typical ED exchange, and proof for my theory that our ED nurses are actually unlicensed homeless personnel and/or circus monkeys:
me: what's the medical history?
ED RN: elevated PSA, basal cell carcinoma, arthritis... (in snotty voice) you know i'm just reading all this, it's in the computer.
me: okaaaaay.
patient comes up, and we're reviewing the medical history. which is "in the computer"...until we get to the reason that he's actually here. a complication from a recent surgery.
a whipple.
not in the computer, for the record.
the whipple: a major surgery in which basically everything gets removed and/or reconnected...stomach, gallbladder, pancreas, duodenum, etc. etc.
huge surgery, kind of a big deal. definitely worth mentioning and/or charting on, definitely something i would have liked to know about.
and it would be nice to know that the patient is one of the chief of surgery's privates, as he is very particular and likely to throw things should we violate one of his unwritten rules.
and it would be nice for the patient to be admitted under the correct service, which he isn't.
and it would be nice for the patient to be admitted to the correct floor, which he also isn't.
circus. monkeys. i rest my case.
Being an ED RN I must say this...I can walk into a pt's room, ask the questions: what brings you in today? This will always be different than what they sign in with; What are your allergies? they triage with none but when you try to give them a med, they all of sudden have one or more allergies; What is your medical history? Nothing...we all know that there is always atleast one thing; Have you had any surgeries in your past? they may answer with one, but the one surgery to know that is most of the time the most important one...they don't tell the nurse...I can look in the computer at my hospital but can't see the medical history/surgeries etc like the MD can. I can ask a list of questions; med hx, sx, meds, infectious diseases? The answers they tell me will always be different than what they say the doc once he/she gets into the room...am I am unlicensed monkey...hell no, I am a licensed hard working medical professional that has to depend on what is told to her. If a pt leaves something out...I am the one who isn't doing the right job? What logic does that follow?
ReplyDeletei agree with you...patients leave things out all the time, and i hate when i get a history from the patient and things change the second the doctor walks through the door. in this case, though, the patient was a good historian and very eager to talk about his medical issues. did he leave something out when he talked to the ED nurse? maybe. but when i asked her why he was being admitted, she had no idea. and i when i tried to clarify his history, she got snotty. do i think that all ED nurses are like this? of course not. our ED had a huge turnover recently and they're trying to get back on their feet. but who's the one who's going to be screamed at by the attending in the morning when the patient's on the wrong floor under the wrong service and no one looks like they have a clue what the hell is going on? that would be me. and when things like this are happening on a regular basis (the ED sending suicidal patients up without sitters, or sending head bleeds to the floor on accident instead of to the ICU), my compassion starts slipping.
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