Docs vs Nurses vs Docs

Notice I put nurses in the middle in the title? There is a reason for it. This is how things work at the hospital I am currently working at. We have our ICU docs who run things in the ICU. We also have the cardiologists and the cardiac surgeons. The problem comes in when they don’t seem to communicate with each other. I had a patient the other day that illustrated this the best.

They were in town on vacation and their daughter had a congenital heart condition that had been repaired surgically in their hometown. She was having some complications and was admitted to our ICU to manage. The cardiologist on-call was the one in the group with the largest ego. He was in the room discussing things with the family when the patients home cardiologist called, the one who had treated the child since birth. When Dr. M, as I’ll call our cardiologist, was asked if he wanted to speak with him, guess what his answer was? “No, just tell them to send the records.” Here begins the problems as this was stated in front of the family.

Later on that evening, the parents asked why he wouldn’t speak with their doc, the one they trusted totally. Let me also add that these parents were very knowledgeable about their daughters condition and very involved in her treatment. The kind of parents we love to have around. I had to honestly answer that I didn’t know. They had a few questions concerning what we were doing as far as treatment was concerned,so since it was a Sunday evening, I asked our ICU doc to speak with them as Dr. M had gone home. His answer to quite a few of their questions was that cardiology had to make that decision. So he had us page Dr. M at home and put him on the phone with the parents. Dr. M, from home, told the parents that the ICU docs should make those decisions. According to the parents, he seemed like he just wanted to get off the phone and get back to dinner with his family. He may have even said so, I don’t know why else they would have thought this.

In case you’re wondering, the big question was why was their child not receiving their home medications. I have to side with the ICU doc on this one as most of the home medications were cardiac medications. Something I think the cardiologist should be deciding. But then again, I’m just a nurse. What do I know. These medications were never ordered even though they were on all 3 medication reconciliation forms we had filled out, a subject for another post.

Bottom line is that I had a patient and family that had good, important questions concerning their child’s care at 5PM that were not addressed until the next morning. Not at all acceptable in my book. This is a facility that is totally run and controlled by the physicians for their comfort and convenience. I have yet to see anything done which in any way involves nursing at any point. Worse yet, many of their practices, in my opinion, endanger their patients. We can have patients being treated by 5 or 6+ specialties, all of whom can write orders and none of whom are ultimately managing the care.