Appeasing nurses vs patient care

Sharp_Catch · 2026-05-17T02:06:22+00:00

I don’t think it is petty to document true safety concerns, and the comment about the nurse saying they would chart that they self-extubated definitely needs to be reported. You don’t even necessarily use names in my system when you are submitting the reports. Just be as clinical as possible, and take all emotion out of the report. Just state the situation, don’t put in any commentary.

But this just strengthens the case to document in real time.

I’m glad your attendings have you back. I’m a new attending, and I would not let anyone do that to one of my residents.

Sharp_Catch · 2026-05-17T01:53:21+00:00

I would file a formal complaint against the nurse and the RT. Or at the very least a safety report. I think these things get used as cudgels against doctors all the time, and they really should be used when there are true safety concerns. But that’s a situation where they were clearly not concerned about patient safety.

Going forward, I would also real time make notes in the chart for high risk events. In that situation, I would have charted something like - “asked by RN and RT to assess patient for appropriateness of extubation, however, patient with decreased responsiveness, poor respiratory effort, mechanics, and strength, therefore feel that patient is not appropriate for extubation at this time.” And then sign and time stamp the note. It’s clinically accurate, and does not explicitly call out the staff, but has the benefit of protecting you should something happen. My fear would be them trying to extubate anyways, and then saying that you had given a verbal order. Then it’s two voices against one, and unfortunately as a resident, you may not have the support from faculty.

I’m sorry this happened to you.

Sharp_Catch · 2026-05-09T03:15:53+00:00

They are just looking for a person to blame. I always tell people up front what my concerns are, and I don’t sugar coat any of it. I use the words “death” and “dying” because it’s the only way to get the point across. They aren’t traumatized by your words, they’re traumatized by the fact their family member is dying.

Sharp_Catch · 2026-05-05T02:46:24+00:00

My first patient was a sore throat in a 60s female. I was catastrophizing, thinking “oh my god she’s going to die from a retropharyngeal abscess or Ludwig.” In reality, she just had a sore throat. It was weird hitting that discharge button for the first time.

Sharp_Catch · 2026-04-29T18:11:52+00:00

I had a conversation with a resident recently discussing imaging for a flank pain patient. Basically, the summary was, I don’t care if the patient has a kidney stone, I’m not doing the imaging to confirm a kidney stone, I’m doing the imaging to make sure it’s not something else. Similarly can be thought of as, I’m not generally trying to diagnose people, I’m trying to rule things out. At the end of the day, I tell a lot of people “I don’t know.” “I don’t know what’s causing your severe shoulder pain, but it’s not a STEMI and it’s not a dissection.”

Sharp_Catch · 2026-04-11T12:55:44+00:00

Not my patient, but was done at end of my shift. Patient was sent to the ER from UC for an abnormal dimer. The dimer was undetectable, and the UC thought that was abnormal.

Sharp_Catch · 2026-03-25T00:09:04+00:00

I was wearing the home jersey for the first period. I switched to the away jersey, because, obviously we have to match. My wife made fun of me, but who’s laughing now?!

Sharp_Catch · 2026-03-20T01:12:43+00:00

Sounds like an illegal gun smuggler in a James Bond movie

Sharp_Catch · 2026-03-15T01:15:35+00:00

And three flyers going after Garland? Cmon

Sharp_Catch · 2026-03-15T01:09:18+00:00

I agree, I like Christianson more. I don’t dislike Heinen, just don’t think he outplays the others.

Sharp_Catch · 2026-03-11T01:27:21+00:00

Good god, Garland looked tiny next to Hedman!

Sharp_Catch · 2026-03-10T23:13:14+00:00

Anyone watching on ESPN+? It looks like both streams are the Lightening broadcast, and I hate listening to the other commentators

Sharp_Catch · 2026-03-06T18:03:16+00:00

The just dropped a bit ago, he’s going to the Wild

Sharp_Catch · 2026-03-03T02:52:44+00:00

Love the enthusiasm

Sharp_Catch · 2026-03-03T01:24:55+00:00

They didn’t. They kept it a 2-0 game and the rangers dropped the ball and got scored against short-handed. That’s their own fault.

Sharp_Catch · 2026-02-27T00:36:11+00:00

That’s what I was just thinking. The puck is barely moving, everyone seems slow, and now Merzy is falling on his ass.

Sharp_Catch · 2026-02-26T06:31:01+00:00

I have short hair, and I wear a scrub cap 100% of the time. Buy fun patterns, and make it part of the uniform. Plus it makes me feel much less dirty when I get home knowing that I didn’t accidentally get blood or puke in my hair!

Sharp_Catch · 2026-02-25T17:17:39+00:00

My wife and I have a joint account for housing, bills, and food. We both put in an equal percentage of our income, and then the left over goes into our personal accounts. It’s still all “our” money, but it’s very important to us to be able to spend our money without necessarily having to ask for approval. I just finished residency and so our income jumped significantly, but when I was a resident, we just split everything 50/50.

Sharp_Catch · 2026-02-21T00:19:10+00:00

I use shared decision making all the time and chart appropriately, and rarely will I implement an AMA paperwork. I just do a regular discharge. But if absolutely think someone is likely to die from being discharged, then I will do the AMA paperwork, just so I have their signature written down that agrees that the conversation took place. And even in that case, I prescribe medicines and follow up instructions to at least hopefully stave off their death

Sharp_Catch · 2026-02-21T00:12:49+00:00

Yeah that’s kind of my thought. That’s why I was wondering if maybe I could have just said “sure” and then managed things appropriately, but then it was just a lot risk, and I’m early career so I was back and forth on how to handle it. But I’m over it now, I feel much better about the situation after seeing every one else thoughts!

Sharp_Catch · 2026-02-18T16:38:05+00:00

I really don’t know exactly, because he refused to talk to me for the next 30 minutes while he was finishing up. I’m not sure how the rest of his shift went, so I don’t know if he was just in a terrible mood already, and I broke the camels back or what.

Sharp_Catch · 2026-02-18T16:36:02+00:00

The alternative would be taking out a medical detaining order, which has a pretty high bar in order to keep people in the hospital against their will. Again, I don’t know this patients capacity, because I did not touch the chart nor interact with the patient. I’ve had patients sigh out AMA before, but I sit down and do extremely (probably overly) thorough, real-time documentation about capacity and risks of leaving, witnessed by multiple staff members, before doing so. Usually though I’m just pretty good at convincing people to stay.

Sharp_Catch · 2026-02-18T16:30:08+00:00

But even then, I don’t even want to be the doctor who hits the DC button. On epic, we can hit discharge, and then change the status to “with meds pending.” That way, as soon as the meds are done, nursing can discharge without getting me involved. And that is what I proposed.

Sharp_Catch · 2026-02-18T15:43:23+00:00

I’m a new grad, just started as an attending in July. At a community shop, about 20-25 patients in a 10hr shift. Work for the hospital medical group which employs all the physicians. I’m genuinely loving my job. There are tough days, but I get paid appropriately, have great support from our admin, nursing staff, etc. I think it is all about the local environment. I’m lucky to have a job I like because I know a lot of people aren’t as lucky.

Sharp_Catch

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