Tuesday, August 15, 2006

the new guys

A couple of times a year we have a new group of doctors come into the unit. They are called fellows. Doctors that have finished their general medical training and are now into their specialties .
We assume the new guys have actually practiced medicine, we have to assume because most of them are foreign,
The joys of working with someone with a rudimentary grasp of the english language are legion.
Actually I lied, there is no joy in this. Most of the time you want to kill yourself.
I have my share of mumblers too. Those that are too damn arrogant to speak up to be heard, always speaking in a whisper..everyone straining desperately to hear. I hate the mumblers and I just assume they are so damn stupid they are scared to speak , they mumble to avoid being outed as morons.
Next is the group that thinks their english is just wonderful but actually they spout meaningless gibberish half the time, the other half they are spouting nouns with no verbs.....bed, needle, monitor...all in a voice filled with desperation..I cannot begin to understand what the hell they want.
Last, the group that doesn't speak any english..and don't think they have to. We just ignore them completely.
What is truly awful is our medical staff leaves these brand new docs all alone to sink or swim. The nursing staff must ofcourse take over and train these docs before they kill someone or themselves.
It is awful to see a perfectly nice person get shoved into the morass of the ICU without a lifeline.
Nurses get a six week orientation with a senior nurse at their side the whole time, a new doc gets nothing .
I try my best to help during the first few days.
This is the time when we discover what kind of a person the new doc is. If they become angry and go after the nurses then we leave them to drown. If they reach out to us we throw them a line and we keep them afloat..We cover their asses for everything because we know the kind ones will eventually settle in and become good, competent ICU docs..And then ofcourse their fellowship will be done and they will leave us. The bad , angry ones never get good, they just get meaner and eventually get hired as staff and we are saddled with them forever.
Just kidding, sometimes the good ones do stay and we love them.

I hate new doctor time, it's scary for the staff because when bad things happen to our patients we want the very best to help us and sometimes we have to accept that best isn't available right away. We have to hope the new guy can keep it together long enough for the best to get there and that is damn scary.

I had a new doc tell me he wasn't going to let anything or anyone in the ICU raise his blood pressure...How do you respond to this? I mean it's an ICU..Scary shit is going to happen, you are going to have to respond quickly and your blood pressure is going to go up..Well hopefully you are going to respond quickly..Not this guy though...And that is scary as hell.

In a time when medical care has become so advanced it's weird to realize that doesn't matter. It's the people who deliver the advanced care that matters.
You can have cutting edge medications and treatments but if your staff can't communicate or has no experience the patient will never see the benefits.

I find I am beginning to grow tired of nursing and healthcare in general. It has become so political and petty. To get good care for your patient you have to ask nicely and make sure you massage the docs ego. Hospital nursing sucks.


At 4:39 AM, Blogger Barbados Butterfly said...

I agree, it really sucks when nurses have to massage the doctor's egos to get appropriate care for their patients.

I wish it were always simple to communicate and that egos didn't get in the way.

I'm fortunate to currently work with nurses who I adore and who are friends, not just colleagues. I've worked with nurses who know exactly what their patient needs but can't get it from the duty doctor - I can remember many times when I've been asked by a nurse to see a patient "as a favour", even though they're not under my care.

The first instance occurred when I was an intern. A charge nurse on another ward asked me to see a guy who was having difficulty breathing. He'd been without his cardiac failure meds for 3 days. The duty doc had repeatedly prescribed salbutamol for his APO and got shirty with the nurses when they suggested that the patient needed frusemide.

I still remember feeling angry at the duty doc. Angry because he mistreated his patient and angry because he mistreated the nurses who were having to watch helplessly as their patient laboured in APO, knowing that the salbutamol was useless.

I also remember feeling guilty for how grateful the nurses were when I prescribed frusemide. It was the charge nurse who called me, of course, because the other nurses were to scared to call me (an unknown doctor), presumably figuring that I'd side with my doctor collegue or tell them to get lost. That made me feel sad.

Poor communication and poor behaviour are shirty things. I hope you get some good docs soon.

At 11:51 PM, Blogger adventures in disaster said...

Thanks for the reply.
It's weird how trying this time is. You would think after so many years I would have adjusted to it by now by every time it makes me crazy or just really sad.
I too have "my docs" the docs I will seek out to get help for my patient when the fellow is doing everything wrong..my favorite being giving the grade 4 ventricle a litre of saline and 250 pentaspan for a low BP despite the fact their Sao2 was 89% and they were gasping..fellows always reach for the fluid..we are regularly accused of drowning our patients by the surgeons and I can only agree.
I must say we have had wonderful fellows though, a few were ready and willing to be trained..they were eager to work with the nursing staff, happy to have someone to think out loud with, someone to bounce ideas off of until we get to the best possible treatment.
Hospital nursing is really awful though..it's getting very hard to be heard.


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