The Customer is NEVER Right - A Nurse Practitioner's Perspective
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History repeats itself, again!

In Phoenix, Arizona I saw a patient with no specific medical complaint and after what I thought was a thorough physical examination and a discussion with the intake nurse, about any concerns he had and as my conscious, I discharged the patient home after the nurse said, “No.” A day later the emergency department director interrogated me about the patient. Not because of a complaint from the patient but because a colleague of the director called him about the patient appearing at another emergency department with a pneumothorax and a lacerated spleen. It just happens the patient was still wearing the identification bracelet from the hospital I worked at.
Without much thought my first questions to the director were, “How did the patient get there?” and “How long after I discharge him did he show up over there? Questions the director had no answers for. However, I thought those were significant questions but the director did not think so. Instead the director went on to state, “I cannot defend you [from administrators] against patient complaints when you make these kinds of mistakes.”
What mistake? I thought. As the director could not tell me how the patient arrived at the other emergency department or how long after I discharge the patient did he show up. My thought was something happened to the patient after I saw him and why I asked when and how he got to an emergency department that was five miles away, as both were level 1 trauma centers, so that was not the reason. So I was curious to when, how, and why the patient ended up at the other emergency department but the director had no idea. Yet, he was sure I had made a mistake by discharging the patient.
Weeks later, the same patient was being presented as a case study before a review board. During the discussion I revealed I had seen the patient, as the boards are conducted in anonymity of the healthcare provider, although prior to revealing myself other providers, all physicians, agreed a thorough assessment had been done and the care was appropriate. One physician stating he may have done a CAT scan of the patient’s brain and skull to rule out why the patient was behaving erratic and vague, however he added, “That would not have found the pneumothorax or the lacerated spleen and if [the CAT scan] was normal I would have discharged the patient too.” It was unknown if a CAT scan of the brain and skull was done at the other emergency department.
A week later I received a letter from the emergency department director, the chairman of the review board, indicating the verdict of wrong was inconclusive, however, I did not recall anyone in the room disagreed with the care I provided the patient.
During the same review board, a case study was presented where a child died after the provider was informed, according to the chart, the child was deteriorating. I do not want to comment on what the verdict was but I cannot say anyone lost their job over that death.
What I do remember was the director, and directors before, telling me “[A healthcare worker] can kill someone but if they do not have patient complaints it is likely they will not be dismissed for that life lost.” I understand patients may die no matter what we do but patients should not die because healthcare workers are negligent, regardless if the healthcare worker is liked or not.
I retold that anecdote from the book because I saw another patient with vague medical complaints and after a thorough physical examination I discharged him home. This time I was alone, without a nurse that could be my conscious, however, as with the previous mentioned patient I was comfortable with discharging this patient home too.
Hours later, the same patient returned to the emergency department but brought in by police. The second time, his medical complaint is not vague at all. Instead, it is obvious the patient was either assaulted or had an injury. Regardless, my thought went back to the patient in Phoenix. What happened to that patient after I discharged him? Here was the evidence, it happens; the patient was no longer the patient I saw earlier.
However, the emergency department director in Phoenix did not see reason to ask what was different. Instead, to him it was obvious I had missed a pneumothorax and a lacerated spleen. How or why the director reached that conclusion? I have no idea but I believe it was because of my customer service record. The only other explanation was the director had his head so far up his rectum he could not see or hear the obvious because his eyes and ears were full of excrement.

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