Sunday 30 April, 2006

Remember that you are the doctor

Posted in Advice, Michael Tam, Rants, Wards at 13:21 by Michael Tam

Original article by: Michael Tam :: Printer friendly

As you work through the hospital system as a junior doctor, you will meet a special group of people. They are usually nurses or sometimes allied health professionals, who think that they are clinicians; and they definitely think that they know more than you.

These “wannabe” clinicians are loud and bossy and almost invariably they do not know more than you. For them, this is a game of power politics. Like any disease they can be identified by a number of symptoms and signs:

  1. Illogical clinical reasoning (e.g., “I think this patient has pneumonia” when they clearly have heart failure)
  2. Diagnosis and management in a single demand (e.g., “You need to call for the chest physiotherapist because this patient has pneumonia”)
  3. Rigidity of their “diagnosis” – you won’t be able to persuade them that they are wrong or at least there may be other diagnoses
  4. Pronounce their “vast” superior clinical experience (e.g., “I’ve worked in the respiratory ward for 15 years and how long have you been a doctor?”)
  5. Are easily offended – they view you not agreeing with them as some sort of personal insult.

When things don’t make sense you must pause and think things through. You are the doctor and the clinical responsibility lies with you. If you are not sure, then “help is only a phone call away”.

Be wary of the “wannabe” clinician’s more dangerous hidden practice of withholding / starting / stopping treatment without notifying the medical team. If someone really thinks that your management is wrong, they should be contacting your clinical superior, and not to “go maverick”.

IT IS NOT OKAY

  • for non-medical staff to withhold, add or change medications (outside of a hospital protocol) without informing a doctor;
  • for non-medical staff to withhold, add or change intravenous fluid orders without informing a doctor;
  • for non-medical staff to discharge or arrange for transfer of a patient without informing the admitting team/consultant;
  • for anyone to write rude, malicious or factually untrue or misleading content in the progress notes.
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