    I love my wife. I fell in love with her when as a young medic I accompanied her on a “mercy” flight from Moody AFB, GA to Tallahassee, FL with two preemies twins watching her do mouth to mouth on both of them for almost two hours (one died) even then the fault lay with the doctor who dither about getting the twins moved to a hospital that could take care of them. And to make it worse when we finally returned later that night we told him, by name, which one had died and he told the parents that that one had lived! To this day we both use that doctors name as a simile for disaster “If you don’t go to the doctor now when you wake up in the middle of the night with an earache I’m taking you to see (fill-in-the-name)”

    After 20 years of marriage I honestly don’t think I knew her as well as I thought when I saw how she and the others “closed ranks” to protect people who obviously needed a healthy dose of sunshine rather that the false courtesy of silence.

    Just reading some of the response to “Nurse Kelly” reminds me of those days.

    My wife’s wake up call came when she spent six hours in a deposition on a lawsuit on a ghastly delivery that a doctor had caused that she hadn’t even been on, she had to testify just because she had been in the building that night. The doctor being sued was one of those she and the others routinely covered for.

    I spent 24 years verbally sparring with defense attorneys so I knew exactly what she was in for and it was brutal. She finally retired from nursing a few years later and I’m convinced it was that deposition that turned her against nursing.

    Sad.

  5. Bad Shift says:

    Jim: “…even then the fault lay with the doctor who dither about getting the twins moved to a hospital that could take care of them…”

    By dither about, do you mean wrestling with complex EMTALA transfer laws, calling hospital after hospital looking for a bed, speaking to multiple specialists, all the while trying to provide care beyond one’s scope of training? Or do you mean playing a Game Boy while an infant lay dying? (I suspect the former, but I wasn’t there. Then again, neither were you.)

  6. That last post is very true. Some people think that transferring a patient to what might seem like a facility with a better capacity is an easy-to-do procedure, sort of like calling FedEx. Sometimes there just isn’t a receiving doctor and facility and you are in fact stuck having to care for someone who really does need that transfer but has the just plain bad luck of needing a transfer when there isn’t either a facility or physician willing to take them.

    It isn’t a magician’s hat trick. And with patients whose stability is questionable, there is always the issue of waiting to stabilize for transfer versus waiting and chancing that they will worsen and become less stable when transferred. You sometimes have to polish that crystal ball real well for those cases.

  7. Jim in Texas says:

    “(I suspect the former, but I wasn’t there. Then again, neither were you.)

    Well, actually I was there in 1971, I was the young medic in the emergency room who drove the ambulance. The only hospital that could handle the preemies in the area was the hospital in Tallahassee (maybe Gainesville it was a long night and a long time ago)

    The USAF wouldn’t authorize a mercy flight so the hospital commander call a friend with a private 2 engine aircraft who flew the children along with my wife-to-be and I to the hospital. And paid for it out of his own pocket. We didn’t have an incubator but something else was pressed into service, I don’t know what it was, I was a young medic, remember? But it had hot water bottles for heat.

    We loaded the children up in one of those old, long hearse-looking ambulances and I drove from Moody AFB, GA to the Valdosta, GA airport, about 15 miles. The city police at Valdosta had two motorcycle cops escorting us and my wife still remembers it as being the scariest ride of her life. The hospital had an emergency crew meet us at the airport and took the babies. The doctor at the scene (I think) pronounced the one infant dead and transported them to the hospital. We flew back and recovered the ambulance at the airport and returned to the hospital.

    The reason I said “dithered” was in the four or five hours after the birth and before the ER doctor surreptitiously got the Hosp. commander involved, the OB-GYN doctor kept calling the emergency room and asking if we could drive the infants to Atlanta, Gainesville, Tallahassee and a couple of other big cities. We’d tell him yes and then he’d say he’d get back to us. The hospital commander showed up, slightly potted from some big “do” at the O Club, and got the ball rolling.

    Of course I wasn’t a physician so maybe my view was more black and white when it should have been shades of gray. My point was that even then there was a culture of cover-up even in a military hospital where the people were immune to lawsuits. I thought it was disgraceful then and I think it is now.

    But, as I said, black/white vs. shades of grey.