family practice issues and general life events

Today a patient made me terribly mad.  It was not at her, but what she told me occurred at her last hospital admission.  The first angering part was that she was admitted without even the courtesy of a notification.  Per her ER chart, she listed me as the physician, and in our case, it is routine for all of my patients to be admitted to my husband.  I don’t take call because when we opened up practice I was 7 months pregnant and had an active 2 year old at home.  If I took call, there was the potential for both my husband and I to be called at the same time, and being forced to take two kids to the hospital in the middle of the night.  So I don’t admit to the hospital.  I never lost my privileges.

Now she did need a specialist, and I could have been merely annoyed if this was not the fourth patient in the past month that this has happened to my husband and I.  Someone elected to admit to the specialist without the courtesy notification, regardless of what the norm admission procedure of admitting to the PCP and consulting the specialist.  However, this is minor compared to the rest of the patient’s story.

Apparently, nursing staff at the hospital decided to bad mouth me and several other physicians, in the hearing of my patient.  Apparently she overheard them say that I was lazy (because I don’t take call) and that I didn’t know what I was doing, that the medications she was on was not appropriate, etc.  She states that she heard many other comments not only about me, but about most of the other physicians in the hospital.

Now as a little background, morale in the hospital is currently low.  And when asked what needs to be done to improve patient care, every physician I know has repeatedly said, “Do something to improve morale.”  or “How can you make nursing and other staff feel that they are valued and that they are desired in their job.”  There has been a lot of changes in the past 18 months with a change in CEO and the changes that go along with it.  While I don’t agree with all of the changes, it is what it is.  I fully understand why the staff feels a little under-appreciated, but there is also a need for professionalism regardless of what you think of someone.

As a common courtesy, you should at the very minimum have the guts to speak to the person that you don’t think is doing a good job.  But if you don’t have the guts to do so, courtesy dictates that you don’t speak poorly of the physician in front of their patients.  Or at the very minimum, make sure that you have evidence.  Speaking poorly of people does not make you appear better.

I try to have a good relationship with my patients.  Many due to the nature of their disease processes or medications I see monthly.  So the short term hospitalization full of bad mouthing does not usually do much but cause people to doubt the care they are receiving in hospitalization.  Show pride in yourself, and not bad mouth others.

Don’t get me wrong, there are providers that I disagree with and specialists that I prefer not to use.  I don’t however, bad mouth them in front of the patient.  My staff might know how I feel about the person, but there is no excuse to bad mouth them in front of someone else.  It does not improve your standing in front of the patient.

This does not only apply in medicine, but few other professions is trust so integral to the health of the patient.  Since I don’t know who made most of the comments, I may sound hypocritical here, but I would approach these people if I knew who they were.  And unfortunately I doubt any would admit it.  It has been reported to the appropriated channels, but I don’t know if things will improve from doing so.  I hope so, but I am now currently considering other options.  

But in this case, reporting is absolutely necessary.  My patient was visibly upset.  I had to answer whether my privileges were revoked and why “I refuse to see patients in the hospital”  And why I don’t mind answering the questions when they ask on the initial visits, it is entirely different when the patient believes that I have deserted them in the hospital.  So now, I have to be their advocate.  This is not to say that nurses don’t have a right to their own opinions, but to be so vocal about them that patients are uncomfortable is not professional.  

Part of my job is to advocate for the patient, to make sure that their needs are being addressed, and if there is a problem, to make sure that their concerns are being heard.  This is not to say that every nurse she had taking care of her didn’t do an excellent job, that some didn’t do their best.  She told me there were some that did good, and were concerned about the care that she had received prior to them.  However, after this hospitalization she had concerns about her care and whether she would want to be seen there in the future.  Remember that, you represent not only yourself but your employer.  And if you are miserable, people know, and they worry about the care that you provide.  So show some pride and act professional.  To do otherwise, it only reflects bad on you.



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