Why Administrators Suck, Chapter XLVII
So I need a female chaperone to stand inside the room for 30 seconds while I do a quick breast exam. All the nurses are busy with other patients, and the techs are doing ECGs or transporting patients. My favorite unit secretary is sitting at her desk literally five steps away from the patient's room in question. The phone is not ringing, and she is contentedly surfing the internet.
"Can you help me out with a quick breast exam?" I ask nicely.
"Sorry, I'm not allowed to do that anymore."
Blank stare. "You've chaperoned me hundreds of times over the years. Who said you can't?"
"Mrs. Peaker, the new hospital administrator."
"Wait a minute. You can take a break, can't you? I've seen you get up and eat once already during the shift."
"Yes, I get two 15 minute breaks per shift."
"And they still sometimes make you act as a babysitter for psych patients, right?"
"Yes they do."
"And I bet if you had to go to the bathroom, you'd be allowed to do that, wouldn't you?"
"They couldn't stop me."
"But this person specifically forbids you from getting up to assist me in patient care?"
"Yes."
"She's a nurse, right?"
"Yes."
"Then get her on the phone and see if she'll come chaperone me herself."
"She probably wouldn't know how."
Indeed.
"Can you help me out with a quick breast exam?" I ask nicely.
"Sorry, I'm not allowed to do that anymore."
Blank stare. "You've chaperoned me hundreds of times over the years. Who said you can't?"
"Mrs. Peaker, the new hospital administrator."
"Wait a minute. You can take a break, can't you? I've seen you get up and eat once already during the shift."
"Yes, I get two 15 minute breaks per shift."
"And they still sometimes make you act as a babysitter for psych patients, right?"
"Yes they do."
"And I bet if you had to go to the bathroom, you'd be allowed to do that, wouldn't you?"
"They couldn't stop me."
"But this person specifically forbids you from getting up to assist me in patient care?"
"Yes."
"She's a nurse, right?"
"Yes."
"Then get her on the phone and see if she'll come chaperone me herself."
"She probably wouldn't know how."
Indeed.
Labels: administrators, bad ideas, ER, rants
posted by scalpel at 5:38 PM
26 Comments:
Welcome back from vacation, I missed you.
She probably wouldn't know how is most likely 100% true. The ones that do the least amount of patient care have the most time to make up stupid rules for those that are on the front lines.
The stupid, it burns!
This is absolutely ridiculous!
I am 43 years old and have never had a doctor use a chperone during a breast or any other kind of exam. I don't think I'd like it either.
Is this an American thing? Either the notorious American prudery or the notorious American sue-happiness?
First - I'm going to refrain from saying anything that would damage my sweet'n innocent reputation about breast exams, you and chaperones.
Carrying on, it does sound like a dumb rule. Someone should smack that woman with a spoon or something.
There are some things in life that I just never EVER want to do.
Eat haggis, for example. Get curb stomped. Or put my career in jeopardy and have to defend my character because some psycho chick thinks I get off on feeling her bewbies in the ER.
No thanks.
In my clinics, I never use a chaperone when women are referred for lumps/abnormal mammograms. The idea of a chaperone defeats its own purpose. It draws attention to the fact that "I'm touching your breasts and, so that is not in any sense misconstrued, we have a female witness for later testimony, if the need arise". Ridiculous. I'm a doctor. Youve come to see me regarding a problem in an area that happens to be your breast. I need to examine you and make a decision on what I find. If that is a problem, please go see another doc.
Suit yourself; Sid said the same thing, btw.
But I would suggest that the situation in the ER is a bit different than that in a clinic setting, for several reasons.
Scalpel, I did not mean my post in any way to offend and I am truely sorry if it came off as such. I would never insinuate anything like that at all and I deeply apologize if you took my comments to mean anything other than a tongue-in-cheek remark.
:(
You didn't offend me, I thought you were being funny. I was trying to be funny too, but I'm serious about the topic.
Ever since one girl ran out of the room all freaked out ("WHY ARE YOU STARING AT ME LIKE THAT!!!???") while I was just listening to her tell me her history, I've been a bit nervous about crazy people who might accuse me of something or misinterpret my actions.
Oh thank God. Here I thought I'd made you upset. Although the haggis thing was funny. It really doesn't taste as bad as it sounds. Tripe is so much worse.
I don't blame you for being cautious, hell I would be to. I make a lot of jokes about gettin' it on with some of the doctors 'round here, but to be honest I'd be really creeped out if a situation ever arose where that came to play. Especially in a clinical setting. At the bar or whatnot - maybe not so much creeped out.
And how were you looking at her? Eyes crossed, or glazed over? LOL
What most people don't know is that the chaperone doesn't need to be female, it only requires that a second person of any gender be present to verify that no inappropriate touching occurs. Having said that, I've only been asked to do it once (and it was pretty unpleasant, your vagina won't die from an occasional encounter with soap, ya know?), and when they come around looking for a witness I keep quiet about it.
I wouldn't ask the clerical staff to do it. It's really not part of their job description...I wonder if she just made up the thing about being forbidden by administration.
Scapel, can I use your post for Change of Shift?
MJ
Of course MJ; I'd be honored.
Thanks for the comment back about my question. Unfortunately, Kevin, MD's sight won't open. :(
I'm just dying to know what the post was a about...since I have no clue. :-P
Gee Scalpel - that is overkill for sure!
Did you ever find out why the administrator took that stance? Some kind of HIPPA violation? or not a "trained" Health care worker? Squirrely about lawsuits? but it is o.k. for the Pt to wait a lo-o-o-o-n-g time until a nurse is free to assist you? And it is o.k. to tie up the bed/room for a l-o-o-o-on-g time too until a nurse can assist you?
I would think that if she worked in your ER as the ER unit secretary she is already privy to confidential patient info. Also, the fact that she had assisted you with that many times before would demonstrate she is technically "trained" to stand there and be a 2nd party. Sort of a grandfathered in kind of thing.
I can't tell you the number of times I got a request to help with something in the ER that was not in my job description and I was Pt Access/ER registration aka paper pusher among other things. There is the job description and then there is the real world. I think at the hospital, at least around the ER we are all in this together on the same team and anyone that can't help when needed can put a wrench in the whole thing. I personally wouldn't have hesitated to help you!
I don't blame you for protecting your self. Go with your instincts.
My OBGYN asked me a long time ago if I wanted d a nurse in there when he did the exam and I told him no thank you? Why? So I can be nekkid in front of TWO people now? So he always did the exam privately, which I appreciated. Sadly he passed away and I will be seeing his partner this fall and I will want the privacy.
My urologist doesn't ask. They always have a woman in there although they are usually doing a procedure so I guess they are needed to assist. Given a choice, I would just have the doc in there and I know a lot of women that feel the way I do. BTW - all the nurses and MA's are nice there and I like them - it is just a privacy thing for me.
Sorry for being so long with this Scalpel. It just irks me that you docs have to be so concerned about lawsuits. And inane administrative decisions really irritate me!
BTW -you probably could have finished the exam faster than it was to have that conversation with her! :)
My Gyn makes me keep my eyes open when he does the breast exam (not sure what the theory is there) but no chaperone.
Did hear of a patient from the ER scream foul! though when she was given an "unexpected" digital rectal exam. If I remember correctly both her husband and another ER employee were in the room. Made the local news but don't think we ever heard the whole story because what ever charges they threatened simply disappeared after a very brief review of the facts. Still, not the type of stygma you want to carry around with you.
MMT - I sometimes close my eyes because it is easier to go to my happy place instead of thinking about them working in the bajingo/sea bisquit area! Or...I find myself looking off to the side or up...just depends on what they're doing! Urological office procedures have a way of interrupting the happy place though, no matter what I do! Or I talk or joke. Just depends on the circumstances. Come to think of it, I don't ever close my eyes during a breast exam and I am usually quiet.
Still, if you are comfortable with your eyes closed you should be able to close them. I wonder why he has an issue with that?
I won't look at a patient's face during a pelvic exam. That seems creepy to me.
I always look at their face when examining their abdomen though.
How come? I think I look back and forth between their belly and face, I want to see if they grimace when I push in various places.
I'm surprised this topic is generating some controversy -- breast and pelvic exams by myself? Are you kidding me? Only if someone smacks me with a stupid stick.
I agree completely that there is some value in looking at facial grimaces, and as long as she isn't looking me right in the eyes, I'll try to pick up on that (especially when wiggling the cervix). But when it comes to pelvic exams, the value of a subtle grimace isn't as beneficial as with abdominal exams. Basically the specificity is too low, because many women will grimace when you are examining their coochie whether they've got significant pathology or not.
If they've got something bad down yonder, you can tell without looking; they'll either tense up, withdraw, or yell out.
Oops, sorry, my original comment was in reference to abdominal exams, not pelvic exams.
And nothing to add to your latest comment, I agree with everything you wrote 100%.
Your right Scalpel about the tensing up and withdrawing and once during a stent removal I did shout out Jesus! But it wasn't as a swear word it was for HELP and tears involuntarily came out the corners of my eyes. I would never shout anything out in a doctor's office (never did before or since)and that experience totally set the tone for future office urological procedures. I DREAD them every time because I always have that 1st one in the back of my mind and also the procedures do hurt in varying degrees. I have been a wimpette for sure. Not proud of it but true.
I will say that my current urologist (not the other one from a few years ago) seems to be much better at keeping the pain level down. He never just rips something out of me that's for sure. However, there have been times that I have gone back up the exam table and I had to go back down. It is an automatic reflex when it feels intolerable. He usually tells me when to breathe and that helps a lot.
I admit that I am so busy thinking about myself - the anticipated or actual pain/discomfort and the embarrassment that I never thought about a doctor having uncomfortable thoughts with a patent.
I mean I know they have thoughts, they're/you're human -I just never connected that you would feel uncomfortable in an exam. I think of it as business as usual.
What sucks here is the very idea of using a chaperone. For some patients, it means kinda embarrassingly being exposed. Why can't they simply chose the audience, if they want audience at all? Another thing is that assaults and professional misconduct can happen, and does happen, even with a chaperone (nurse, assistant etc.) present.
we should come up with an addendum to the old saw, "those who can, do. those who can't, teach."
how about, "those who can, do. those who can't, teach. those who can't teach administrate (and make life miserable for the aforementioned)."
Nursing is no longer fun. It is liability driven charting. In our Omnicell, we now have to answer a question when accessing I.V. Toradol. "Is the client allergic to Aspirin?" That not being enough, we then have to "Confirm" client not allergic to aspirin.
If you are OCD go into nursing. It will feed your compulsive behavior every single day.
My other favorite? We have to FAX our orders to pharmacy from PACU. Until pharmacy enters the orders, we have to hit "override" and give a reason why we are accessing narcotics, etc. We have been instructed to click "Physician present."
O.K. Let me get this right. I have a BSN, took six hours of pharmacology, have had a 26 hour course in conscious sedation, and am considered too dangerous to give a drug which has already been orderd by the physician? Woof!
Tammy
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