Liability is why your doctor told you to come right to the ER

An ER nurse tells us how she really feels
A tirade for the ages. I’ll quote one part that rings true (expletives censored by me):

Do not believe that because your doctor told you to come right to the ER that you have a right to be seen right away. Let us discuss why he really said that; LIABILITY. Your doctor doesnÂ’t give a ratÂ’’s ass about little JohnnyÂ’’s sniffles as long as heÂ’’s out of the clinic before 5:00. Filling up his over-booked appointment calendar could have an adverse affect on that, but sending them Â‘right awayÂ’ to the ER wonÂ’t! AND no one can ever sue him for bad advice or irresponsible behavior because he TOLD them to go the ER Â‘Right awayÂ’ for the Â‘Highest level of care.Â’ Gotta keep those malpractice premiums down! . . .
. . . 2) Advice nurses are the bane of our existence. Sure they canÂ’t tell everything over the phone, sure people are generally bad communicators, sure the clinics and doctors are over-booked, sure itÂ’s 2-6 weeks out to even see a doctor, sure my cheap-ass HMO added another 90,000 new members last month but no infrastructure to deal with them, but the solution for this is not Not NOT to Â‘go to the ER right away where they will fill the fantasies that our unscrupulous marketing department has instilled in you.Â’ **** off. I love getting advice nurses for patients. They must know because they are reluctant to mention it. We hate them all and feel no shame in railing against them while they suffer (off the clock) in their sick and/or injured misery.

She’s right. The fear of liability is why we send so many people to the ED. But don’t take it out on the advice nurses, they are simply doing what the docs are instructing. And that means sending everyone in question to the ER to be evaluated as a cya measure. You can see the pressures of defensive medicine has gotten to this nurse in particular. (via GruntDoc and code: theWebSocket;)

Comments

Carsten
I completely agree with everything said. I can’t count the number of patients that tell me that their doctor told them to come to the Emergency Department. This creates the false impression that they have an emergency, when in reality they have a simple medical condition that could have safely been handled in the office the next day. Are primary care physicians no longer keeping a few appointment spots open for “urgent” visits? Must be much easier just to dump on the ER, but this is a very poor solution, since the massive influx of patients who really don’t need to be seen in an Emergency setting just makes wait times longer and allows ED MD’s to provide less than perfect care. Not to mention providing care in the ED is the most expensive by far – no wonder health care costs are spiraling out of control. And guess what it all comes back to? CYA, because of the lottery-based incentives of the tort system.
And the rant about the unscrupulous PR department reminded me of an incident I had working as an ED Tech where a father nearly became physically violent towards me.
Anonymous
well, its all the fault of the system.
its no longer patient care.
its business
its
money
and apparently the schools here dont teach doctors to care for patients, they teach you how to handle LOADS OF PATIENTS….all for the interest of the business.
people dont sue for their right, they sue for money.
meds? …money business
hmos? …$$$$$$ business
anywho…
what can we do now.
sulea din panduri.
THOUGHTS FROM THE HEADOC
I’m a general psychiatrist who recently left the hospital jungle. I knew it was bad when I found myself treating an ER Physician. It’s becoming a pressure cooker for those expected to provide care.
The ER unfortunately has become the pathway of least resistance for primary care overflow. Psychiatric emergency criteria has become limited to a loaded gun with clear intent or x amount of pills already ingested. Anything less usually doesn’t qualify as medical necessity for managed care orgs. Yet the doctor must accept the liability for what choices a mentally unstable patient makes. Patients pick up on how the system is evolving and will do or say whatever necessary to get their perceived or real needs met.
We have created a monster that can become self defeating if all the providers are at great risk of high frustration and eventual burnout.
Anonymous
What can you do?
Send the patient to the ER, in case their stomach ache turns out to be tubal pregancy that ends up in brain death. See previous post.
From now, I am sending EVERY SINGLE ONE OF MY PATIENTS who call in the middle of the night, to the ER. This way I can go back to sleep like a normal person.
Acutally, they should really open a graveyard shift primary care clinic in every ER to relieve the ER docs of non er issues.
Anonymous
I couldn’t agree with the Graveyard Shift idea more.
Maybe the ER should spin off the Primary Care After Hours, and true ER.
Seriously, I think we should make it a national policy, aka standard of care, to send every single person who calls in the middle of the night to the ER.
In fact, NO ONE should be on call at night.
Every citizen in this country, afterhours, go the the after hour clinic or the ER.
There are cases of missed diagnosis of infant menigitis, tubal pregnancy, rupture AAA, progressive PE, etc.
Healthcare is such a mess. I am so deprssed thinking about it.
Anne
The Platypus
Pt think that if they say a doctor sent them it means something to us. It doesn’t.
Often they demand that we call their doctor. I tell them that they’re going to be seeing OUR doctor now. Their PCP is out of the picture once they hit our doors.
peds10708
I shouldn’t have a telephone at all. There should be open office hours whenever I’m there (and not off someplace else trying to earn money at my second job, to subsidize my practice costs) and when I’m not there, the patient should go to the Emergency Department, or other open facility.
Telephone calls are 1) not paid for 2) dangerous. (After all, I haven’t seen the problem at hand, have I? Why should I take responsibility for it?)
In an earlier era, the phone call was paid for by the subsequent, or earlier, office service. But now, the office service payment has been stripped of any additional amenities (and often downcoded, that is, payment reduced) by the insurance payor.
The phone call can’t survive as a medical service.
After the last doctor has been driven out of practice, the ER will be what’s left. Enjoy.
Nurse Practitioners Save Lives
In our ER, we have a Fast track that takes care of the all of the “doctor office/clinic type” visits. It helps to decompress the situation. The person has most of the points right on though. They said what we all would like to.
Anonymous
I can’t believe that each of you are commending what the woman says and just blaming the system for the problem. People have to be able to trust their doctors; if your physician tells you to go to the emergency room, you have to assume that s/he’s giving you the right advice. And having done what the doctor told you to do, why should we put up with the crap from the nurse? Because she’s just as much at fault; let’s not blame the patient when the medical profession is clearly futzing around on all sides.
Anonymous
I need some advice. Should I pack up my doctor bag and quit after only a year in practice?
I am already being sued for prescribing antibiotics for a UTI in a 75 year old diabetic, who then got c diff colitis and died of dehydration after her nursing home doc didn’t stop the antibiotics after the urine culture I sent turned up negative. I had a patient code on me (recovered and is fine now after a pacemaker) because the EKG looked like first degree AV block and was 3rd degree. And I misdiagnosed a spinal epidural abscess as pyelonephritis. I did well as a resident and never had any problems, but seem to be doing everything wrong this first year out. Should I quit?

Liability is why your doctor told you to come right to the ER

Related Stories

More in Uncategorized

Comments

Site

Channels

Subscribe

Related Stories

More in Uncategorized

Comments

Site

Channels