Every inducement to what?
Is the nurse holding coffee pots or metal urinals?
At first glance this ad appeared to be for some mighty sturdy urinals.
In reality, those are Thermos brand coffee pots.
What was I thinking?
If it confused me, imagine how the patients must have felt!
I hope nobody confused their coffee pot with their urinal.
That would be bad.
When did hospital administrations begin dictating what physicians will or will not do in the emergency department?
I’m not talking Joint Commission requirements, I’m talking the practice of medicine.
I’ll use this fictitious story to illustrate my point.
Sorry if it seems a bit over-the-top.
When a patient arrives in the emergency department, they are evaluated by the emergency physician. This occurs every time the patient presents, even if the patient is well known to the physician.
Even if it is the seventh time the patient has presented with the same complaint in four days.
The physician examines the patient. Based on their assessment and the patient’s history, a diagnosis and plan of treatment is prescribed.
Let’s say the patient expects a certain medication in a certain amount on every visit. Say the patient arrives in the department looking like they have already received a great deal of medication.
The physician on duty believes that administering this medication to the patient would not be prudent as the patient appears to be “dependent” on the medication.
Addiction is such a strong word, don’t you agree?
However, the physician has other treatment modalities (ie, medications) available for treating the patient. Given the nature of the complaint and the treatment requested by the patient, the physician discusses his concerns regarding “dependency” with the patient and explains why the requested medication will not be provided during this particular visit. They order something other than what the patient requests.
(For the sake of our story, let’s assume that the physician is seriously concerned about administering the amount of medication the patient insists on receiving. Withholding the requested medication is not a punitive decision.)
The patient is pissed. Excuse me, I mean the patient is experiencing anger at the unwillingness of the physician to administer what they want to be given.
The patient is so angry that they take it all the way up to the head administrator of the hospital.
The administrator is concerned. Although the Admin is neither an RN nor MD, they do see an unhappy patient/client/health care recipient who feels they were treated inappropriately.
This needs to be addressed.
A meeting is called to address the patient’s issues.
The bottom line: the patient gets what they want. Every time they come in, from anyone who happens to be on duty.
This message is relayed back to the ER and the physician who did not treat the patient per the patient’s request is reprimanded.
The patient is now given exactly what they ask for every time they come in by every doctor in the department.
Given this scenario, fictitious though it may be, a few questions come to mind:
1. What happens if the physician absolutely believes that the requested treatment will be hazardous to the patient, but is required to order the treatment or risk being reprimanded?
2. If the requested treatment is ordered and the nurse administers it, are the physician and the nurse now enablers of the addiction? What if the nurse says “no”?
3. Do you, as a health care provider, ever feel like a drug dealer/pusher/enabler/codependent? How do you handle those feelings?
4. Where is the line between true concern and being judgmental?
Which brings us back to my initial question. When did hospital adminstrators begin dictating health care decisions by medical personnel?
If it is occurring in the real world, someone forgot to send me the memo….