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Old 11-13-2007, 11:39 AM
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Default Docs not going in to see (examine) patients??

I've noticed at work that sometimes if a patient is sedated and vented, the doc won't even go in to see them on rounds. They sit at the computer, look up the labs, write a note and leave.

My grandmother was recently in the ER (again). My mother (who is a nurse) said that the doctor ordered a bunch of tests and for her to be admitted without even seeing her!

How is this legal? How is this not insurance fraud? For surely the doc is charging for his time.

Has anyone else seen this?
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Old 11-13-2007, 01:03 PM
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I can't see how the doctor would have a leg to stand on if questioned about it by senior managers, more senior doctors or heaven forbid in some kind of court. I'd be interested to hear other people's experiences.
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Old 11-13-2007, 05:32 PM
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It’s not ethical, but this type of stuff has been going on since dawn of time. When I was a new nurse many years ago, doctors use to make “Roosevelt Rounds.” The doctor would come onto the unit and wave to all the patients as he strolled down the hallway, and then he would write his patients notes. Some things never change.
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Old 11-14-2007, 03:24 PM
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We had a patient that this was happening to this past week. She had not seen a doctor all weekend, and was adamant that she needed to see one. Monday passed, and a resident was by when the patient was sleeping so she didn't go in. Monday night when I had her, her condition worsened and she is now in ICU. The patient knew something was going on but the doctors would not listen to her. Yes, she often got very anxious very easily, and I am sure that when the doctors would see her it would not be a quick visit. However that is no excuse for avoiding patients.
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Old 11-15-2007, 07:40 AM
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Where I used to work we had an attending that would come in at 6am and do a full exam of every patient in the MICU. I have great respect for him as a doctor.

There were some docs from consulting services that would come around and not even enter the patient's room. Then they would document things that they couldn't possible have known unless they entered the patient's room.
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Old 11-15-2007, 06:26 PM
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My own former PCP disappointed me by putting in my chart that I had no pedal edema and good pedal pulses. I had on jeans, bulky socks, and sneakers. He never looked or felt. Interesting, as I was PMSing at the time, and had +1 edema in both lower extremities. That's why he's a 'former' pcp.

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Old 11-15-2007, 06:49 PM
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We were told to document it in the patient notes, if the doctor has written something and it is wrong, go and test it again, and get the next shift to do it as well to reinforce it, just state the facts. If we knew that something hadn't been done we generally did it, as it could solve many problems in the long run if something went wrong with the patient.

Just stay professional and do the job properly.
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Old 11-18-2007, 04:29 PM
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Indeed, I'm with P/J. I work in mental health and we regularly document contradictory notes to medics if we think different.

As for not seeing the patient at all.. I once had a consultant psych who promised to see a patient after the pt requested it, but he failed to do so after 3 days. Friday afternoon I escorted the patient to the consultants office in the sacred hallows of the admin department and left him there with him.

I've often asked for a medic to come and review a patient and they try and fob me off with either a verbal order or some excuse when I really need the pt to be seen. I just tell them that's fine, I'll document you didn't have time to come see them and treatment was with held.

So far I've never actually had to do that.
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Old 11-22-2007, 04:06 AM
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LOL - Now Mother Jones, dear, I know you aren't old enough to have been nursing when Roosevelt was President, so I'd like to know where that term "Roosevelt Rounds" came from!

When I picture waving I think of the Royal Family, so "Royal Rounds" might work, but Roosevelt? : D
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Old 11-23-2007, 07:07 PM
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As far as I have seen, we do not have this problem at the hospital where I work. All of the doctors make rounds on all of their patients, some of course are a little more thorough with their assessments than others. I guess maybe we have a good group of docs, even if a few can really test our patience at times!
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