February 2, 2012, 11:37 am

(Not) Everybody’s Talkin’

Looks like someone has some explaining to do.

This photo has a very “Twilight Zone” feel to it.

The only thing missing is Mr. Serling.

Unless he’s standing at the other end of the table…

<cue theme music…>

**********

The nursing blogosphere is on fire with the Amanda Trujillo story, but there haven’t been too many comments from our physician blogger colleagues.

Dr. Dean over at the Millionaire Nurse Blog, dedicated one of his The Best in Nurse Blogs: Amanda Trujillo Edition to the topic, and followed it with a discussion of nurse/physician/healthcare team communication.

Today, I found this post by Dr. Terry Simpson at Your Doctor’s Orders, entitled Transplant or Hospice. Dr. Simpson has some valid opinions as a physician.

Unfortunately, they are buried in a lack of understanding of a registered nurse’s scope of practice, overwhelming arrogance and the use of an image of the book “Angel of Death” to make his point.

Everyone needs to go read this post.

Go ahead. I’ll wait.

This is what nurses are up against on a daily basis.

Not all physicians.

Not most physicians.

But enough physicians.

**********

The idea that nurses are supposed to just “take care” of the patient and defer all questions and education to the physician is mind-boggling.

Dr. Simpson posits that there is a time and a place to discuss end-of-life care.

And that the doctor is the one who makes that decision.

Seriously?

What happens when the patient asks about it?

“There, there Mrs. Smith, don’t worry your pretty little head about stuff like that. Doctor Welby will be in first thing in the morning and he’ll take care of everything. You just get some rest.”

Don’t worry that you will be transferred. Don’t worry that you will be undergoing extensive testing. Don’t worry about what a transplant entails or what it means for your life. Don’t worry about how old you might be or how involved your care might be or what resources you have.

We know what’s best.

Well, the doctor knows what’s best.

In your depressed, ill state, you can’t possibly know what you want or understand what it all means, or have the strength to make the right decision.

The doctor will decide when it’s time for you to know what you need to know.

Some doctors call that autonomy.

Whose autonomy?

**********

So, I guess as patients, we have a choice.

We can wait, and only ask questions of our physician, who may, like Dr. Simpson, tell us what we need to know when we need to know it based on their professional judgement.

Or, we can ask questions of the entire healthcare team, including our registered nurse, and receive information and education that will enable us to have a discussion with our physician about our health and what we should do.

You know, exercise our autonomy.

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15 Comments

  • Rob Lindeman
    Rob Lindeman

    February 2, 2012 at 12:41 pm

    Kim,

    If I were still a physician-blogger I’d stand firmly behind Amanda Trujillo.


  • Michele Roberts
    Michele Roberts

    February 2, 2012 at 2:57 pm

    OMG Kim, I read Dr. Siimpsons post, and I am nearly sick to my stomach! And as for the physicians who followed his post with their own – unbelievable –
    Where do they get the impression that Amanda was providing the patient with informed consent? Neither her letter, nor her attorney’s letter even suggest that – yet those who posted on Dr. SImpsons website keep suggesting that she did.
    If, and this is an if – there was an explicit policy against ordering the hospice consult that has been upheld in all previous instances by Banner Health, then I guess that they could have made a case for her dismissal. Otherwise, they are grasping at straws –
    Dr. Simpson has single handedly ruined my optimism on collaborative care between nurses and physicians


  • Terri Polick
    Terri Polick

    February 2, 2012 at 3:17 pm

    I read Dr. Simpson’s post. GOD has spoken. (Eye roll)


  • Marsha
    Marsha

    February 2, 2012 at 4:30 pm

    Well I replied to Simson’s post. It is awaiting moderation. I wonder if he lets it through. I am of course civil but I reply in kind to his post.


  • Who?me?
    Who?me?

    February 2, 2012 at 5:13 pm

    Just loved the Angel of Death book cover pic and the attitude that the AZ nurse is an angel of death just waiting to happen. Dr. Simpson is unfortunately typical of the transplant surgeons I have worked with over the years-”I return patients to health all on my own.” Let’s forget about the nurses, therapists, pharmacists, etc., that are vital to that patient’s continued well-being.

    He is right about there being transplant educators, but we don’t know if the nurse in AZ was a transplant educator or had received education about the transplant process. One would like to think so if she was working with transplant patients.

    Dr. Simpson is assuming much in his post and showing his reluctance to get to the truth of the matter. I can picture him having asked for someone’s job…

    Notice his final quote, “There is no dignity in death.” Well, perhaps for the patient in AZ there was dignity in choosing how they wanted to live.


  • RehabRN
    RehabRN

    February 2, 2012 at 5:36 pm

    I shudder to think what my late relative (a well-respected, respectful MD) would have to say about a post like that!

    Thanks for posting. I made sure I left a reply with the Transplant Nurses’ Scope of Practice. (see this page: http://www.nursesbooks.org/Table-of-Contents/Standards/Transplant-Nursing-Scope-and-Standards-of-Practice.aspx)

    Health teaching, which is noted. sure seems like education to me!


  • T
    T

    February 2, 2012 at 7:11 pm

    I sympathize what you nurses go through.

    Years ago, I thought about being a nurse. Bought 2 books talking about “Why be a nurse?”

    But they were brutally honest about how nurses were treated.

    I didn’t become a nurse.

    You guys are still my heroines though.


  • jadziacat
    jadziacat

    February 2, 2012 at 8:39 pm

    This doctor is a jerk. I seriously hope he never takes care of any of my loved ones.


  • Alpine, RN
    Alpine, RN

    February 2, 2012 at 8:43 pm

    I left a reply- I’m a new-grad nurse, and my floor gets ALL our transplants. I am LIVID to think that Dr. Simpson thinks that ANY sort of “education” is part of “informed consent”. Sadly, i think probably that’s the only kind of education he DOES! That and saying that what a doctor “WANTS” should be law for nurses!!! if the doctor doesn’t “WANT” a patient educated, said doctor can have WORDS with my manager!


  • Nurse K
    Nurse K

    February 3, 2012 at 5:26 pm

    I laughed my ass off at the fact that he suggested that nurses call the surgeons’ cell phones when patients have routine questions about surgery and that nurses shouldn’t leave notes for the doctor re: patients.

    I’m sure nurses just love working with him. I do, however, understand doctors have no clue what nurses’ education is and that we are CAPABLE of answering patient questions.

    The nurse asked for a case management consult from ANOTHER NURSE. Big f’in deal. The patient should have had a case management consult anyway if she was being considered for a transplant.


  • CT
    CT

    February 4, 2012 at 6:41 pm

    So lets get this straight, a physician who is a weight loss surgeon is spewing the credo for transplant surgeons everywhere? Wonder who died and made him all knowing? Someone needs to send him back to the hospital to learn what patient education is. It is not informed consent, the patient was being transferred for a diagnostic work up. If every CBC that gets ordered requires a phsyician to obtain informed consent you can kiss health care goodby. Obtaining a case management consult for what was in all likelihood a social worker to present information about hospice is not outside a nurses scope of practice. Hope to heck his family never gets sick, he will make all their decision because when they are sick they can’t make their own. This truly amazes me yet on another level it doesn’t.


  • Barefootnurse
    Barefootnurse

    February 6, 2012 at 3:57 pm

    Dr Simpson’s post…wow. I’m speechless.


  • Jilly
    Jilly

    February 9, 2012 at 8:06 am

    Wow – what a jerk. Sorry if that’s who you have to put up with….


  • The Angry Medic
    The Angry Medic

    February 10, 2012 at 6:52 am

    I realise it may be a little dangerous being a doctor and wading in here, but wait! I’m one of the good ones. No really. I bring cookies for my ward sister every Monday. Cough.

    I saw Mother Jones’s post at Nurse Ratched’s place and agreed with her opinion on why docs are quiet – there’s the closing ranks thing, and docs traditionally stay out of nursing issues. Even here across the pond, I’ve heard fellow doctors talking about the Amanda Trujillo case, but they all discuss how horrible it is then go “ah well it’s a nurse thing, we have our own problems to worry about”. And if this is what’s happening in London it can only be magnified in the US of A.

    I do feel compelled to apologise on Dr Simpson’s behalf though. I’d go over to his place and post fist-shaking abuse, but he reminds me too much of my boss.

    I’ll, uh, go back to my corner now.


  • Dan
    Dan

    February 12, 2012 at 10:10 am

    He posted it after you wrote this, but Whitecoat over at EP Monthly had a great post about Ms. Trujillo — he’s promised to get involved and help if he can. Pretty good post at http://www.epmonthly.com/whitecoat/2012/02/amanda-trujillo/


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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