Skip to main content

Is Your Doctor 'Aware'?

Every doctor understands what the phrase, doctor aware’, means.  This is the phrase that hospital nurses record in their nurses notes when they have notified the doctor, usually by phone, on a patient’s issue.   Once the ‘doctor is aware’, the nurse is in the clear and has transferred responsibility for the issue to the physician.
Here are some samples of doctor awareness.

Phone Call Notification                                           Nursing Record

Doctor, Mrs. Leadbelly just vomited.                       Doctor aware!
Doctor, Mr. Wobbly is dizzy.                                        Doctor aware!
Doctor, the ultrasound showed a gallstone.         Doctor aware!
Doctor, Mrs. Hothead has a fever.                             Doctor aware!

Physicians often roll our eyes over these conversations.  Some of these notifications are communicated in the middle of the night about patients we do not know.   Although we can’t usually address the abnormal finding directly at that time, nor do we often need to, once we have been made ‘aware’, the responsibility of the entire case is now ours.   For example, if we are awakened by a nurse asking if she can give antacids to quell a patient’s heartburn, we are likely to agree with this seemingly reasonable recommendation. The chart will record that we are ‘aware’.  If that ‘heartburn’ turns out to be a harbinger of a more serious condition, then the physician will be liable for his action.

If  it's more than heartburn, will we end up in the dock?
 
Before you pounce on this doctor accusing him of haste and sloppiness, keep in mind that we handle hundreds of these calls every year.  If we were to run to the hospital on every one of these calls to see the patients personally, we’d have to live in the hospital like a medical intern. 

A standing joke between physicians and nurses is after a nurse reports an abnormality to the doctor, the physician wryly responds, ‘I am not aware!’

One particular vexing example of this is when a nurse calls me at 8 pm as the attending physician wants me to approve that the patient can be discharged home.   Often, one of my partners has seen this hospitalized patient during daylight hours.  As I have no knowledge of the particular patient, I am reluctant to sign off on the after-hours hospital discharge, which would force me to accept enormous responsibility on the appropriateness of sending the patient home.  In the most recent example of this, I told the nurse that I cannot clear the patient as I was not involved in the case.  The attending physician must make his own independent decision if his patient can be sent home.  Of course, the attending doctor who is asking me to approve hospital discharge is engaging in the same ‘Dr.Aware’ procedure at the physician level.   Familiar with the concept of CYA?

We do the same thing with our patients.   When patients reject our medical advice, guess what phrase we enter into the record.


Comments

  1. In Australia it goes a step further.
    If they want an empty bed in a hospital they are likely to burst into the ward/room with the statement "I hear you want to go home' - how 'aware can you get.
    You then are aware how tenuous your stay in hospital is.
    YThis happened when I was visiting my wife who , unforunately , is old - as I am. So we are expendible.

    ReplyDelete

Post a Comment

Popular posts from this blog

Why Most Doctors Choose Employment

Increasingly, physicians today are employed and most of them willingly so.  The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals.  In addition, the alternatives to direct employment are scarce, although they do exist.  Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings.  Another practice model is gaining ground rapidly on the medical landscape.   Private equity (PE) firms have   been purchasing medical practices who are in need of capital and management oversight.   PE can provide services efficiently as they may be serving multiple practices and have economies of scale.   While these physicians technically have authority over all medical decisions, the PE partners can exert behavioral influences on physicians which can be ethically problematic. For example, if the PE folks reduce non-medical overhead, this may very directly affe

Should Doctors Wear White Coats?

Many professions can be easily identified by their uniforms or state of dress. Consider how easy it is for us to identify a policeman, a judge, a baseball player, a housekeeper, a chef, or a soldier.  There must be a reason why so many professions require a uniform.  Presumably, it is to create team spirit among colleagues and to communicate a message to the clientele.  It certainly doesn’t enhance professional performance.  For instance, do we think if a judge ditches the robe and is wearing jeans and a T-shirt, that he or she cannot issue sage rulings?  If members of a baseball team showed up dressed in comfortable street clothes, would they commit more errors or achieve fewer hits?  The medical profession for most of its existence has had its own uniform.   Male doctors donned a shirt and tie and all doctors wore the iconic white coat.   The stated reason was that this created an aura of professionalism that inspired confidence in patients and their families.   Indeed, even today

Electronic Medical Records vs Physicians: Not a Fair Fight!

Each work day, I enter the chamber of horrors also known as the electronic medical record (EMR).  I’ve endured several versions of this torture over the years, monstrosities that were designed more to appeal to the needs of billers and coders than physicians. Make sense? I will admit that my current EMR, called Epic, is more physician-friendly than prior competitors, but it remains a formidable adversary.  And it’s not a fair fight.  You might be a great chess player, but odds are that you will not vanquish a computer adversary armed with artificial intelligence. I have a competitive advantage over many other physician contestants in the battle of Man vs Machine.   I can type well and can do so while maintaining eye contact with the patient.   You must think I am a magician or a savant.   While this may be true, the birth of my advanced digital skills started decades ago.   (As an aside, digital competence is essential for gastroenterologists.) During college, I worked as a secretary