Thursday, April 14, 2011

Reminders to Self

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. 

My husband had a screening colonoscopy last Friday.  His nurse in the recovery is the only one I had issues with.  I, not my husband. 
All went well, but let me tell you he is not an ePatient Dave.  He did not read his instructions about when to quit eating and the prep.  I did.  I then reminded him along the way:  “Only clear liquids today.”  “You must take the Ducolax at 3 pm.  Do you want me to text you a reminder?”
Sometimes the instructions we give patients are clear, but not always read.
The staff at the front desk were very kind and organized.  Calls had been made the day before and I had insured the insurance information they had was correct.   I did not tell anyone I was a doctor.  I’m not sure if my husband did later or not.
When I was called back by the nurse, she mispronounced my name calling me Rhonda (which I forgave easily).  She did not introduce herself to me.
As we entered the recovery area, she did not take me to my husband and assure me he was okay.  She took me to the desk and abruptly said, “You need to sign this.”
No explanation of what “this” was, so I replied, “What is it I am signing?  I don’t sign anything until I have read it.”
She then said, “It’s the discharge instructions.  He’s already been given them.”
Note she had not reviewed them with me.  I would be the caregiver.  Note also that I had no way of knowing if she had reviewed them with my husband (who is not an engaged ePatient Dave) prior to sedation or in his current state of post-sedation fogginess.
She said, “Sign it when you’ve read them then” and quickly moved on to some other task.  I felt like a box that was simply being checked off.
I reviewed them, signed it, and moved over to my husband’s bedside.
The nurse with no name came by soon after and told him it was time to get up and go to the bathroom.  She led him over and said to me, “You can go to the bathroom with him.” 
Me, “Why would I want to go to the bathroom with him?”
Her, “Well, you don’t have to.”  [I think she found me difficult and perhaps uncaring.]
She left him alone in the bathroom with his clothes.  After standing there for about five minutes, I knocked on the door and entered.  “Are you okay?”  He was dressed, but swayed as he bent over to try to put his boot on.
Me to my husband, “You can sit in this other area where we are to wait on your doctor and put your boots on.  Here let me help you.”
In hindsight, I think she meant for me to help him get dressed in the bathroom, not to watch him actually use the bathroom. 
Reminders to myself
1.  Check names.
2.  Always introduce myself.
3.  Slow down and tell patients/family what is going on and why. 
4.  Patients and caregivers need to be given the instructions.


Elaine Schattner, MD said...

Really this post is a reminder to everyone else that people, including ancillary health care staff who may be tired or having a tough day - no matter what - should treat patients with kindness and respect. Sounds like your husband is lucky to have you there!

StorytellERdoc said...

Great post, Ramona! Whether you were a plastic surgeon or flipping burgers at the local joint, this nurse should have had a much better approach to her treatment of her patients as well as engaging and ensuring the family was involved in the care.

I NEVER tell anyone I'm a doctor. I want to see someone's stock, their inner core, without that influence.

Great post. Hope you are well.

Anonymous said...

Good post. Good points for us all to keep in mind. I never tell anyone in that situation that I'm a doctor, as I think it sometimes just gets in the way.

Gizabeth Shyder said...

Love this post! Ha! on the last misunderstanding. Made me think of my tete a tete:)

Chrysalis said...

Loved this post, Ramona.

When Fireguy had surgery, the nurse was wonderful. She went over his discharge instructions with us both, at the same time. He was still pretty out of it, and she knew he wouldn't really understand all of what she was telling us. It was refreshing to have her take the time, and we didn't feel like they were just kicking us out the door.

Jeralee said...

good post and it was nice to hear your perspective on the other side. communication is key and it is frustrating when you don't have all the answers because they didn't provide them.

It sounds like you were a great advocate for your spouse.

Carolyn Thomas said...

Hooooo, boy - I think I've met this nurse!

I recently wrote about whether staff burnout can influence such intolerable behaviour towards patients - at

Just this morning I had to go to the lab for a blood test and overheard the tech having a VERY LOUD conversation from the room next door with an elderly woman who clearly was not understanding the basics of her take-home Fecal Occult Blood test instructions. "THREE STOOL SAMPLES! No, THREE SAMPLES! No, you take this test HOME with you! No! It's a THREE DAY test! You take ONE STOOL SAMPLE the first day, then one the SECOND DAY, and one on the THIRD! No, you do this AT HOME, NOT HERE!" By this time, everybody within a two-block radius could understand that this poor patient (whose first language was not English) was absolutely NOT getting it, yet the tech's response was just to YELL LOUDER, each reply positively dripping with eye-rolling contempt that I could feel even from the next room! I could only imagine how confused and humiliated the patient was by now. She was on her own, with nobody to help her except the increasingly exasperated and impatient lab tech.

Finally she yelled: "GO HOME AND READ THE INSTRUCTIONS INSIDE THE KIT!" as she ushered the woman out the door. Unbelievable...