Thinking of the Big Picture

download-47I often get frustrated at work with the difference in the way doctors think to the way that nurses think. (Well, the good nurses anyways). Doctors don’t often see the “big picture” or what’s in the patient’s best interest. An example from my work week: Patient has been in the hospital for 3 weeks. He had open heart surgery, followed by a long recovery plagued by respiratory, musculoskeletal, and mental/cognitive issues.

For 3 days or so, we (the medical team…nurses, all 6 doctors on his case, social services) had been talking about sending this man to a rehab facility to improve his strength and coordination until he is able to return home… very common occurrence for our long-term patients. By the time we started talking about the patient being transferred to this rehab facility, he was fully ready to leave the hospital.

He’s sick of his ICU bed, sick of the same ol’ hospital food, sick of the daily routine, etc, etc; long story short, he needs a change of scenery. So, we have everything set into place, all the doctors have signed off on the case so the patient can transfer except the hospitalist.

We finally get a hold of him to write the official orders (he was well aware the day before that the patient was going to leave that morning) and after 3 weeks of being anemic (H&H was about 8.2 and 27) and not transfusing, the doctor ordered 2 units of blood to be given BEFORE transfer.

*sigh* As if that wasn’t frustrating enough, as the blood was infusing, the pulmonologist happened to round in the ICU and saw the blood going and decided that he would not sign off on the transfer that same day because the fear of fluid overload and respiratory distress. Sooooooo, this patient who had been sitting in an ICU bed, just waiting to get the OK to get out of the hospital had to wait an extra day all because a doctor wanted to treat the blood counts that had been stable for weeks on the very day he was to be released.

The doctor didn’t think of the ripple effect that his decision has. First and foremost, the patient and his family is inconvenienced.  He had been looking forward to this day and actively asking questions about the rehab facility, looking at this as a huge positive in the midst of an extremely difficult recovery. Second, it has an impact on the rehab facility- they had reserved a bed in their facility, which went unoccupied for an entire day, losing their facility income.

Lastly, it inconveniences our hospital, having an ICU bed taken up by a patient who doesn’t need ICU care which takes up valuable hospital resources.