The Customer is NEVER Right - A Nurse Practitioner's Perspective
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In Nov 2016, a great friend asked me if the current job I been working at, for three years, had been the longest I have worked at? The answer, aside the U. S. Army, yes.
December 2016 was the third year I had been working at the same emergency department. I would like to think it had been because of my contribution and what I bring to the job. However, I know that’s NOT it as my contributions and work ethic have not changed and what I have always relied on as to the reason I am hired over other candidates. Yet, that work ethic and contribution have NEVER been the reason for why I remained employed before. So, then, why would it be the reason I have remained employed at this job?
Well then, have I been here this long because FINALLY no one is complaining!?! No, because, although that would be great as to the reason I been here so long I doubt it VERY MUCH that no one has complained.
That said it has been some time since I wrote about patient complaints. Not because patient complaints have disappeared, as much as I wish that were true, but because of other things that have taken precedence. Not at work but overall life precedence as everyday life comes first. Then, of course, I been busy with submitting abstracts and writing presentations for where the abstracts have been accepted and that too takes a chunk of time.
Thus, for this three-year anniversary of working at the same emergency department the following are patient complaints since I last wrote about patient complaints at the same emergency department, although for the most part more of the same, so don’t be bored. But as for the redundant patient complaint stories NEVER a dull moment.
EUEE #1:
Less than a week after seeing an adult female in the emergency department I was asked by the administration, although I am not sure if “asked” is the best word for being probed but nonetheless for a lack of better words let’s just say “asked,”. “Do you remember ‘X’ patient?” A question which makes everyone in healthcare cringe as the question is taken as an assumption that something bad has happened to that patient. Because, frankly, for what other reason would you be asked considering the number of patients we interact with?
Nonetheless, this time it was a patient who complained that I had treated the patient without performing a pelvic exam. Again, I do not remember patients and much less what the medical presentation was. However, I can always rely on the administration to know the DRAMA details, as described by the patient’s experience complaint, as administrators DO NOT, EVER, bother to read the chart from patients who complain. At least they DO NOT read the chart in the manner that would answer the patient’s service complaint. Because more common than NOT the medical complain is clearly addressed in the chart as that is the purpose of the chart. But that is NOT what administrators are seeking answers to and why they DO NOT bother to read it.
After informing the administration that I did not recall the patient the administrator shared with me that I had provided the patient the correct treatment but that the patient complained that I had not performed a pelvic exam before treating the patient.
What? I provided the correct treatment, the business in which we are in, yet the administration still feels that I need to be interrogated! Because, really, aside the correct treatment what else are we to do for patients?
After looking up the chart at the request of the administration, NOT mine as I am NOT interested, the diagnosis for the patient was vaginal candidiasis. A clinical diagnosis, meaning, a diagnosis based on history of present illness and past medical history. Especially for a patient whose past medical history includes vaginal candidiasis “every time I [patient] take antibiotics,” which was the case with this patient. NOT TO MENTION, a diagnosis for which the treatment is over-the-counter (OTC). Meaning, a diagnosis the patient themselves can diagnose and treat without seeking medical attention and much less a pelvic examination.
A diagnosis that if can be treated with OTC medications should be more than enough evidence as to why a pelvic examination—the patient’s complaint, was NOT necessary.
A diagnosis that if CAN be treated with OTC medication and is obviously a clinical diagnosis to ANY healthcare worker then WHY, WHY(!?!), would any administrator, especially one who is also a healthcare provider themselves, choose to question anyone who provided the CORRECT treatment? “The CORRECT treatment”! NOT my words, although the EXCLAMATION is my addition, but the words of the administration. WHY!?! WHY ARE YOU ASKING ME!?!
Here is another instance when an administrator’s head is so far up their rectum, OR, OR, so far up the rectum of whoever they must answer to, they are NOT able to be objective and much less appreciate what just happened. As the administrator’s eyes, ears, nose and mouth are covered with the content of whoever’s rectum their head is inserted into and it prevents them from seeing, hearing, smelling and tasting anything other than CRAP rather the OBVIOUS! In this case, the OBVIOUS clinical diagnosis a LAY(!) person themselves can make and treat themselves with OTC medication and MOST definitely WITHOUT a pelvic examination. So, again, WHY ARE YOU ASKING ME!?!
Because, once AGAIN, a patient’s experience complaint causes such mass hysteria in healthcare that administrators are incapacitated and incapable of the simplest of function—like common sense.
Now for the rest of this story, NOT that it matters regarding the treatment of the medical condition but simply for its comic relief.
The administrator adding that the patient had a direct line to the hospital’s administrator and to who the patient complained to. My reply, “And? It’s still an OTC treatment.” Me, trying to avoid pointing out to the administrator the OBVIOUS—it was a self-diagnose and self-treatment case. Let’s move on.
The “JUNIOR-HIGH” administrator stating, “Don’t kill the messenger.” Really? Where do they find these people? It’s like they are fabricated them from a gigantic cookie cutter somewhere from which they ALL sound and act the same and the “foals” among them lacking the simplest level of management. “Don’t kill the messenger” is an answer NO manager should ever recite. Really? “Don’t kill the messenger?” However, unfortunately, that reply is EVERY wannabe-manager’s best defensive answer.
This is what “Don’t kill the messenger” means to me and why I find it so inappropriate from those responsible for others. “I agree. This is stupid. BUT, and a HUGE BUT, I, whoever is willing to repeat such words, DO NOT have the tiniest of tiny courage to voice that to whoever asked me to be the messenger.” The disagreement is NOT why they repeat it. They repeat it because the LACK the courage to tell the sender how stupid their idea is. Well guess what, bad outcomes happen when you lack the courage to push back when you too know it is wrong and you just repeat it anyhow.
Nonetheless, thinking of the conversation later, I was not sure what that meant, “the patient had a direct line to the hospital’s administrator”, not that it interested me but for some reason the administrator wanted me to know that. SO WHAT! I have the number to my mother and I DO NOT call her for stupid $HIT!
Interestingly, again I DO NOT recall these incidents for three reasons. First, I treat EVERYONE the same and it is ALWAYS with respect, just like those I LOVE MOST. Second, I am NOT able to discern who is going to complain and who isn’t going to complain. And third, I am NOT interested in those who complain. But also, as far as I am concerned, patient complaints are an administration issues, as administrator are the ones who created “healthcare service excellence” and customer satisfaction in healthcare. So, if a patient is going to complain then I would think it would be the hospital’s administrator’s direct line that they need. It makes no sense in having them call the cafeteria to tell them the provider didn’t do a pelvic examination. Or is it that the hospital administrators, despite it was their GREAT idea, DO NOT want to be bothered by patients complaining to them and why administrators take it out on those of us doing healthcare. Just a thought.
Again, I do healthcare and why I am concerned if I get a diagnosis or treatment wrong. I DO NOT do customer service and why I dismiss those issues when patients complain. Contrary to popular belief, I am NOT against patients complaining as they are only venting their frustrations, anxieties and feeling of powerlessness. And why I encourage patients, family and whoever to complain. However, again, the problem with patient complains is NOT that patients complain BUT the administration’s knee-jerk reaction and sequel JUST because a patient complained.
Nonetheless, in this case, the patient’s complaint, I was told, was that I treated the patient for a vaginal candidiasis without a pelvic exam. Again, WHAT!?!
I do not get into these discussions with administrators and I am NOT interested in explaining myself to them either as these complaints are crazy. Not that the patient is crazy, although some of them could be, as patients, again, are simply venting and unaware of what is necessary or not as that is NOT their responsibility to know and why they come to us.
But a healthcare worker, like this administrator asking, should know the complaint is crazy.
That said, after the fact and only as I am writing as I am not interested at all, but is the patient’s complaint based on experience that every time the patient has been seen for the same, thick white vaginal discharge with itching after taking antibiotics, a provider did a pelvic exam. Huh? Because if so, that is that which needs to be questioned!
That aside but as a side note as I am not interested either, at ALL, well, maybe just a tad curious, if administrators, especially the ones who left clinical practice to be administrators, ever put any thought into whatever concerns them. Because. Really? Are you for real? Have you thought this out before confronting healthcare workers over what patients complain about? Because. Really! Think about it for a moment. You are interrogating me, and in this case my credentials, over a patient complaint that I was negligent, I guess. Yet, YOU, yourself, a HEALTHCARE WORKER, who sees patients, are unable to see this patient did NOT need a pelvic examination. Yet, AGAIN, YOU are questioning me.
To administrators, especially those who are/were healthcare workers, you have not thought this out! Have you? That’s NOT good. If anything, it is that lack of awareness that should BOTHER you. NOT that a patient complained but that your head is so far up yours or someone else’s rectum that you are NOT able to figure this out. NOT BUENO!
Reminds me of the eye patient in the book who was transferred and expected to see the ophthalmologist that night. The emergency department director interrogating me for NOT doing more for the patient. Interrogating me two or three days after the fact about a patient who DID NOT follow up with the ophthalmologist the following day. That is the patient DID NOT follow up. Actually, NOT the following day but within a few hours of me discharging her. A patient who was so concerned about her vision yet DID NOT follow up. And the administrator is asking me. Really? Yet, when I asked the director if the patient had lost her vision the answer was no. NO! The patient had NOT lost her vision. And DID NOT follow up with the ophthalmologist. The ophthalmologist the patient DEMANDED to see at 2am but DID NOT follow up with at 8am the same morning. THE PATIENT DID NOT LOOSE HER VISION! Anyone! Anyone! Yet the director asked me to resign because the patient complained.
Anyone! Anyone! This patient asked for a pelvic exam, despite NOT clinically indicated and I am the one being interrogated. WHAT THE HELL IS GOING ON!?!
EUEE #2:
A 19-year-old female. An adult with complete mental capacity and competence and not limited in any manner. Her mentation and competence pointed out only because it is VERY important in this story. I was NEVER told this patient complained, however, if not the patient the family could have easily been one to complain. Actually, I am surprised I didn’t hear them complain. The interaction was so bad that while interviewing the patient I thought I was either on candy camera or was being set up. And why, if you had been in the room during the interview you would have noticed me stealthily looking for a camera somewhere in the room.
Anyhow, the patient had returned to the emergency department after discharged, for the same medical complaint, less than 48 hours prior. Not by me but by another provider two day before I saw the patient. The medical complaint was abdominal pain, the details escape me at writing, however, I was not impressed when I walked in the room. And less impressed after the interview, which included the patient telling me her last meal was a sandwich from Subway just prior to her arrival for abdominal complain—I CANNOT make this stuff up! Not to mention, the physical examination was benign as well.
To critics, “not being impressed” is NOT dismissal or disrespect. It is simply a state of awareness in an unforgiving environment that is the emergency department.
Again, at writing I was NOT able to recall the details of the patient’s medical complaint but as mentioned I was not impressed. And as mentioned, time after time, many of the patients who complaint more common than not DO NOT have any significance to whatever their medical complaints are and more common than not they would be fine without seeking medical attention in the first place. And why I say, you came to me for my expertise. So then why challenge that expertise. And if you DO NOT agree with my expertise, NO BIG DEAL, go get a second opinion. However, if what you are looking for is to fill in the blank with whatever your agenda is than fill the blank yourself and save yourself the money, drama, and the time of others from seeking out the expertise’s diagnosis.
On that note, after interviewing the patient and the physical examination I informed the patient her diagnosis was nonspecific abdominal pain secondary to constipation for which she could treat herself with prune juice. DONE!
NOPE! Because if it had been that easy it would not have been a story to write about. Much less a concern for losing one’s job. That said, for the sake of comic relief, this is not a story to write home about but instead a perfect story for the blog.
Because now the family jumps in. Again, a 19-year-old ADULT female without any limitations. However, the family is present, which is NEVER an issue of mine despite, more common than not, it is the family, in these cases that make all the ruckus. But, as this patient was ready to go, those being her own words, this was more a case of, “I just wanted to make sure nothing was wrong with me,” the family jumped in.
The family, “Did you see her labs?”
“No, I do not have any reason to order any labs,” I said.
The family, “Well they drew blood and she gave urine when she came in.”
“Imagine that,” I thought to myself but instead said, “They draw blood and get a urine specimen on everyone that complains of abdominal pain. That’s fine. I will go look it,” I said.
“They did blood and a CT-scan when you were here yesterday too,” I shared with the patient when I returned. “And it was ALL normal yesterday and again today,” I added.
The patient adding, “Yesterday they didn’t tell me what I had. They just told me to come back if it got worse.”
“I don’t know,” I replied. “But nonetheless, today is the second day in 48 hours that all your labs are normal,” I added.
The family injecting, “But today they didn’t do a CT-scan!”
“Oh NO! She doesn’t need a CT-scan today. Actually, I would NOT have ordered the labs today either based on her history of present illness and physical exam. A CT-scan even less reason,” I shared with the family.
“Oh, but you DON’T know what is wrong with her. She needs a CT-scan,” the family fired back.
“I do know what is wrong with her. I just told her that she is constipated. That is her diagnosis. That is what is causing her abdominal pain. That is what is wrong with her. She is constipated,” I said. This conversation with the family went on and on, to include the risks of an unnecessary CT-scan despite the patient was ready to go and other family members in the room were ready to go too. The family disagreeing with the ONE family member, the patient’s parent, the parent of an adult child, who insisted the patient needed another CT-scan. The other family members voicing concerns that the unnecessary exposure to radiation was not worth the benefit, just to see what was NOT present, especially after having a CT-scan of the abdomen and pelvis the day before. However, the family insisted. I walked out of the room, sick to my stomach, to order the CT-scan of the abdomen only, sparing her pelvis. I also, like so many times before, documented in the chart, “Abdomen CT-scan per family request despite not clinically indicated.”
Sick to my stomach not only because of the unnecessary exposure to radiation but more so because of the unnecessary diagnostics and visit. Not just the CT-scan was unnecessary but so were the blood and urine and EVEN the fact that YOU were back in the emergency department for abdominal pain you’ve had for some days. AND worse, that you came in just after EATING a Subway sandwich. Not only is it a waste of money but also a waste of time and effort as these visits bottleneck patient flow and we are not able to get to patient with significantly more urgent medical conditions.
Once the CT-scan report was available I returned to the room and provided the patient with a copy and discussed the findings with the patient, to include pointing out—Moderate stool in intestine. Telling the patient, “That’s just a more expensive way of describing constipation.”
Did they complain? I DO NOT know and although surprise they might not have complained I am NOT interested if they did or not.
These cases I describe in the book as well as patients who come in seeking our expertise but when it does not match their EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS they are NOT satisfied. It’s almost as if they are hoping I would have said, “You a massive tumor in your abdomen that looks to be cancerous and you have one-week to live.”
Could it be a lack of knowledge? Possible. And I DO NOT blame patients or family for that. But you came to me, I DID NOT go to you, for my expertise and when I provide that expertise you will NOT accept it. Why? It is that “why” which gives me pause.
Let’s put “a lack of knowledge” on trial. You knew to come to me, seek medical attention, for whatever is bothering you. You knew that much. So here I am. The expertise you sought. Yet when I give you the diagnosis, rather be content that your worst nightmare is NOT the cause for your worries you will NOT accept it. You will NOT accept the good news b-e-c-a-u-s-e? The ONLY answer then is that you will NOT accept the good news because you were hoping for something worse. And that knowledge, RIGHT THERE, that YOU were expecting WORSE, for whatever reason, tells me you DO NOT lack knowledge. Just my two sense [sic] of putting “a lack of knowledge” on trial.
If NOT “a lack of knowledge” then WHAT else could it be?
Nonetheless, the patient and other family present in the room were satisfied with my extensive discussion and explanation of the same information, diagnosis and treatment plan I had given them BEFORE the UNNECCESSARY CT-scan. And had NO knowledge deficit when reading the radiologist report. A piece of paper! Written by someone who was NOT present! Let alone interacted with the patient and MUCH less DID NOT touch the patient. YET! A piece of paper they believed. Over the subject matter expert they sought and who was present AND actually spoke with the patient and performed a physical examination. YET, a piece of paper, they read on their own, they believed. Thus, I doubt a lack of knowledge was the reason. But rather a lack of reason or evidence other than my words of expertise.
I CANNOT make this stuff up. If I could have I would have offered them a piece of paper with the diagnosis from the onset. CRAZY!
Interestingly, at the time I was caring for the above-mentioned 19-year-old patient who was constipated, I was simultaneously cared for an adult male, in his 60’s, who the family brought in due to the patient had acute mental status changes. Now that was a difficult diagnosis to reach with a plethora of differential diagnoses. And it DID NOT help that neither the patient or the family were helpful either regarding the patient’s past medical history. The patient was confused and the family ONLY knew there was something wrong with the patient but they had NO clue why that was. Again, NOT the patient’s or the family’s responsibility and the reason they sought medical attention. Nonetheless, after an extensive evaluation the diagnosis was hepatic encephalopathy.
Again, this was an adult patient whose mental capacity WAS limited, unlike the 19-year-old just mentioned. On a good day this patient was a poor historian and why his family knew nothing about what could possibly be wrong with him as the patient NEVER shared with the family his past medical history or the medicines he was on, better yet, supposed to be on as the family stated they had NEVER seen him taking any medicines despite they lived in the same household and interacted daily. And of course, it did not help the patient was unreliable due to his mental status changes, again, unlike the above just mentioned patient.
Did this ill patient or his family complain? NO! On the contrary, the family was the most appreciative and they expressed their gratitude a number of times to staff who walked in their room. Amusingly, “Atta boys” never reach administrators. Yet, patient complaints ALWAYS reach administrators, at the highest levels and at the speed of light, as complainers ALWAYS have direct lines to administrators.
Yet, those MOST satisfied NEVER find such needs. Why? Because a simple thank you is MORE than enough for them and for me as well. Or not, as I DO NOT do what I do for any recognition. I do what I do because I enjoy helping others regardless if that help is recognized or not and even if they complain. That is not to say that if you are going to be inappropriate I am still going to reach out to you. Because if inappropriate then they WILL be dismissed, no ands or ifs about it, as the culture of any organization is shaped by the worst behavior tolerated.
On the other hand, contrary to popular belief, I hear MANY MORE thank yous than NOT at all. And disproportionally MANY MANY MORE thank yous than complaints but that is NOT what matters to administrators! Because if it did matter to them I could easily be “Healthcare Worker of the YEAR”! Thank you. Thank you very much! Thank you!
Nonetheless, this patient’s story shared NOT because they complained but because their story was the opposite extreme to the just mentioned 19-year-old with abdominal pain in so many ways. To include this family and the patient as well did have a knowledge deficit. Despite that, they sought medical attention not knowing what was wrong but that something was wrong. And when I gave them the diagnosis and admitted the patient to the intensive care unit (ICU) the family did NOT push back but instead was the most appreciative. And when the family asked how the patient became this ill they were most appreciative of the lay pathophysiology explanation I gave them as well. That is what we are here for. To help others and NOT for rating scores.
A 33-year-old female with abdominal pain whose symptoms, history, and examination are not recalled at time of writing. However, what stood out about this patient was that after an extensive work up, which included labs and a CT scan of the abdomen and pelvic, the findings were unremarkable except for moderate stool in the intestines.
This is NOT the 19-year-old female mentioned before, however, abdominal pain is in the top five reasons as to why patients seek medical attention in the emergency department. And despite most of the cases are unremarkable most of them are difficult to assess for a plethora of reason but the patient’s hidden agenda is a HUGE factor. A hidden agenda which if ascertained a lot of time, effort and money can be saved. Keep in mind, ONLY healthcare workers are liable if something is missed. NOT that my practice is influenced by the medical-legal aspect of what we do BUT it is quite the force and for a number of reasons as to why we do the things we do.
That said, when I provided this patient with her diagnosis—abdominal pain due to constipation the patient became argumentative. As best as I can recall I do not recall the patient being upset while caring for her. However, when I mentioned to the patient her diagnosis and that she was being discharged the patient became argumentative and declined to be discharge yelling at me, as to why the abdominal pain was radiating to her back. Back pain the patient had not mention previously. Back pain I did not appreciate during my physical exam. Back pain I did NOT notice the number of times I went to reassess the patient and found her sleeping in no apparent distress. Back pain that was not appreciated when the patient was awaken either and when I saw her a number of times repositioned herself in bed to grab objects off the table next to the bed.
Nonetheless, back pain which I would then specifically assess, after the patient became belligerent, and after my assessment was not impressed with either. Back pain for which the patient did not have any saddle paresthesia, incontinence or disability from. Again, not to mention, the patient’s blood, urine and CT were unremarkable.
A significant and commonly missed differential of back pain is a retroperitoneal abscess which is an insidious and difficult diagnosis with significant morbidity and mortality if missed. But again, nothing, not the physical exam or diagnostics, pointed in that direction.
Not to mention, it DOES NOT help when the patient decided to yell at me, “You don’t know what the fuck you are doing!” Again, behavior which had NOT expressed itself until given the benign diagnosis. If so the patient would have been dismissed then.
But really the patient seemed to be okay with the care prior to the discharge, as I had visited the patient a number of times concerned that patient had some pathology of which I was unable to pinpoint with history and physical exam. Of course, that was a thought to myself and not something mentioned to the patient. Because although I have NO problems with saying what is on my mind to the patient my experience has been that administrators do. So, instead, I simply told the patient, “Here are your discharge instructions. You are discharged. And I walk out of the room. At that point, because of experience, I no longer take any issue with patients. If they leave they leave. If they don’t they don’t. Nor do I share with anyone of the staff as I have found that is more injury to the self-psychic than what it is worth. Especially when some healthcare workers think they are the superhero who will salvage ALL situations. Or administrators obsessed with “customer recovery”. SHEESH!
Of course, by not telling my story when administrators ask I am labelled as the problem in the equation. However, over time I have learned that NO matter what a healthcare worker says, whether me or anyone else for that matter, if a patient complains it is the healthcare worker who will be labeled the problem in the equation twenty times out of ten incidents. Yes, twenty, like two zero, out of ten, it’s that obvious and that bad.
Nonetheless, I have no idea what the outcome was from that patient. However, the patient did change and stormed out of the department without assistance or limitation, which I made sure of documenting in the chart because patients with retroperitoneal abscess or any other significant differentials DO NOT spontaneously heal and storm out without, at a minimal, some difficulty and likely limitations as well. But storm out? NO!
That said, if the patient had a poor outcome related to my care without doubt I would have been CRUXIFIED as those at odd with administrators NEVER last, regardless of reason. Unlike those ADMIRED by administrator who are NEVER dismissed, regardless the poor outcomes.
Interestingly, I NEVER heard from administrators about this patient. If anyone, this would have been a patient I would have heard about who either complained or had a bad outcome but neither. But for the one who complained about NOT having a pelvic exam I was interrogated.
I say that because this patient, a 33-year-old female without cause for her abdominal pain and ALL her blood, urine, and CT-scan finding being normal did have a pelvic exam, which was ALSO unremarkable. A pelvic exam because it was medically prudent when everything else was normal. A pelvic exam of which the patient had no qualms about as the patient only became inappropriate after I shared with her that the extensive work up was unremarkable. Yet, NOTHING from administrators. CRAZY!
I say CRAZY because I still am NOT able to get over the CRAZINESS that I was interrogated for NOT doing a pelvic exam that was NOT clinically indicated and the administration made such a big deal about it. CRAZY!
47-year-old female comes in with foot pain after “overuse” of her foot, as she stated. Overuse only because she was supposed, operative word supposed, to stay off her foot after foot surgery. And, at 4am, she was concerned something was wrong with her foot.
Again, I CANNOT MAKE THIS STUFF UP! I wish I could because that would be a different career, like writing emergency medicine drama for TV. But NOPE! Just not able to make it up. Not to mention, post op patients are difficult to evaluate—how much is it pathology and how much of it a lack of education and how much of it is just plain psychosis.
As for the patient’s medical complaint nothing gets my attention. Her foot looked just fine. A conclusion I reached by visual examination of the surgical site. Looked good. Not red. Not swollen. Not warm. No drainage. “Looks fine to me,” I said. Adding, “You can follow up with your podiatrist whenever your next appointment is.” Which, of course, didn’t go well with her EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS! And why an additional story here.
Then after my reassuring findings and comments to the patient the long story and VERY LONG story. However, I will spare everyone such histrionic rendition from the patient and instead provide the abbreviated and very abbreviated version, “I wouldn’t be here, at 4 o’clock in the morning, if there wasn’t anything wrong with it. I need a referral to be seen in the podiatry clinic.”
“No ma’am. You really don’t need a referral from the emergency department at 4 o’clock in the morning to be seen in the podiatry clinic which opens at 8am and where you are an established patient. Just call the clinic at 8am and ask them for an appointment because you are concerned about your foot surgery. Otherwise, your foot looks fine,” I said to the patient. Nope. Again, NOT good enough despite not only correct but just plain common sense.
“No!” she fired back. Adding, “I know that I need a referral.”
Not sure how I get a referral to a podiatrist she was already seeing. Of course, I could call her podiatrist at 4am but I am sure the podiatrist would not be happy. Nonetheless, knowing there was no recovering from this one I gave her a work note and told her to call the podiatry clinic at 8am to make an appointment.
Of course, not enough and why this story too is here in detail. Now that I was done, or thought I was done, I had to hear from the patient who wanted to scold me, “I have worked in customer service for 20-years and you have poor customer service. You came in here with your hands in hands in your pocket and you wouldn’t even touch me.”
The rest of it sounding like Charlie Brown’s teacher to me, “Waaa Waaa Waaa.” But I am sure whatever she was saying was to give me pointers on how I could improve my customer service. Maybe even talking to me about “customer recovery” or what in lay terms I have labeled, “Kissing her ass.”
But I was NOT interested. Ah! NO! Not for me. The skill sets I have are to save lives and stomp out disease. I am not here to kiss anyone’s ass. Not patients. Not families. And NOT administrators either. If I had wanted to kiss anyone’s ass I would have taken up a career where that opportunity was in the job description, like, “customer service”, but I didn’t. Not something I said out loud to the patient but believe me I was very close to telling her.
Once she was done with her diatribe, as I didn’t want to be rude, I walked out of the room and on to see the next patient.
Interestingly, the next patient, after the foot patient mentioned above, was a 47-year-old male who I also saw while I had my hands in my pocket. But something I only noticed after the previous patient lectured me as I had not noticed it before. That said, I know other patients have complained to administrators that I cross my arms across my chest or lean against the wall or furniture when I interact with patients, none of which I had noticed before it was mentioned either. That said, ALL of which I still do despite those who complained found it offensive and administrators agreed with them. I don’t do it just to spite folks. I do it because that is me and my arms across my chest or me leaning on furniture or the wall has NO other meaning, message or significance EXCEPT just that, my arms across my chest or leaning and NOTHING else. And despite this was the first time someone mentioned me having my hands in my pockets I doubt it was new.
That said, I am sure this next patient didn’t even notice and if he did I am sure he could NOT care less as he made no mention. I mention this about my hands in my pockets as prior to the previously mentioned patient I had never noticed I walked around with my hands in my pocket. Not to mention while in uniform in the U. S. Army, regulation, YES regulation, dictated “nothing should protrude from the pockets”. That included your arms from your pockets and why in the Army we did not walk around with our hands in our pockets. However, although already stated a number of time, but just to make sure it is clear one more time, this patient, as every patient before the previous and since, no one had made mention of my hands being in my pocket.
Nonetheless, this patient’s examination too was obvious. And from where I stood, with my hands in my pocket and without touching the patient, it was obvious the patient needed intravenous antibiotics, surgery consult, and admission for an infected arm with a DVT (deep vein thrombosis) after an intravenous drug use site had become infected.
Interestingly and why this patient is detailed here, this patient, despite me NOT laying hands on him, was most appreciative without complaints and instead was apologetic for where he found himself. To which I replied, “No reason to apologize, Sir. We are going to get you better.”
As already mentioned, but one more time for those who missed it, patients have complained that I stand with my arms across my chest and that I lean up against the wall or furniture when I speak with them and now, at least one patient, has complained that I had my hands in my pockets, okay.
Interestingly, one thing I DO NOT do is sit in a chair or on the bed as some have suggested as a skit or script that has a more personal touch. Nonetheless, I believe some, patients, families and, even, administrators, just like to complain.
At the change of shift I was given report (signed-out) about a 28-year-old male who was waiting on a CT scan of the chest after a cavitation was seen on plain film chest x-ray. The patient’s history was questionable for TB (tuberculosis). Fine. Easy peasy, as they say. However, just for the record, “sign-outs” are not to be taken lightly as a number of them end up in litigations for a number of reason. With that said, otherwise, again, fine. Easy peasy. The patient is already in a negative pressure room and the CT will confirm whether the patient gets admitted for TB, for which the Hospitalist is already aware, or goes home. Easy peasy.
CT report—TB cannot be ruled out. Ok. Call the hospitalist, who was already aware of the patient and the potential plans, in this case to have the patient admitted for empiric treatment and further evaluation to rule out TB. Easy peasy. Right? Wrong and why we are here.
For my practice, I prefer to let patients know they need to be admitted before I place a call to the Hospitalist. However, again, this patient was from the dayshift and already known to the dayshift Hospitalist so I could have easily called the nightshift Hospitalist who would have seen and admitted the patient without me talking to the patient or getting involved at all. However, that is NOT my practice so off I went to speak to the patient regarding the findings and the treatment plan. Easy peasy!
NOPE! Why would it be so “Easy. Peasy”? The patient DOES NOT want to be admitted. Again, why do people come to us for our expertise and when we provide such expertise they sought they refuse the treatment plan.
Unknown to me, not that it matters, the patient had been trying to leave before I walked in the room and why the charge nurse was in the room talking with the patient about waiting for the results. Of course, the patient had already decided he was leaving regardless the diagnosis to which I said, “Sir, it is possible you have TB which is a highly contagious illness. If you leave without treatment or a completed evaluation you could contaminate others. Making matters worse not only for you but for the community, to include your family as well. All of this we want to do for you is in your best interest.”
NOPE! The patient insisted on leaving stating, “I have to go to work…I have a two-year-old at home…yada…yada…yada.”
“Sir, you came here for us to help you and that is what we are doing in your best interest. It would not be in your best interest, or your child’s best interest, or your coworker’s best interest if you leave. Not to mention, if you leave I will call the police.” YES! I said ALL of that to the patient to include me calling the police. The suggestion of involving the police was more of a strategy than actual intent as it is common for those with outstanding warrants to yield when the police is mentioned. That said, the latter also being a two-edge sword however and why at times I will NOT notify the police if the patient declines to have the police notified. However, I thought in this case, for no other reason other than luck, that it might make the difference of the patient staying versus leaving. That said, for NO reason was I suggesting the patient had warrants for his arrest. That you would have to ask him.
Of course, after my mention of the police, the patient became irater. So, maybe, just maybe, there were some outstanding warrants. But for me that is neither here or there. But then, anything is possible. Anyhow, then the patient resorted to junior-high-school behavior telling me, “You’re just insecure.” The charge nurse abruptly looking at me and then to the patient as to say to the patient, “Insecure? NOT!” That, of course, being how my ego interpreted the charge nurse’s reaction as I have no clue why the reaction, what it meant or what it was for. However, now that I am writing this and knowing the nurse, by the way one of the best charge nurses I have worked with and I have worked with MANY, but I digress. Maybe, just maybe, what the charge nurse was telegraphing with her look instead was, “I guess he told you! You tell him, Sir!” And why she looked to me first before looking at the patient. If so, if that was the charge nurse’s reaction I am sure it had to do more with me NOT EVER buying her Chick-Fil-A, which I believe she is still waiting for. But that is another story for another day or NOT!
Nonetheless, my reply to the patient’s comment, “Sure but that is neither here or there.” After going back and forth the patient eventually yielded and agreed to admission. I doubt it was because of me and more to do that the patient knew I would have the police called and I DO NOT believe that would go well for him. Maybe that was why the charge nurse looked at me to see if I was serious about calling the police. But, again, it might have been because of the Chick-Fil-A story. Nonetheless, after ALL the drama I walked out of the room and called the Hospitalist and the patient was admitted.
Months later I saw the same patient, not that I remember him, but because the patient told me that after all the test the diagnosis was NOT TB. Interestingly, the patient was apologetic to include a comment that I was not only looking out for his best interest but also in the best interest of his child. My reply, “There is no reason to apologize. But I will tell you this, you came here for our expertise and that is what we are here for your best interest. We DO NOT write you off the Christmas list. That is not what we do. And regardless of your behavior I am going to be here every time because although you might not appreciate us at the moment there are many more patients who do. And if you chose to come back we don’t hold your previous behavior against you.”
I always find it interesting, if not even comical in some manner, that patients remember me. I am not sure that is good, regardless if the experience was a positive one or not. That said, I could NOT pick any of them out of line up if I tried. That mentioned because I see my lack of memory, regarding patients who return that is, as something positive and that is because it keeps me objective rather basing my assessment on previous experience.
Of course, then there is the mantra mentioned in the book which administrators share with me a number of times, “Customers will not remember what you said to them, they will not remember what you did for them but they will remember how you affected their feelings.” That being a version of Maya Angelou’s quote, “People will forget what you said, people will forget what you did, but people will never forget how you made them feel.” An admirer of Ms. Angelou that is one quote of hers I DO NOT agree with, imagine that. My reasoning, I value what people say and even value MUCH more what they DO for me before the drama of how they made me feel. But that is my two sense [sic] as I DO NOT get caught up in the drama of others.
Or, “You may not control all the events that happen to you, but you can decide not to be reduced by them.” -Maya Angelou
Or, “Never make someone a priority when all you are to them is an option.” - Maya Angelou
Or, “If I am not good to myself [patients], how can I expect anyone else to be good to me.” – Maya Angelou
Or, “Most people don’t grow up. Most people age. They find parking spaces, honor their credit cards, get married, have children, and call that maturity. What that is, is aging.” – Maya Angelou
Or, “We need much less than we think we need.” – Maya Angelou
Or, “Hate, it has caused a lot of problems in the world, but has not solved one yet.” – Maya Angelou
Or, “If you are always trying to be normal, you will never know how amazing you can be.” – Maya Angelou
Nonetheless, the first quote by Ms. Angelou administrators likely picked up at some manager seminar while neglecting the other quotes. A practice of managers, that of cherry picking what benefits them and repeating it over and over while neglecting those not in their interest. A practice I counter, to myself of course as I would NOT want to hurt the feelings of administrators, “I do not yet know [of anyone] who became a leader as a result of having undergone a leadership course.” – Lee Kuan Yew
Not to mention, administrators MUST know that the paradigm, “Customers do not remember what you said to them or did for them but will remember you hurt their feelings,” has reached its expiration date and it is time for new material. Customers may not be content about their EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS not being catered to. But I have NEVER had a patient complain about their outcome and it is because of that that they return and what healthcare needs to be attentive to as that is what we are there for.
The next three patients, although, arrived at different times and were triaged at different times they were ALL roomed at about the same time. And then their charts were placed in the to be seen rack according to their arrival times.
Grabbing the first of those three chart I walked into the right room, according to the chart. But the wrong room according to the patient’s name because the charts were assembled incorrectly. No big deal it happens. Not knowing what the patient’s medical complain was, in the room I just walked into, I spun around and walked out the moment the patient stated her name. The error mentioned to the nursing staff who then pointed me towards the room of whose name I had as that person had came in first. Again, it happens no big deal. Entering the correct room, according to arrival times, I found a 19-year-old female who complained of breast pain. When I asked the patient for her name she unleashed a barrage of curse words instead. When I asked the patient to refrain from using profanity the patient then went on a tirade of how long she had been waiting. To which I replied, “I am here now.” And before I could finish that four-word statement the patient began the profanity again. To which I replied, “Ma’am, I asked you not to use profanity. I have not used it with you. You will NOT use it with me or anyone here.”
NOPE! As if I was there talking to the wall. The profanity and inappropriate behavior continued. “Okay ma’am, you are discharged and you can follow up with your PCP (Primary Care Provider),” I told her. Because in that short interaction I concluded the patient had a non-emergent medical condition per my medical screen examination from where I stood and without a physical examination. I then walked out of the room only to return shortly with a diagnosis of breast pain, a non-emergent medical condition, and discharge instructions. DONE!
Next, I walked into the room I had walked into initially. Only to find a 71-year-old female with shortness of breath and near syncope. Easy peasy. In short I said to the patient, “Ma’am, even if after everything I do here is normal you will need to see a cardiologist, which we do not have here and why you will need to be transferred.” “Okay,” the patient said.
I then walked out of the room to find the patient’s nurse after I found the patient laying in bed not on a cardiac monitor and without an ECG in the patient’s chart.
The reason none of that was done I was told, “Because we are having to deal with the other patient you just saw who was crying.”
“Wrong answer,” I shot off. “I didn’t just walk into this patient’s room. I walked into this patient’s room before I saw that other patient. And even then, when I first walked into the room, this patient was NOT on the monitor. She was sitting on the side of the bed. Regardless, the patient should have had an ECG when she came in,” I added in disbelief.
The nurse replying, “No one said she had chest pain or that she needed an ECG.”
“She doesn’t have chest pain. She is 71-years-old with shortness of breath and near-syncope. She needs an ECG and to be on the monitor,” I answered.
“Well, I was taking care of the other patient,” the nurse replied.
Oh, really, the non-emergent patient that was discharged suddenly became the highest priority patient in the emergency department base on what? Some customer satisfaction or customer recovery ludicrous mandate? YES! That mandate, which makes priority any patient who complains and MUST be recovered regardless the means necessary or the cost. Really!?! That IDIOT-ology [sic] being a major problem outlined in the book. That when patients complain everyone must gravitate to them regardless of what else is going on, to include with the rest of the patients regardless if others need the most attention. Administrators, over and over and over, have told me that what matters most when a patient becomes upset or complains is the recovery of that ONE patient JUST because the patient complained or became upset and nothing else matters.
I wish I could have summoned that IDIOT-ology [sic] when I was a child and upset my parents wouldn’t let me do what I wanted and when I wanted.
Anyhow, disinterested with the ongoing drama I moved on to place orders for the 71-year-old urgent patient who needed to be transfer to a facility of higher care for a cardiology consult. However, since I discharged the patient with all the profanity, rather coddle her, the staff gravitated to ALL of that patient’s yelling and crying. And the more significant patient could not be cared for expediently and appropriately until the upset patient was recovered, I guess. The staff and administration NOT only consumed with the tantrum throwing patient but they were also consumed with trying to convince the attending physician to see the already discharged patient. That said, I NEVER have a problem with complaining patients being seen again, by either myself or anyone else for that matter. However, those patients should check in again as a new chart needs to be generated.
That said, I have given up on sharing anything with peers, colleagues or administrators about patients who complain. Based on experience, I have come to experience the same outcome regardless what I might add or NOT and that is that I always come out to be the terrible monster that I am not. I just DO NOT put up with anyone’s inappropriate behavior. Not from patients. Not from families. And NOT from administrators either. And because I am always the one who is the monster why bother and the reason why I simply discharge the patient and walk away. That said, patients who are sick NEVER complain and why it is so easy to discharge those who are inappropriate and I have LOTS of anecdotal experience to show that those who are sick NEVER complain.
Again, regardless what happened the conclusion from administrators is the same, I am the consistent variable so it must be me who is inappropriate. However, if seen from my point the consistent variable instead are those with EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS. Something EVERYONE in healthcare experiences. The difference, others bow and I will NOT!
The customer experience literature’s substitute for bowing or kiss up to customers is titled “customer recovery”. A common script from such “customer recovery” IDIOT-ology [sic] is, “I apologize that we started off wrong. I am going to step out and walk back in and we can start all over [as if nothing happened].”
I say, “NO!” I instead resort to, when someone, anyone, pushes me I push back and I push back HARD! Had you NOT pushed I would NOT have pushed back. That simple!
Why do I push back? YOU came to me. You sought my expertise. You sought my desire to help others. However, just because you did not get what you wanted, thought it was too noisy at the nurses’ station, missed your honey-bunny, or whatever flavor of the week it is, is NO reason for you or anyone with you to be inappropriate.
By “you came to me” I mean you came to a place that is unknown and unpleasant to you and unforgiving to us both. A place where services are sought during some of the worse moments of our lives and during inconvenient times, for uncertain, unpredictable and volatile choices. I get it! Believe me I am on your side. However, my desire to help you and others DOES NOT give you or anyone a green light for you to take out your frustrations, anxieties and/or feelings of powerlessness on me or anyone I am working with.
Here is why, I AM NOT A PUNCHING BAG! I AM A HEALTHCARE WORKER, a member of a time-honored profession genuinely dedicated to helping others that is trusted and OBLIGATED with saving lives and stomping out disease.
You would NOT want me to go to your place of work or home and behave inappropriate. You WILL NOT with me.
Isn’t it ironic that when one treats others as they treat you they get offended only because they expected you to bow? If you are inappropriate you MUST leave because the culture of any organization is shaped by the worst behavior tolerated.
Not to mention, regardless of my contribution with patients I see those who become upset, for whatever reason, and the end story is the same. Some patients will walk out and some will DEMAND their rights of being seen by another provider. The latter despite I always discharge patients to follow up thus a second opinion and/or being seen by someone else. But NNOOOOooooo!
Back to the anecdote on hand. Disturbingly, just another example of where customer service trumps healthcare, as everyone is now concerned and attending to the one non-emergent patient that is yelling and crying while an urgent patient sits without any one paying attention. Nonetheless, the non-emergent patient, at the persistence of the coddling staff and administrators, was seen by the attending and the 71-year-old urgent patient was eventually transferred to a facility of higher care.
Now some, because healthcare is JUST like junior-high school, will say or suggest to me, “Don’t play the victim to circumstances you created.” No. I never see myself a victim. On the contrary, I see as victims ALL those who bow to EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS. Because everyone experiences that inappropriate behavior from patients at one point or another. They might NOT blow up as I do but everyone experiences inappropriate patients and families, administrators as well. I just push back and push back HARD!
In the book, I mention of healthcare workers who are the epitome of kindness yet even they experience inappropriateness from those they are trying to help. By no means do they have the number of negative experiences that I do but they do. With me I can understand why as I push back but with those kind people there is ABSOLUTELY NO REASON why anyone should be inappropriate towards them. NONE!
Wait, the PARTY isn’t over yet. While still caring for the 71-year-old patient, before she was eventually transferred, I grabbed the chart of the third patient from the bad batch. I did so because despite ALL the drama already I am at work to work and NOT to win any popularity contest or to get on anyone’s x-mas list.
The third patient was a 4-year-old brought in by his parents due to the patient had a fever. A fever which the nurse claims she was advocating for when she asked me for an antipyretic order due to the patient had not received anything for the fever. However, an order requested while I was very much still involved with the 71-year-old patient and my priority. Can I chew gum and walk at the same time? Absolutely. However, at that moment when asked I was very involved in a different patient’s care and trying to come down from the previous drama. Not to mention, fever medication was NOT a priority. Especially after everyone ran to coddle a crying 19-year-old despite a 71-year-old urgent patient sat patiently waiting her turn.
And when I mention that fever medication was not a priority for me at the moment to the nurse, the nurse fired back that care was being delayed for the 4-year-old with fever. Oh, really? Now, suddenly, care was being delayed. Not for the 71-year-old urgent patient who sat and waited her turn patiently. No thought care was being delayed then. But, for some reason, now, fever management of a 4-year-old was being thrown around as delay of care. Who comes up with ALL of these silly catchy phrases? Oh, almost forgot, healthcare, or better yet, the same behavior of junior-high school.
Let’s NOT forget, these three patients were roomed at the same time despite they arrived and were triaged at different times. And you want to point out that I am neglecting a 4-year-old’s fever. WHAT FREAKING PLANET HAVE I LANDED ON?
Rarely have I pointed out other healthcare workers as being part of the problem and not the solution. But I have. However, these three patients’ management was just off the chart. Of the three patients, only one of them needs urgent attention yet did not receive it. Instead, the staff, to include the administration, was attending to the minutia related to customer service whether they see it that way or not. On top of that, it does not help when the staff pull out the compassionate card, or the delay of care card, or any other card to be pulled for that matter when instead they are JUST placating. To them I say, “Placating is NOT advocacy. Placating is JUST placating.”
A more detailed answer to that is rather placate to customer satisfaction scores healthcare needs and would benefit most if we placed all our energy, time and money on clinical outcomes, those responsible for those outcomes-healthcare workers, and the safety of healthcare workers and patients.
Because not only have we NOT moved the needle regarding customer satisfaction scores, despite ALL time, energy and BILLIONS of dollars wasted, but when the dust settles following a patient’s tantrum that is behavior, the same ones pulling out ALL the compassion cards and delay of care cards and whatever else is the latest customer recovery card is, would NOT accept at home from loved ones. And why I get a chuckle when some suggest we treat patients as if they were family. Behavior healthcare administrators would not accept at home either. Yet, administrators and those placating want us to accept that venomous behavior from those we are helping.
I say dismiss those who annoy us. Dismiss the rude. The entitled. The abusive. The demanding. Those who tread on us and those who have taken us down the wrong tracks, to include administrators and staff who rather placate before performing their jobs of helping others. By dismissing those who annoy us it frees us to focus on those who value, trust and appreciate us for the care we give. On this we must stand in solidarity and not waiver otherwise those who annoy us will not change their behavior as long as they can find tolerance elsewhere.
DO NOT confuse accommodating or appeasing with advocacy as indulging those who make unreasonable demands on us not only leads to running up the bill but it leaves us vulnerable too. And truly accomplishes nothing as the needle to customer satisfaction HAS NOT moved despite the BILLIONS of DOLLARS WASTED!
Instead, we must side with loyal employees and coworkers over those who are undermining, the petulant, unreasonable, angry, demanding and those who tread on us for us not submitting to their EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS. This is not about us versus patients but about convincing complaining patients and those who coddle them that we are looking out for the best interest of ALL patients. But if those who complain desire our help then they must stand with us. If they decline they must leave along with administrators and staff who coddle them because intimidating or undermining us until they get what they want is manipulative and not what we are here for as it only divides healthcare workers trying to help others.
And despite the worse answer anyone can give at that moment is, “You have to pick your battles.” And that was the nurse’s answer as well. Another ALL to common line many learn from managers who believe they are leaders and why they repeat them.
Really? ARE YOU FREAKING KIDDING ME! Are you that oblivious that you cannot see that my battle at that moment was that of a 71-year-old with shortness of breath and near syncope that needed to be transferred. That was my battle. Not some 19-year-old who believes the world revolves around her or some 4-year-old with a fever that could have been treated at home. Yes, these three patients were roomed at the same time but THAT IS ALL they have in common. Of the three of them, the priority was getting the 71-year-old transferred. Anything other than that, even those working with the physician caring for the 19-year-old, teeters on undermining. AM I ON THIS PLANET ALONE!
Not to mention, picking your battles is a position of convenience, as anyone who has fought any battle will tell you how inconvenient that is and it is that inconvenience and sacrifice which gives worth to the battle. Rookies and managers have no idea what that is and why they throw out those catch phrases they learned in management 101.
Eventually I got to the 4-year-old who was playing in his pj’s. And shortly after he was discharged home with an upper respiratory infection. After ALL the drama surrounding the delay of care for the antipyretic. AFTER ALL the FREACKING DRAMA the medicine had not been given when I discharged despite I had order the medicine one hour before.
At that point I just told the parents to give the patient something for fever when they got home and to expect fever for a few more days and to treat it as needed. The parents had no complaints and after agreeing to give something for his fever when they got home off they went. The staff upset that I would discharge the patient without the patient getting the medication I ordered an hour before.
The point to all this madness, as some don’t see how all this stupidity has overridden common sense and why it needs POINTING OUT—don’t waste resources trying to recover customers. Because when you do those needing the most attention get the least attention. Healthcare is NOT retail, hospitality or any other industry for that matter. Healthcare is a time-honored profession genuinely dedicated to helping others that is trusted and OBLIGATED with saving lives and stomping out disease. Yet, despite that heritage and DUTY healthcare has been cheapened, by any means necessary and at the cost of so much, into just another customer-driven service. And for WHAT!?!
Healthcare must NEVER be cheapened just to accommodate a few As it puts others at risk.
Of course, had the patients been triaged appropriately then maybe none of this would have happened as I would have initially walked into the 71-year-old’s room first, as I did, and NOT walked out to see the 19-year-old or the 4-year-old. However, in some way I am glad it did happen as it exposes the overwhelming collateral damage that customer service, customer satisfaction and customer satisfaction scores are and how it has rotted healthcare, a time-honored profession.
A 7-year-old was brought in by parents due to the patient had been having foot pain since Friday after an unspecific injury without treatment or seeking medical attention prior to arrival SUNDAY night. SUNDAY NIGHT! Because what is on the next day? SCHOOL! It’s like RomperRoom. It really is that simple to identify the hidden agenda sometimes. When asked the patient, initially, was unable to recall which foot hurt. So, I check both. And both feet, ankles and legs were unremarkable. The skin was intact without bruising, deformities or swelling. When I asked the patient to walk the patient first looked at her parent before walking with a slight limp. Afterwards, when the patient was instructed to dress again the patient did so without any difficulty or limitations hopping on both feet while distracted putting her legs though the pant legs. Also while distracted the patient stood up from the bed and ambulate to the other side of the bed without the previous limp to get her shoes.
WHAT!?! IT’S A MIRACLE. The ceiling in the room parting and a beam of BRIGHT WHITE light suddenly appearing with frolicking Angels playing harps descending through the light from the ceiling. WOW! What a sight! Oh, just poor acting. Darn!
Looks great! You get to go home.
Right? WRONG! Why else would we be discussing this patient if everything were right? The parent is not happy. Imagine that. “What about a note for school?” the parent asks. What? A note for school? But why I thought. Instead I simply asked, “Why?”, softly as not to upset anyone. “Because she walks to school that’s why,” the mother said. But wait, you been walking all weekend I thought to myself. Thought to myself only because I been told that when I think out loud I am heard and people get offended that I challenged their BS!
Okay, a note for school it is. Why not? I’ve been passing out school and work notes at this emergency department like they were candy. Talk about pick your battles. One note coming up.
“And a note for taking the elevator at school, too, instead of the stairs,” the mother added. WHAT? My FIRST “take the elevator and NOT the stairs note in fifteen years. Finally. The missed punched hole for my credential and career. After 15 years, I have finally reached the pinnacle of my career. A credential SO FEW obtain—the note for the elevator not the stairs’ excuse. I will be the envy of everyone in our industry. Hospitals and clinics across the nation, maybe the planet, will be baptized with my name. Actually, the only reason I went to school in the first place. So that someday I might be privileged enough to write the “take the elevator and NOT the stairs note.” My work HERE is DONE!
“Jose. Jose. Wake up,” I heard from a distance only to realize I was still there. And worse, THEY were still there TOO!
I cannot make this up, YES! The parent asked for AN ELEVATOR NOT THE STAIRS NOTE! I have NEVER heard of such LAZINESS! NEVER! But I will NEVER be able to stay that again!  Anyhow, my solution, “Here is a note. In the comments write as you desire. Anything else?” The parent nodding no. “Good. Bye,” I said. The last two words were two different words separated by a period intentionally to permit for a different meaning. Yet, said close enough as to suggest a totally different meaning but NOT intended at all.
Again, I CANNOT make any of this up. I wish I could so that I could work elsewhere.
EUEE #10
A 12-year-old brought in by his parent due to the patient had a nonproductive cough for greater than one month. At the onset of the cough the patient was seen at an urgent care where he was treated with a 5-day regimen of azithromycin after diagnosed with a questionable lingular pneumonia according to the radiologist report. Ten days after completing the azithromycin as directed the patient was seen at the same urgent care, not a pediatric clinic or his PCP, both which were available for the patient to be seen. But, what? NNOOooo! Instead, the patient was at the same urgent care and placed on levofloxin due to his symptoms had not improved. However, after completing levofloxin as directed there was still no improvement and the reason for seeking medical attention in the emergency department. But, ONCE AGAIN, NOT the pediatric clinic or his PCP despite both were available and either significantly a better choice for follow up. Not only for continuity of care but both are pediatric subject matter experts. But, I guess, Urgent Care and Emergency Department sound better when you’re telling the story as to why you had to seek medical attention.
Nonetheless, during my assessment there was no clinical evidence of pneumonia. The history of present illness was not consistent with pneumonia. And neither was the physical examination which was more consistent with an allergic rhinitis versus upper respiratory infection but most definitely NOT pneumonia. There wasn’t any fever, sputum, shortness of breath with exertion or when supine, or chest pain. Instead, the patient had, and continued to have, a running nose and the cough that was mostly at night time. The patient’s lung sounds were clear, he had sniffling with swollen nasal turbinates and post nasal discharge in his pharynx, otherwise the physical exam was benign.
A chest x-ray that was ordered prior to me seeing the patient by the medical screening provider was also unremarkable. A chest x-ray I had not seen before seeing the patient and when the parent informed me of the x-ray my answer was, “I would not have ordered an x-ray but since they did it I will go look at.”
The parent becoming upset after I declined the parent’s request for, “a strong antibiotic”.
In my practice, I DO NOT consider any medicine as being strong or stronger, as in “strong pain medicine”, “stronger antibiotics”, or anything else of the like as being strong or stronger. Instead, I consider them as the “appropriate” antibiotic or pain medicine but strong and stronger are not adjectives I would use.
“No Ma’am. He doesn’t need a stronger antibiotic. He doesn’t need an antibiotic at all. What he needs is an antihistamine.”
Not that the mother knew or should know but rather getting upset with me, for not prescribing an inappropriate antibiotic, whether, stronger or just strong, the mother should be upset with whoever prescribed her 12-year-old son a quinolone (Levaquin), even if he was a 210lbs 12-year-old. As quinolones, especially Levaquin, have a US FDA BLACK BOXED WARNING due to potentially permanent and disabling adverse effects of tendons, muscles, joints, nerves, and central nervous system and should ONLY be used if the benefits outweigh the risks. Which was NOT the case here as this patient DID NOT have need for antibiotics at all. Thus ALL risk without any benefit and why he still had the runny nose and the cough after completing NOT one BUT TWO antibiotics.
Yet, patients complain about me. But WORSE, administrators are okay with that.
EUEE #11
41-year-old female comes to the emergency department, “To get the medicine my doctor prescribed.”
“Why didn’t you go to the pharmacy to pick it up?” I asked.
“Because the pharmacy was closed,” she fired back. Keep in mind, I work at night time.
“OOookayyyy. Why don’t you pick it up tomorrow?” I asked as if it were a brainer.
And all hell broke loose. Not because how I asked the last question but because, “You are supposed to be here to help me,” she yelled back crying with tears.
“There is no reason why you need to yell. I am right here in front of you. But, yes Ma’am you are right. I am here to help but you already been helped. You just need to go to the pharmacy tomorrow and pick up your medicine. The pharmacy opens at 8:30am,” I replied.
After a short moment, the patient was able to share more information with me beside the initial question, “What brings you in?” To which the patient added, “To get the medicine my doctor prescribed.” The patient adding that a few days ago she was seen by her Gynecologist (GYN) due to the patient was having vaginal pain. After that visit, the patient was discharge home without treatment pending culture results. Three days ago, the GYN called the patient at home and left a voice message after unable to speak with either the patient or family regarding medicines to be picked up at the pharmacy.
Three days ago! IS ANYONE PAY ATTENTION!?! It was almost midnight when I saw her. I cannot recall how long she sat in the waiting area but the pharmacy closed at 10pm.
I am guessing the GYN talked to the patient regarding the differential diagnoses and their treatments if the culture were positive in some manner. But then I am only speculating, which is NOT good, however, the word “speculating” chosen wisely, as assumptions only evolve to one making an ass of oneself. Nonetheless, speculating because the patient was too upset for her to make any sense of NOT only what her differential diagnoses were but how did she get whatever it was she had.
Okay, so the patient is not making a good enough effort to tell me what she knows. Not a first, regardless if upset or not, as patients commonly exclude details, whether intentional or not, of why they are seeking medical attention. Not to mention, the only one liable between the patient and I is “I” regardless patients, at time, might withhold information, again, whether intentional or not, related as to why they sought medical attention. But that is our system.
Fine. So, I go look at the GYN’s note to try to figure out ALL of this unnecessary DRAMA.
DRAMA that, ONE, could have been avoided by either picking up the prescription earlier or just waiting to pick them up the next day. But NNOOooo! And, TWO, DRAMA that doesn’t provide any information for me to help the patient’s needs. Yet, the patient is yelling at me and the patient is the one with ALL the information, I simply picked up the chart. I get it, it is my job. A job that is exponentially easier when pertinent details are expressed without unnecessary drama.
After reading the GYN’s note I return to the patient’s room and share with the patient “The rest of the story”. “You were seen by the GYN for vaginal pain. The GYN reported lesions on your vaginal and a culture was done which showed you have genital herpes.”
Out of nowhere, the patient began wailing abruptly, all crazy! I am not being judgmental but offering a diagnosis of wailing-itis, crying as if I had mentioned the end of the world was upon us. What the hell is going on? I thought.
“Ma’am. Ma’am. I cannot help you if your screaming,” I said not knowing it would make it worse.
“Ma’am. Ma’am. I cannot help you if your screaming,” I said again. Because, as they say, if at first you fail, try again. So, I did.
“Where did I get this from?” she asked sobbing.
Is that a trick question? Are we being recorded or on candy camera? I thought. “Ma’am. I do not know where you got it but it’s sexually transmitted.”
And once more, the wailing started up again. To make a long, actually, a very long, story short I said, “The GYN wrote you a prescription which you can pick up at the pharmacy tomorrow.” Now why did I said that? Because it makes sense.
Unfortunately, more crying and whaling. “Why won’t you give it to me now?” the patient asked.
“Because it is already at the pharmacy. It’s been there for three days and going on four. With your name on the bottle from your GYN. One more day is not going to make a difference. You can pick it up tomorrow,” I said. Eight-thirty in the morning tomorrow being less than 10 hours away.
NOPE! More crying, sobbing and whaling. I walked out of the room and returned with her discharge instructions and walked out again. When the nurse asked me, “What happen?” I replied, “You will have to ask the patient what happen. What I know is that I discharged her and she can pick up her medicines from the pharmacy tomorrow.”
And I went on to see the next patient.
EUEE #12
41-year-old male came to the emergency department to request his seizure medication that was prescribed six days earlier but he had not picked them up yet. The Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 mandates that everyone, EVERYONE, presenting to the emergency department must receive a Medical Screen Examination (MSE) and then, and ONLY then, can those who have a non-emergent medical condition and are able to care for themselves can be discharged.
I VERY MUCH appreciate EMTALA and believe it is VERY appropriate and I would NOT change it in any manner. The problem is NOT EMTALA but those who abuse EMTALA’s intent, BOTH patients and HEALTHCARE!
BUT why would you come to the emergency department to get medicine that you KNOW, like the previous patient, is at the pharmacy? WHY!?! WHY!?!
Like the previous patient, I work at nighttime when the pharmacy is close. However, this patient, unlike the previous patient, came in so late into the night shift that not only was the pharmacy closed but the night shift medical screen examination provider was long gone as well. That said, I DO NOT know why the triage nurse cannot inform this and the previous patient to stop by the pharmacy, when it opens at 8:30am, to pick up there prescription. It really is that simple rather than going through the whole thing of registering, triage and whatever else has to be done for such silliness. The same goes for other “little booboos” and other non-emergent medical complaints that present to the emergency department but then I digress as that is another story.
But before returning to the story on hand allow me to entertain critics. I am one of the first to point out that patients do not know and why they seek our expertise. However, coming to the emergency department to pick up a prescription that is sitting in the pharmacy, regardless if for one day, three days, or six days, or refill for any medication is no longer a lack of knowledge but simply an EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATION and a blatant abuse of a system intended to be a safety net for some. Off the soapbox.
Nonetheless, back to the story on hand, I mention the above not because it is the triage nurse’s duty to do so but because that is what I am going to tell the patient, “Stop by the pharmacy when it opens at 8:30am to pick up your prescription.” Done.
I also mention the above, again, about the triage nurse sending those patients to the pharmacy, not because it is the triage nurse’s duty to do so but it is language administrators can change so that the triage nurse can do that and more.
And here is why—what is the difference who tells the patient to stop by the pharmacy to pick up his prescription? Because, imagine, just for a moment, what would have been different if the patient HAD gone to the pharmacy on his own to pick up his prescription rather came to the emergency department? So, it is possible.
Of course, those who coddle and enable manipulators will say, “Why not just write another prescription and be done?” Simple. That is running up the bill. It does NOT matter that I am NOT paying the bill but someone will have to pay it.
How about some responsibility, instead? The pharmacy is open between 8:30am and 10pm, how about making an effort to pick it up in between those THIRTEEN AND A HALF HOURS? And if 13 ½ hours is NOT enough somewhere in the nation’s sixth largest city I am sure there is at least one 24hr pharmacy somewhere. I am sure!
As to nurses having a greater role, unfortunately, the administration’s fear is LIABILITY! Sure, and I can understand. But between the patient going on his own to the pharmacy and the nurse telling him to go to the pharmacy, between the two, the nurse knows the patient should go to the pharmacy. Not to mention, completely avoidable had the patient JUST gone to the pharmacy to pick up his prescription and NEVER stopped by the emergency department AT ALL.
This is the thinking, actually the LACK of thinking, of administrators. Not only do they run up the bill with such IDIOT-ology [sic] but they are also bottlenecking the same inputs, throughputs and outputs they claim they are trying to resolve. Make no mistake, both increase liability as well, as study after study has shown that running up the bill and bottlenecking a system increases the system’s liability.
Talk about the elephant in the room. In this instance administrators think like the very old childhood story where there is a mouse in the house so they get a cat to get the mouse out. Good, the mouse is gone. However, the home owner is allergic to cats so a dog is brought in to get rid of the cat. Good, the cat is gone. Now the dog won’t stop bark so they bring in an elephant to get rid of the dog. Good, the dog is gone. But now the elephant is taking up all the space inside the house so they bring in a mouse to get rid of the elephant. Good, the elephant is gone. But now you have a mouse in the house again.
For those unable to follow the animal analogy here is how Ross Perot described such IDIOT-ology [sic] at General Motors’ (GM), and a common culture of businesses, “I come from an environment where if you see a snake you kill it. At GM, if you see a snake, the first thing you do is hire a snake consultant. Then you get a committee on snakes and discuss it for a couple of years.”
Those are managers. Because leaders would JUST kill the FREAKING SNAKE and be done!
The same happens in healthcare, the simplest of the simplest problems need a consultant, then a committee, then…then…then…and before you know it the problem becomes the solution with the IDIOT-ology [sic], “That’s how we have always done it.” Or, better yet, another industry is created without solving the problem. But that IDIOT-ology [sic] culture TOO another story.
The end point, there really is no way of avoiding ALL liability. Why then not just get a mouse trap and get rid of the RAT!?! In the same tone and manner, why not change the language that prevents nurses from using their full potential, in this case their common sense, to be part of the solution rather JUST another “staff person doing stuff.” Nurses, yes, Registered Nurses, are more than capable of redirecting a lot of patients out of the emergency department. A LOT!
All that said, unlike the prescription needing patient before, with ALL her crying and wailing, when I told his patient he had to go to the pharmacy to pick up his prescription he said, “Okay. I was just walking by (outside the hospital campus that is, and yes, somewhere between 3-6am) and thought I would come in to get my prescription.” Yes, the patient was intoxicated. So what? The other patient wasn’t intoxicated and she was in the emergency department looking for her prescription. So, that this gentleman was intoxicated is irrelevant. Not to mention, the other patient wasn’t “just walking by” either. She actually, with a purpose, came to the emergency department to get her prescription.
Nonetheless, this gentleman made no mention of being disappointed or otherwise and was on his way. His story added, not because he complained, but ONLY to add as contrast to the one who was yelling, carrying on and inappropriate after coming to the emergency department to get her prescription. Again, I cannot make these stories up.
EUEE #13 OR better yet EUEE #1 above. YES, the same patient, AGAIN, during a different visit! (Not that I recall the patient or even the story of patient #1 above but because I was told later.)
Yes, the one who complained after NOT having a pelvic exam for vaginal itching which is treatable with OTC treatments. SHEEee is back! This time yelling at the top of her lungs, “I DO NOT want you in my room,” the moment I walked in the room.
Again, I find it interesting and even comical that patients remember me. Yet, I could NOT pick any of them out of line up if I tried.
Anyhow, since the patient was yelling at me for no reason, other than me picking her chart I thought to myself, “Good! You don’t want to see me. Discharged! That was easy!”
So, I went to look at the patient’s chart and thought to myself, “With ALL that energy and unnecessary inappropriateness, again NOT recalling the patient as patient #1 above, she must be feeling a lot better and she can go home. If her symptoms, whatever they are get worse, try again. It really is that simple for me after fifteen years of the same CRAP! You don’t want to be seen by “X…Y…Z…” in the emergency department than you DO NOT belong in the emergency department. BYE! DONE! NEXT!
What also has NOT changed in fifteen years is how the staff and administrators rally support and side with the patient over their trusted colleague.
“Trusted”, I say because why else would healthcare workers allow anyone they DO NOT trust to evaluate, treat and disposition any of their patients if distrust were an issue. They too have a license they would like to maintain and allowing blatant negligence or harm for any reason by any healthcare worker is NOT an excuse to a bad outcome.
I am NOT alone and like those I work with, present and past, I am a member of a time-honored profession, a patient advocate responsible to care for the sick, promote health, prevent illness and injury and maintain levels of health for others. It is ALL our responsibility to cultivate our profession and steer it in the right direction while placing patients’ reasonable concerns ahead of our personal convenience, pleasure, profit and safety without bias, stereotype or compromising the contributions of other healthcare workers.
That said, I DO NOT know what others believe about me or am I interested in knowing or their thoughts. For ALL I know they could NOT care less about their profession, their license, their patients, themselves or me. And why they just go along when a patient blows up with their EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS and why everyone rallies around the patient, to protect the patient from the evil monster that I am.
However, I DO NOT believe that. Instead, what I believe is that colleagues and peers side with patients because they fear losing their jobs. But I could be wrong about that too.
As I ask in the book, “Do healthcare elitists believe only a chosen few are capable of caring and being compassionate for the sick and injured, promoting health, and preventing illness and injury? Do those elitists believe that being submissive and apologetic are the only super powers a healthcare worker must possess? Why then do such elitists believe that becoming a healthcare worker by any means other than their approved ceremonial rite of passage discredits one’s desires to help others just because it DOES NOT fit their definition?”
I am NOT interested in what others think. Nor will I allow others to define me and why I have NOT changed since growing up on the mean streets of New York. However, the rite of passage and peer approval that is so common in healthcare does affect others and why they are submissive. That example, one of the book reviews on which pointed out:
“[Mr. Torres] has no understanding of what non-medical people go through when seeking medical care, and little compassion. I am a pediatrician working in emergency/urgent care so I know the frustrations that providers deal with. We complain to each other about patients and parents, but we express concern and compassion when dealing with them face to face. It sounds like Mr. Torres is not able to do that. Perhaps he needs to seek another line of work.”
A healthcare worker wrote that. Or at least someone who claims to be a healthcare worker wrote that.
Dear to whoever wrote the above, You are correct, I am NOT able to FAKE my compassion. More important, unlike you, I DO NOT want to FAKE my compassion. By the same token, I am NOT able to FAKE letting others walk ALL over me either and much less with their $hit covered feet. Not to mention, when you unload your frustration and complaints onto colleagues rather pushing back those who impose it on you is NOT deflecting. Instead, it’s BEING A HIPOCRITE!
Here, let me help you:
n. pl. hy·poc·ri·sies
1. The practice of professing beliefs, feelings, or virtues that one does not hold or possess; falseness.
2. An act or instance of such falseness.
Is it NOT ironic that when you treat others the way they treat you they get offended? My answer, DON’T be offended because I did to you what you did to me but I just took it to another level and now you are offended because you thought I was your punching bag. NOT! It just happens that when someone pushes me I push back 100 times harder and then they complain but never mention they pushed first. Of course, some will say I get offended easily. It’s not that I get offended easily—it’s just that you cannot take your own medicine when served to you with a MORE INTENSE FLAVOR!
That said, I DO NOT expect anyone in healthcare, and much less administrators, to side with me when it comes to dismissing patients. However, although some might find it hard to believe, like the rest of healthcare workers I TOO want to preserve life, restore health, relieve suffering, limit disability, and reverse clinical death when possible. Why? Because I AM A NURSE! I became a nurse because I want to help others and have done so for a LONG time. A LONG TIME! Not just for pay but as a volunteer as well.
I will NOT apologize that for me nursing is a JOB! PERIOD! It is NOT a calling! It is NOT an art! It is what I signed up for and how I get PAID. A JOB! It just happens that unlike other jobs, I am tasked to preserve life, restore health, relieve suffering, limit disability, and reverse clinical death when possible and once that is completed I rinse and repeat and continue to do so until the shift ends. Just like a carpenter, a hairstylist, a plumber, or a banker does their job, rinse and repeat until the shift ends.
DO NOT fault me, with your suggestion that I “need to find another line of work”, for not meeting your definition of a healthcare worker, whatever your definition is! I am NOT interested! I know who and what I am and what I am NOT! I DO NOT allow others to either define me or put me in a box somewhere. Nor do I let others wall all over me with their $hit covered and then go complain about it to colleagues. NO! I WILL NOT!
“…we do not scare easily. We never bow, we never bend, we never break when confronted with crisis. No, we endure, we overcome and we always, always, always move forward.” U.S. Vice-President Joe Biden DNC speech (27 Jul 2016)
Why does our great nation’s Vice-President get a standing ovation for just saying the words I LIVE by every day and when I personify those same words I am ousted? A rhetorical question as I am not interested in the suggestion.
Why am I NOT interested in the suggestion? Because I am NOT anyone’s punching bag. NOT to patients! NOT to families! And NOT to administrators either!
I AM A NURSE! A member of a time-honored profession. NO one! Is more professional than I! NO ONE! And NO ONE is more caring than I! NO ONE! But I digress.
Back to EUEE #1 and #13. Unfortunately, ONCE AGAIN, the staff and administrators rallied around the patient and as usual urged the attending physician to see the patient. A patient that had been discharged. And rather sending the patient out to be registered, before being seen again, the administration placated to the patient by having the patient reregistered in the room and the attending physician seeing the patient.
It DOES NOT matter to me if the patient is seen again or seen a hundred times over for ALL I care or by who as that is not my issue. However, when administrators cater to such EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS they NOT only place patients above the loyal staff and other patients waiting but they also set a precedent which the same patient or others will seek the next time it’s not going their way. Granted, the patient likely will be comfortable with seeing the attending. But what then, when the patient DOES NOT want to see the attending either. Will administrators offer to bring in someone else from home or just give the patient a GROUPON they can use the following day?
This IDIOT-ology [sic] that conflicts between customer satisfaction and healthcare workers jeopardizes the administration’s goal of customer retention and profits, a well-guarded secret of healthcare and why customer satisfaction scores are the driving force in healthcare and why administrators side with customers over their very own and extensively vetted loyal employees, MUST change.
An IDIOT-ology [sic] that only leads to distrust, not just from the employee labeled a risk but from all in the organization, as ALL fear of being next if a patient complains.
AGAIN! I say dismiss those who annoy us. Dismiss the rude. The entitled. The abusive. The demanding. Those who tread on us and those who have taken us down the wrong tracks. By dismissing those who annoy us it frees us to focus on those who value, trust and appreciate us for the care we give. On this we must stand in solidarity and not waiver otherwise those who annoy us will not change their behavior as long as they can find tolerance elsewhere.
DO NOT confuse accommodating or appeasing with advocacy as indulging those who make unreasonable demands on us not only leads to running up the bill but it leaves us vulnerable too.
Instead, we must side with loyal employees and coworkers over outsiders, the petulant, unreasonable, angry, demanding and those who tread on us for us not submitting to their EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS. This is not about us versus patients but about convincing patients that we are looking out for their best interest and if they desire our help they must stand with us. If they decline they must leave because intimidating us until they get what they want is manipulative and not what we are here for as it only divides healthcare workers trying to help others.
Lastly, we must get rid of the IDIOT-ology [sic] that got us here in the first place. We must NEVER see the ill or injured as customers, clients, or guest but as the patients they are, ill or injured.
But I get it, as others are concerned, NO one wants to be fired. Neither do I. However, I will NOT bow or compromise my integrity just to keep a job. I have yet to find that place, but I will NOT stay where I am tolerated when I can go where I am celebrated. Until then I WILL continue to push back on those who tread on me or those I share the shift with.
Granted, after fifteen years and working at more than thirty jobs in those fifteen years and with ONLY five more years to work, before I can throw away my stethoscope to NEVER have to see another patient, I am sure that job where I will be celebrated will not be found. However, this I know, those I have worked with are some pretty awesome people. However, NO ONE wants to be unemployed. I get it!
As for patient EUEE #13 or #1, I had discharge her so her reassessment and disposition is no business of mine or am I concerned. However, I am sure if the outcome were different than what I had discharged her for I would have heard of it. As administrators drool over the opportunity to terminate those who will NOT bow to their IDIOT-ology [sic].
EUEE #14
After administrators missed on the above opportunity, twice, as negligence here was that opportunity of negligence.
Not long after the above melt down with EUEE #13 that, once again, I was approached by an administrator. This time not about a patient complain but about a poor outcome.
Interestingly, this was a poor outcome I tried to avoid. A poor outcome I tried to admit. A poor outcome I told the patient when I first saw him that he needed to be admitted. A poor outcome I initially treated with intravenous antibiotics as the intent was to admit the patient. A poor outcome I was told to discharge home. A poor outcome I did discharge. However, a poor outcome I asked to follow up first thing in the morning with orthopedic surgery when I discharged the patient and the patient did. A poor outcome which could have been prevented if the patient’s best interest were taken into mind by others besides me. Did I get that credit? Of course, not.
Instead, a poor outcome I was approached by the administration and to who I said, “You obviously have NOT read the patient’s chart. Because if you had read the patient’s chart you would learn who you need to ask about the patient being discharged home.”
Administrators NEVER read the chart. And why I DIDN’T get credit for what I DID DO but instead BLAMED for what others DID NOT do. WHY? Because rather READ the chart administrators, AGAIN, drool over the opportunity of what they believe is the smoking gun to FAULT those of us they rather see gone and why they go on an ill prepared witch-hunt. Ironic, a witch-hunt that is mostly against their MOST reliable and consistent workers but because of some disagreement they want us gone.
Isn’t it sad the reason administrator want those of us who push back gone is not because of incompetence, breach of duty, or negligence. Nor because of injury, disability, or death to a patient. Nor because of prejudice, alcohol, or drug addiction. Nor because we are unreliable, cannot be trusted or undermine those I work with. Nor because we lack compassion or do not care. Administrators want us gone because we will NOT bow. For me it is because I WILL NOT bow to customer service. NOT my lost!
That said, this rant is NOT about getting credit, turning blame toward others, not accepting responsibility or suggesting that others cannot complain. It is simply about pointing out the junior-high school culture in healthcare, whether from patients, families, other healthcare workers or administrators.
This rant is NOT about being thin-skinned either, as I can take the push back. If anything, it is others who CANNOT take it when I push back with greater force, as their expectation is that I bow and NOT push back at all.
Keep in mind, ALL of this, the book and the blog, ALL of it, is about channeling my energy elsewhere with the hope that it will catch the attentions of others. Not for me but the betterment of healthcare. Because although others in healthcare are going through the same most remain silent and look away. Look away and DON’T say anything about the overwhelming damage that drags us down and the exhausting minefield we must navigate, ALONE, just to stay safe and/or keep our jobs. Reason enough as to why so many leave healthcare and not fatigue as no one fatigues from helping others. Yet, despite everyone knows, as none of this is new, healthcare workers rather bow and remind silent. Many of them rather I NOT push back as well as they appreciate my contribution. But I will NOT bow, even if it costs me my job.
EUEE #15
While I DO NOT make it a habit of including healthcare workers with EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONSin the blog. This one nurse’s story is one for the books. To critics, this is NOT about bashing other healthcare workers as that is not my modus operandi. On the contrary, in the book I establish that nurses are the foundation of healthcare. I also point out that whenever a patient mentions being grateful for their care I redirect them to thank the nurses, as it is the nurses who do the work.
The patient involved in this story was a post-partum C-section who was septic. Because the patient would need a number of interventions, to include medications, I asked the patient if she would like to breastfeed before the initial medications were administered. The patient asking if it was going to be okay to breastfeed while ill and on the medicines. Questions I entertained with the patient and the family while the patient’s nurse was in the room. After answering the patient’s and family’s questions, again, while the patient’s nurse was still in the room, I left the room to put in orders.
While I am putting in the orders the patient’s nurse, the one who was JUST in the room JUST a moment before, approaches the attending physician to ask if it was appropriate practice for a septic patient to breastfeed. I was sitting NO MORE than 10 feet when the nurse asked the question. I, of course, stopped what I was doing and asked the nurse, “Is that “x” patient you are asking about?”
“Yes,” the nurse replied.
“Why are you asking the attending about that patient when you well know it is I who is seeing that patient?” I asked.
“I didn’t know,” the nurse replied.
“How can you NOT KNOW? You were in the room when I did the physical exam and discussed with the patient and family in length the patient’s diagnosis and treatment plan. You were even there when I told the patient it was okay for her to breastfeed. What part of that did you miss?” I stated and asked. Of course, the tone never goes well and is one discouraged by the entire planet as being harsh. Again, you pushed me but when I push back HARD you’re offended.
“I didn’t remember,” the nurse replied.
I DON’T know how the nurse could NOT remember. It was literally JUST moments ago. NOT even a minute had gone by. So I asked, “Did you forget to take your Aricept?” A common and playful question I throw around, to include at home.
However, it must not have gone well this time because the nurse said, “That’s not nice.” I guess the nurse was so bothered by the Aricept comment that the nurse went home, as I did not see the nurse the rest of the shift.
The same nurse, and the only reason for this whole story, the same nurse had asked me a week or so before, if lidocaine with epinephrine was appropriate to use as anesthesia for a finger. The answer was, “Yes”. I also offered the explanation as to the why after many studies had debunked previous practice. However, at the time, I did not know the nurse’s inquiry was because the attending physician was using lidocaine with epinephrine for a digital block. Yet, the nurse, instead of asking the attending physician or looking it up the nurse chose to ask me.
After learning the nurse’s habit of asking others when in disagreement and other actions of the nurse that were questionable before the experience with me exposed the nurse’s undermining behavior, which NEVER goes well with me.
EUEE: 16
Then, for the last story of this series, there was the mask of shame for not taking the influenza vaccine.
THAT’S ALL FOLKS! Those were the up-to-the-minute stories of the EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS (EUEE) kind since I last wrote about patient complaints at the same emergency department. And although, once again, more of the same NEVER a dull moment. I hope you were not bored.
As promised, NEVER a dull moment. Shortly after asked by a great friend about a third year working at the same emergency department I was told, one morning, after the shift, by the emergency department director, “Last night was your last shift. Turn in your badge.”
And just like that three years was out the door. In this case, literally, because as the last word was uttered by the director, I unclipped my badge from my pants, tossed it on the counter, grabbed my bag and walked out the door. Just like that, without being told why I was dismissed, me saying a word or asking why, me interested in why or me looking back.
Once home, I hugged and apologized to my Life [sic], took a shower and went to bed. After waking, I went about my business to find another job.
Also, just like that as well, this which began as a celebratory post for this three-year anniversary of working at the same emergency department ended with more of the same, being let go. And like every time before let go not because of incompetence, breach of duty, or negligence. Nor because of injury, disability, or death to a patient. Nor because of prejudice, alcohol, or drug addiction. Nor because I am unreliable, cannot be trusted or undermine those I work with. Nor because I lack compassion or do not care. ALL of which are more important to me than any other reason as to why I been let go from another job, especially when compared to being let go for not bowing, whether to patients, families or administrators.
Winton Churchill said, “You have [haters]. Good! It means you stood up for something in your life.”
With that said, I am okay with being let go for NOT bowing. But isn’t it sad that in an industry genuinely dedicated to helping others, it is NOT my contributions, like my work ethic and what I DO for others, which keeps me employed. But instead that I placate to the EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS of a few that does.
That said, one would believe that after so many dismissal for the same reason, NOT bowing to EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATION, I would NOT be amazed. But I am. Every time! NOT so much that I am dismissed for the same but that our honorable profession, like healthcare, has been cheapened into just another service-driven industry, by any means necessary and at the cost of so much, and everyone looks away.
I have NO idea or am I interested in why I was let go but I am sure it was for one of the above-mentioned complaints, complaints from a previous blog or not listed at all, the undermining nurse, not wearing the mask of shame after I declined the influenza vaccine or because I killed someone? I DO NOT know. Again, I was NOT told, I did NOT ask. Nor am I interested. Unfortunately, it likely will not be the last time I will be dismissed for NOT bowing.
One thing is for sure, I was not asked to leave because I killed anyone. Because if that were the case I would have been CRUCIFIED!
Again, DON’T stay where you are tolerated. Go where you are CELEBRATED. And if NOT wanted, like at this job, as this manager wanted me gone from the first time we met when he stated I was partially to blame for the department’s poor morale. WHY? Why would ANYONE want to stay?
For critics, NONE of this is about poor little me, boo-hoo, the victim as I DO NOT submit to that label. Instead, this is about, “Our lives begin to end the day we become silent about things that matter.” Words I believe Dr. Martin Luther King DID NOT only mean in regard to social justice but in our lives in general, to include our private and professional lives.
Nonetheless, on to other pastures. NOT greener just other pastures.
Thanks for reading as I know that was long.

More important, thanks to the staff, the nurses, the clerks, the techs, to include lab and radiology techs but most of ALL the emergency department techs and sitters, oops, the companions (administration's politically correct term), the registration staff, the physicians, physician assistants and nurse practitioners. It is TOO BAD the administration DOES NOT support them. SAD!

Oh YES, and the patients as I have said MANY times and in multiple post here, by FAR this emergency department has the MOST APPRECIATIVE patients ever, and I have worked at many!

“Do what you feel in your heart to be right, for you’ll be criticized anyway.” –Eleanor Roosevelt

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