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Saturday, January 16, 2010

Some doctors don't like RTs to think

I was paged to the ER for a "diff breather." I assessed the patient and determined a breathing treatment was indicated. I grabbed a neb off the shelf, a vial of Ventolin from my pocket, and fixed up the treatment. Yet, before I hooked it up to the wall I hesitated. I looked at the nurse and said:

"Is the doc that's on today one of the kind who doesn't like us to think?"

"I don't know," she said. I'm certain she knew exactly what I was referring to. Two of the docs that regularly work in our ER have lectured many of us RTs and RNs that we are not to give anything without an order, protocol or no protocol.

It's pretty bad when you know exactly what to do, are trained to do it, yet you have to wait to treat the patient. It's even worse when the patient knows what he needs and still I can't do anything.

Most of the doctors we've had in the past just let us RTs and RNs do what we think is necessary, especially if the patient is critical. Yet these new docs seem to be less willing to give away some of their autonomy. They seem to be control freaks. I'm not sure if something happened to make them this way, or if it's their personality.

Yet I can't help but think this is not good for the patient. It's not good to wait to start a therapy you know is needed.

Now I'm not talking about invasive procedures, I'm talking about doing simple tests to keep the pace moving. I'm talking about ordering or doing EKGs, breathing treatments. An RT is trained in knowing when a treatment is indicated even more so than doctors in many cases. And it's not like we want to create unnecessary work for ourselves either. We certainly aren't going to do a procedure we think is not needed.

It's not like I'm going to give the patient 20 breathing treatments without talking to the doctor. It's not like I'm going to set up the patient on BiPAP without an order. It's not like I'm going to do a racemic epi treatment without an order.

Yet, still, here I was holding the nebulizer in front of a patient having obvious bronchospasm and I was hesitating. This was bad. Yet I was scared to get lectured again. If we had a protocol (or a decent doctor working) we wouldn't have this problem, but I've been told by these two docs that RTs aren't doctors, and aren't to do things without first an order.

I suppose you can say I'm tired of it all. I like to think. I like to question doctor orders. Yet also I like to do what I think needs to be done, within reason. So now it's come to me thinking but not doing anything. It's pretty bad when it comes to this.

The problem is I don't know how to stop thinking. I don't know how to be one of these RTs who just does what he is told without questioning. I don't know how to become one of those RTs who never make recommendations.

Yet some doctors look at you when you make recommendations. They give you THAT look. They turn a blind eye. They give you 1 reason why they are doing it the way they are doing it, if they give you the time of day. So it's come to the point when some doctors are working it's easier to just do what he orders and shut up.

It's frustrating that it's come to this. Then again, sometimes I think it's better to do what you think is best and apologize later. It's never wrong to question doctors and make recommendations even when they grumble and gripe or give you that look you hate to see.

Thinking is good. Doctors who don't like it when RTs and RNs think, who prefer us to be ancillary services, are not good doctors at all. And that's the thought of the day.

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