So I don’t mind if another doctor or nurse disagrees with something I order, or the way I am doing something. That said, there is a proper way that you let a person know that you disagree with them. Usually, it involves being discreet, polite and generally non confrontational about it. Let’s review an example of how NOT to do it…

The patient is a young, non sexually active female presenting with RLQ pain, who was found to have a hemorrhagic cysts on imaging. From across the far side of the ED, where the admitting resident is doing her paperwork.

Admitting Resident: (at loud volume for all to hear). Are you taking care of this patient in bed 12?

Me: Yeah, I’m just signing out the patient now, what can I do for you?

AR: I don’t see on the chart where you documented your pelvic exam (how classy of you to point that out!)

Me: That’s because I didn’t do one

AR: What do you mean you didn’t do one? Why not?

Me: (now getting annoyed, I’m happy to talk about if you think she should have one, but don’t shout it across the ED). Because the patient didn’t need one.

AR: Her urine  shows 5-10 white cells which means she might have PID.

Me: Well, as I DID document on the chart, she’s never had sex, which makes that theory impossible, and she has a finding on CT which perfectly explains her urine.

AR: I really think you should do one, as she could have PID.

Me: She’s never had sex, and I’m not about to make my gianormous fingers her first experience.

Me: Fine, well, I’ll just have to do it upstairs then since your are failing to do a thorough assessment here.

(Really? We going to play the passive aggressive game? Okay fine, the ED attending is sitting two feet away, who also happens to be the chief of the department)

Me: Dr. X, the girl in room 12, the medicine team is curious as to why we didn’t do a pelvic exam. She’s never had intercourse, but the medicine team feels her 5-10 white cells on urine dip are indicative of PID, despite that she has no malodorous discharge, dysuria, bleeding or frequency. Do you want me to do an exam on her before she goes up?

Dr. X: She’s never had sex?

Me: She’s denies it up and down

Dr. X: (Turning to the medicine team). We don’t do pelvics in this ED on children who have not had intercourse. What you’re suggesting can be considered sexual assault and battery, so if you’d like to assault your patient, you can do it outside of my department.

Booya! (Fist bumps were had by ED residents all around.)

So that whole situation could have easily been avoided. The medicine resident could have been like “hey, can I ask you something about this patient’s chart?” Which would have piqued my interest, I would have walked over, we could have talked about it, discussed why or why not, I wouldn’t have had to throw her under the chairman’s bus wheels, the nurses wouldn’t have had to comment what a you know what she was when she left, and all would have been well.   Just sayin’.


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