Wednesday, October 9, 2013

Non WoW Rant - Don't tell me how to do my job!

I was having a nice day at work today until my head of department walked in, with that look on his face and "I need to talk to you before you go home..." comment which I KNOW means there is an incident.

I levelled my gaze at him.  "What now?  What did I do wrong?"

"It's about MRI last week," he said.

I knew EXACTLY what he was talking about and I wasn't really surprised.  "Did a parent put in a complaint about me?"

He laughed, shaking his head.  "Yes, but I want to hear your version of the story."

I took a deep breath, and began to rant.


My hospital does a paediatric MRI list for children who cannot tolerate being awake for the MRI and we give them a general anaesthetic (GA).  It's a special list, and all patients who are going to come in for an MRI under GA have to be assessed preoperatively before we proceed.  It's a relatively new service that I helped set up and it's not only something sorely needed in our area health service, but it also means that local families don't have to travel far away to have this relatively simple procedure done. I would rather they DIDN'T have a general anaesthetic, as it's far safer for the child!

I wish all children had their MRI like this!  It would save me lots of work!
Not every anaesthetist is comfortable doing GA MRI.  It's in a remote environment, you're working with children, and those children are often difficult - autism, developmental delay, attention deficit disorders, hyperactivity, foster kids... getting them off to sleep is a challenge in itself!  But I have heaps of experience in doing difficult kids and making sure it's safe for us and the patient that it irks me when people think they are exempt from my safety rules.

One important rule that I tell parents is that they may stay with their child until they are asleep but as soon as they are asleep they should wait outside or back in the ward for their child to wake up.  Conversely, when the child's MRI is completed then I don't allow parents in until the child is awake.  The reason I get parents to leave is because once the child is asleep we have to do things like put breathing tubes in, put in drips/cannulas and things can get hairy when patients to go to sleep.  Children are prone to obstructing their airways and turning blue, so anaesthetists need to concentrate and not be distracted by anxious parents floating around asking if everything is alright when snoring noises and strange drug induced movements that look like epilepsy are totally normal when going under anaesthetic.  Similar complications can occur when they wake up.  Laryngospasm (which is where the voice box closes and the child cannot breathe) is a scary situation that requires immediate attention and special care to rescue and resuscitate and those seconds can be scary as a child suffocates in front of you - having a parent there watching and getting traumatised by us doing things to save their child is stressful for them as well, even if they don't realise it!  A parent standing by feeling helpless and panicky as their child is turning blue/grey in front of them... I would not want to be that parent!


So last Friday, I had an 8 year old boy coming in for a repeat MRI of his leg after a tumour was removed. He had Aspergers so his mother said he was anxious and difficult but intelligent, but he was old enough to have a drip put in and be put to sleep with intravenous drugs.  I was very pleased with this because giving gas to an 8 year old unco-operative patient is hazardous to the patient as well as to my staff, as the children bite and kick and scratch and fight and at 8 years, they are very strong!  They can throw themselves off the bed and injure themselves!  So I explained to the mother what we were doing, and she said that she was a staff member and she knew all the procedures and understood everything.  The child was frightened and didn't want to go into the MRI room, so I put his drip in (which he did without a fuss, he was a good kid) and gave him 2mL of magic white stuff (propofol - the stuff that killed Michael Jackson) which was enough to make him sleepy and cooperative and then I took the child into the room and put him to sleep.  The parent went outside (and were supposed to go back to the ward, but she was waiting outside the MRI suite, which is fine as well).

When we completed his scan, I sedated him heavily so that he wouldn't wake up hysterical - he had woken up terribly the last time despite sedation so I gave a larger dose of sedation to make sure he didn't do that again.  The parent was hovering outside, and wanted to come in but I left clear instructions with my nurse recovering him that she was not to come in.  He told that to her, and she was very agitated - so agitated that staff from the nearby department came into the MRI to tell us that an upset parent was outside.  I knew she wanted to come in but I had already explained to her that is not part of our safety procedures and expected her to comply.  I told the MRI radiographers to tell her, then decided it was probably better if it came from me.


I went outside and she was angry.  She told me that she had always gone inside whenever her son had a scan and been there when he woke up. I politely explained to her that these are my safety rules and I do not compromise them as it is for the safety of my patient - even if the patient is her son.  She said she was a staff member and she was medical and I reaffirmed to her that even if she was another anaesthetist and one of my colleagues the same rules would still apply.  I told her that in an emergency I needed to ensure she would not get in the way or collapse or cause me to be distracted from the care of my patient and she adamantly told me she had first aid training and could handle a child going blue - her own daughter had epilepsy and turned blue in front of her and she had taken care of her.  I said to her that I was sorry that I could not change my rules for anyone, and she again told me that every other time her son had an MRI she had gone in.  I looked her in the eye and said politely but firmly, "You may have been allowed to do that at other times with other anaesthetists, but these are my safety rules and I do not compromise my care for anyone.  Next time, you can have your scan done on a different day and go in with your son, but I'm sorry, you cannot do that on the day that I do MRI."  She went quiet after that, looking angry, and I said that I would like to go in now and look after her son, and I would fetch her the moment he woke up.

When the child stirred (it was a while, since he was sedated), I brought her in and told her what to expect and if he had any nausea and vomitting to let the staff know and I would chart some anti-vomitty medications for him.  She nodded and I left to go look for the next week's MRI patients so I could talk to them about what to expect and fasting instructions and where to go on their MRI day.

So, the complaint the parent put in was that I was rude and "told her that she should go somewhere else to have her MRI."  She also complained that her son got too much sedation because he was sleepy for the whole day - gosh you can't please some people.  If they wake up screaming, they complain.  They stay sleepy and calm, they complain.  She was upset that she didn't get to go in with her son despite her requests to go in.  The patient liaison officer was very concerned that I had said "She should go somewhere else to have her MRI," but maybe the patient can do that and be happier somewhere else where she can boss the staff around to compromise safety!  I doubt that any other place would be different to my rules though!

Naturally, I was infuriated.  I had spoken to her in the politest way possible!  And she works in the medical field (as a ward clerk) in our own hospital - she should know better and follow the rules!  How dare she come in and tell me what I should be doing, when she is the one who did not comply with the rules stated and make me have to LEAVE my patient so I could deal with her.  Of course, my child was being looked after by the recovery nurse so they were in good hands and I was just on the other side of the door, so it wasn't terrible, but it made me grouchy nonetheless.

I UNDERSTAND that it is your child, and you are concerned for their welfare and care.  I REALISE that it is an anxious time for parents and they just want someone to be understanding and cater to their needs. But I have rules for a reason, not to be a bitch!  All I need is just ONE parent to be present and something bad happens to their child and they are emotionally scarred for life, have post traumatic stress disorder, or worse, they obstructed me from doing my job by getting hysterical and collapsing on the floor, now leaving me with not one but TWO critically sick patients to care for!

I know that if anyone examined what I did, that nobody would criticise my care.  What I did was standard care that most people would follow!  Now who knows what things she is saying about me behind my back to other people, making me sound like a hideous horrible person!  I know I shouldn't let it bother me but it does.  You try to do the right thing by people and they just want everything their way!  I bet there are tons of parents out there who think doctors are stupid people who don't know what's good for their child - but I am a parent, and I would follow the procedures if my child had been in the same situation.

This is not an isolated incident.  I get all sorts of funny parents sometimes - there was one time that our secretary contacted a parent to come in for their child's preanaesthetic assessment for MRI and the parent said "Our child doesn't like seeing doctors and I don't want to traumatise them so we're not coming in for assessment, we'll just see the doctors on the day."  Now that was HIGHLY unacceptable to me!  I rang the parent and told them that if your child requires a general anaesthetic then our protocol mandates they must be seen prior to the procedure to be assessed and the family given instructions on fasting and where to go on the day so there are no mistakes with fasting.  The parent was rude and said that it was highly inconvenient to bring their child to hospital (it was a foster child) and they could not come.  I politely informed them that I don't mind if they don't come in, but if they didn't want to see the anaesthetist prior to the procedure that they would have to have a normal MRI, without a general anaesthetic and therefore would not need to waste any time coming at all, and it would be quick and easy and they could go home the same day.  However, it meant they could not occupy a spot on our GA MRI list as those spots are reserved for patients requiring a general anaesthetic.  I reassured them they would get another booking, but they grudgingly decided to come in for assessment.  Fortunately they were pleasant in person and not too obstructive and followed all instructions given to them.

Sigh, I think my rant has run out of steam!  To all concerned parents out there, I hope that you understand why we mean doctors do the things we do - it's not to be mean, it's for safety and patient care, and please, please do not ask us to compromise patient care as it makes it unpleasant and awkward for everyone.

18 comments:

  1. I'm sure it feels good to get that off your chest and I can see where you're coming from. I don't think you did anything wrong either but it must be hard from her perspective even if she is a staff member. I still remember fainting in the OR while observing a particular procedure years ago. It's quite funny thinking about it now but back then it was embarrassing.

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    1. Thanks Cym, I think after writing it I feel better, and wonder if maybe I shouldn't have published it. I probably look like a big unfeeling meanie. But I do understand the stresses a parent goes through, after all, I am one as well!

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  2. This is such a sucky situation. I watch Scrubs - no, I don't at all claim to have any knowledge about medicine or disabilities beyond my mother's disabilities, even those of which I am shaky on - and they said on there that doctors make the worst patients and parents of patients because of the 'burden of knowledge' - they know what can go wrong, so they may be more likely to panic over small things, and I can understand that. But the flipside is shown here, that because they know how to handle things they think that they can stand to watch it happen to their own child, or believe they won't get in the way or that seeing it happen to their own child won't affect them. Okay, for some people it wouldn't, some people are just strong like that, and they're amazing, but I'd assume that the majority would be affected. And if they're going to kick up that much of a fuss about being at their child's side then odds are they're NOT made of the steel they think they are to stay calm and unaffected if something did happen.
    I think parental instincts take over in cases like this, and professionalism (though at that point they weren't at work anyway) or knowing better go by the wayside. If she had been in your position, and a parent like her came in, she would have done exactly as you did and stuck firm to the rules. But because it was her child, she couldn't stand to stand aside. It's a shame, and I doubt that she realises the importance behind your rule even now, but what can you do aside from stick to your rules? I get very annoyed when people break rules, especially if safety is involved or we're playing a board game, because rules are there for a reason, and no one is exempt from them. Sadly, there will always be people who think they are and make lives difficult for other people.

    I don't often go to the doctors or hospital, but when I do I sit patiently, I do as the doctors ask, even if it means I'm going to be waiting to be seen longer or if it means that I have to wait nervously outside of a room. Because, even if I was a nurse, a doctor has more medical training than I do, and they're doing me the highest service of curing my illnesses or fixing broken bones. Doctors are HIGHLY underappreciated.

    I RESPECT YOU! I hope this doesn't happen again, and nothing negative comes of the complaint.

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    1. <3 Daeaye! As a full time carer for your mum I know you would have to see medical people a lot, and I totally would understand if you thought all doctors were horrible people! I only want to get MY point of view across, so that people can see both sides of a story when it comes to patient care.
      This service I helped set up is a free one - patients don't have to pay anything to come and have this done, for those who really need it. And now I am thinking is it worth doing this work if I'm going to keep getting grief like this? I think I would much rather have the afternoon off!

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  3. Navi

    It is not about the child, it is all about MeMeMe the parent... could be a generation thing, you know the sensitive precious generation Y parents.

    Staff members are either the best or the worst. And when they are bad they are bad, because they think they dont have to follow the rules etc (although many dont have to be a staff to behave that way).

    Interestingly, my favourite line is "there is nothing a bit of propofol cant fix"... bad I know haha and I dont even give that stuff the most I ever get to use is a healthy dose of midazolam.

    Ksret

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    1. Propofol is wonderful stuff! What a shame I couldn't put the parent to sleep so she didn't have to get stressed over the whole thing! Then the parent and child could both sleep together LOL! But I don't envy my head of department who has to go down and have a meeting with her - he is already dreading it because he said he doesn't want to get angry at her, and I rang the head of Paediatrics to complain and he offered to come and go to the meeting. That would be worse though - he would probably tell her that she should go somewhere else and not fill up the MRI list when it's his patients who are on that list waiting for their scans! And I thought I was a bit politically incorrect LOL!

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    2. At least nebulising propofol may fix your problem.
      We had a few instances where we had to wedge the patient in the MRI for cardiac MRIs... that didnt go down too well. One patient was happy to be wedged in but only to give up 1 minute later when he realise he cannot breath...

      KsRet

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  4. I had to come back a few times to get past MRI, I even see the word and I start panicking. I didn't know I was claustrophobic until I had to have one. I think it's good to have a place to yell about stuff. And I don't think she should have thought the rules didn't apply to her just cause worked there.

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    1. I had to get in there as a guinea pig on two occasions, they got carried away and kept me there for 1 hour + each time... The first 10 seconds are the worst for me, then it is all cool, and I fell asleep.

      KsRet

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    2. It is a little claustrophobic, but I found it horribly noisy. I wished I had a book to read! But I was having my head MRI (for fun) so I couldn't move an I wasn't supposed to move my eyes either!

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  5. My sister's friend is a Matron (still amuses me that we have Matrons!) and her son broke his arm a while back. I'm not sure exactly what happened but she tried to get a doctor to 'bend the rules' for her using thwe whole 'I work here', 'I'm medically trained' etc. but the guy wouldn't budge. She proper kicked off about it but afterwards she realised what a cow she'd been and felt terrible. I think she ended up taking him for a drink to say sorry.
    So, hopefully this parent will realise what an arse she was and you'll hear no more of it! I'd say you were 100% right to stand by your rules - it's not like their unreasonable or for no good reasons.

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    1. I totally understand people getting upset - it's your own sick child after all - and she was sorry after so that's all ok! If this mum did that, I would tell her it was alright, since I understand it can be stressful! But to then put a formal complaint in when I was only doing the right thing not recognising that she was being unreasonable when I TRIED to reassure her... ugh, it makes me upset. Yesterday I rang the head of Paediatrics and told him that I was considering not doing the service anymore and the kids go back onto a 2 year waiting list for their MRI instead of a 3 month one! I don't need nasty people making my life miserable when I'm trying to help out! But of course that's just a hasty decision and I shouldn't let one person ruin it for the majority of children in my health service area.

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  6. As a mother myself whose been known to be over-bearing when it comes to my children I completely understand this mothers point of view. However she's not the doctor nor does she write the safety rules for these procedures so no matter what field or office she works in herself she over-stepped period. You mention above that looking back now you wonder if you should have published, well if I we're in that mothers shoes I'd be looking back now and wishing I kept my mouth shut. Sometimes in the heat of the moment we say things in such away that even though we know we're pushing the boundary (stretching our version of the truth whether a little or a lot) we don't care at that second because we're to frustrated to care. I think you did the right thing, and hopefully your boss agrees.

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    1. I look at it like getting in a plane. If the pilot told you to put your child's seat belt on for safety reason and a parent said "No, I won't, because my child gets upset when you put the seat belt on," and then complained loudly that the last time she was on an airplane she didn't have to put the seatbelt on, it wouldn't be THAT unreasonable that the pilot would ask you to disembark the plane! My boss agrees with me and thinks the whole thing is a bit stupid and unfounded but all the meetings that arise from a formal complaint just take up a lot of time.

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  7. You have remarkable patience to be able to deal with people like that. Although I couldn't read it without getting flashbacks to all the crazy people I had to deal with when I worked retail. And they didn't even have a child to be worried about to explain their craziness! There's not really any good way to deal with people convinced they can say or do anything until they get their way except hold fast and stay calm. That and wish people would stop believing that stupid lie about the customer always being right. It makes them think they can get away with so much more crap.

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    1. I don't think it's patience exactly - I know she was concerned and I was trying to reassure her. But she refused to be reassured LOL!! People talk about patient's right and yes they have rights, but I too, as a medical practitioner have rights and I have the right to practice what I do in a way that is safe, and I also have the right to refuse to treat a patient because I am unhappy with their behaviour towards me!

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  8. Navi, leave it to me to offer another perspective, but I can see how this is a situation no one wants to find themselves in, and the heartbreak collides. You as a caregiver want to help your patients, and parents want to protect their children at all costs. I don't know how my inner momma-bear would respond to someone, anyone, doctor or no, telling me what I could and couldn't do for my child, and I know you would be the same. In those sitatuations where emotions get high, it's too bad there isn't a mediator or counselor to act as a go-between. I know you know how to deal and handle people well, but some bedside manners have a lot to be desired, and perhaps this mother has had horrible experiences with that (I can tell you I certainly have, and yes, when it's come to my cubs, and yes, it sucks.) This was a break-down of trust, and from what it sounds like, her trust was broken long before she got to you, so though it had nothing to do with you, it sure did feel like that. I have known so many folks who have had to "fight" and advocate for their children against a system that seems as complex and confusing as a labyrinth. Right now my big rant are parents who won't vaccinate their children (at least the nutjobs here in the States) and now we're seeing the effects. She refused to be reassured because her lizard brain was in control -- she had gone to the emotional state where no reasoning could happen, and that is when someone who can talk her off the ledge would have been nice. And yes, to answer your chat question, I have lots of stories too, from both sides.

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    1. I know in your profession you would have seen your fair share Matty. But I am more cross with this lady for not seeing my side of the story when I could see hers AND my side. Not considering what I would be required to do for safety standards is a bit selfish imo.

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