I'm not happy when the 1st year emergency resident, who is just supposed to be shadowing and watching the OB resident on L&D, decides to take it upon himself to scare the living crap out of my laboring mother with talk of her baby dying if she doesn't have a c-section.
Get out of her room ER resident!
I had to then help calm her down, and reassure her that her baby was doing fine on the fetal monitor, and that she was progressing normally with her labor, and that yes, she can have a vaginal birth.
Seriously - to that ER resident who doesn't know jack about labor and birth - you are hereby banished from the laboring woman's room!
I had a heart to heart talk with the OB resident, and apparently the ER resident was also rubbing her the wrong way that day.
In the end, she had a nice, rapid vaginal birth with no complications. She refused to allow the ER resident to come in her room for the birth, and not surprisingly, he wasn't offended that she didn't want him in there.
17 comments:
Ugh, our ER residents actually manage triage pts and do deliveries. We had one rip a third degree on a multip with his "perineal massage." I kept telling him get his hands of her perineum while she pushed, and he had the nerve to pull the "I went to med school" line with me. Needless to say, he was no longer welcome in any delivery when I was the nurse. Luckily the residents on my floor respect me enough as a nurse to let me get away with that!
Somebody needs to slap that boy silly. What in the world was he thinking? I hope he gets a big black mark on his review.
I hated the ER residents when I was chief resident of L&D. Worse than useless, as they INCREASED my workload, didn't give a shit, and were generally obnoxious.
That resident would have been put off of L&D permanently if I was chief.
Ack. How can a woman be sure not to get one of these in her room? Not approve students? Not allow anyone but an approved person to touch her? I would be livid if a student did this to me, and LFO's comment about how an ER resident ripped a mom up, that would be a very bad thing to do to me...I would be writing letters at least!
Blessings!
Dawn
Wow... well, that's terrifying. Good work on the empathy there, Dr. Resident. Good for her for not letting him back in!!!
@ Dawn: Please don't deprive ALL students the opportunity to share your birth with you... it was seriously one of the greatest opportunities I've had as a nursing student. It's good for you as well because we typically only have 1 patient at any given time (well, 2 if she delivers :) and have oodles of time to spend with you and your family. I spent over an hour the other day providing teaching to a new family, because I had the time.
Wow I have heard this before when one of my patients wants to try to go without an epidural. The resident told her that she would tear and she would feel them stitching her back up. I felt exactly the same way. "Get out of my room"
I think it depends on the person, and mom needs to feel him/her out - they're not all bad, certainly. I had one resident come and "counsel me" when I was admitted for observation five days before my due date - baby had turned transverse, I was a VBAC attempt, and my BP was elevated. I could sense he was not very confident, and he actually told me that the rate of rupture was *much* higher than it really is. I corrected him, explained myself and my feelings about going through a cesarean if I didn't need to, and he finally agreed that I was making a wise decision to go home, rest and think about my options.
I'm an EM resident on OB right now, and the attitude expressed here is very much the attitude I got from all the OB staff from day one -- who are you, you don't know anything (teach you? why?) get out of the room, you're doing it wrong.
I have a solution. Every OB nurse, and every OB resident and attending, should be required by law to staff every emergency room, everywhere, twenty-four hours a day. Do it yourselves. When it's pregnant, it comes to you. Expect the same level of respect you extend to EM professionals to be extended to you.
Or, here's a wild thought, you could remember that we don't want to be there any more than you want us there. Residency is not a salad bar. We go where they send us.
I'm sure some of your EM folks have been obnoxious. If you take a cursory look at this thread, however, I think you might notice that the hostility seems to be mutual. If you've ever had to spend a long day being scorned for your ignorance by the people who are ostensibly supposed to be allaying it, you might find it makes you a bit testy, too.
No one does as many off service rotations as an ED resident. No one has to know as broad a range of topics and skills, and hence nobody is better acquainted with being unskilled and having to learn. We can do it. We do it over and over. You could help us learn your field and make us welcome in your house. A guest makes better company than a prisoner.
Not to practice thread necrophilia, but I had to follow up with a case dropped on us at signout today: 15yo G1P0 31(0) is transferred for premature labor, is found to be spiking temps to 39.9C, tachy to the 150s(!), evidence of GU infection, severe flank pain. Last BP (I had to look it myself, since the OB/Gyn resident didn't know) 92/33.
Resident didn't know how much fluid she had had. Happens. HAD NOT ORDERED A BOLUS. Just running in at 125/hr. They ordered Tylenol and a cooling blanket, but no blood cultures and NO FOLEY. Hence no urine output. People are satisfied with this. Signout goes on.
After signout, I poke my head in the door, say hi to the patient. Don't examine her, don't question her, just literally put a Mark I eyeball on her to ensure that this patient TACHY TO THE 150s WITH A MAP IN THE 60s is stable. None of the OB/Gyn residents or PAs, naturally, felt that this was important to do.
Nurse immediately bites my head off. Patient is NOT COMFORTABLE WITH MEN. Hopefully we can arrange a woman pathologist to do the autopsy, I do not say. I politely share my concerns that the patient is not stable. Withering "I know." Another friend on OB.
I try the resident. Very relaxed. "Wow, she's tachy, and her pressure is kind of low." Response: "That's not a good patient for you to follow." Oh. Well, I hadn't actually planned on following her, I'm headed home and . . . "But it's not a good patient for you to follow tomorrow either. She has a lot of social issues." Because as an EM resident, patients with social issues are something I am NEVER EXPOSED TO. I am left to suggest, as meekly as possible, that the patient makes me nervous. "Me, too" the senior says, and turns to other things.
For those keeping score at home:
Patient with SIRS, possible urosepsis, tachycardia and marginal pressures (r/o septic shock), with:
*No blood cultures
*No foley
*No fluid boluses ordered
. . . under the care of doctors who had not bothered to check her blood pressure and who likely think "starting a pressor" is a new exercise at Curves.
If you gave us in the ED a bad, complicated OB emergency, we might screw up this badly. But what we would not do is push away help and ignore experience. I can picture what it would look like going the other way:
OB resident is off service in the ED. Walks past a room where a delivery is in progress. "Holy hell! What's that?" "Oh, it's just a breech delivery in a lady with no prenatal care. Blood pressure is patent pending/120, and her platelets are 15k for some reason. Weird. But it's not a good case for you. Social issues."
But we wouldn't ever do that. Because while we have our arrogant jerks, like any field, we use all our resources and work as a team. A team, not a tribe. You should try it.
However - when you, as an ED/ER resident are in your first year, have only your med school OB experience under your belt, and are going into a normal laboring multip's room without the OB resident, and then proceed to advise the patient that she needs a c-section or her baby will die - then you bet your ass, I am going to make sure you stay out of her room.
#1 - he scared the living SHIT out of her
#2 - he had NO RIGHT to say what he said to her
#3 - excuse me, where is the OB resident or the attending OB?
#4 - in this case, guess what? The L&D RN knows a hell of a lot more about OB than the ED/ER resident.
#5 - I then had an already anxious woman to talk to and calm back down. Again.
#6 - She REFUSED to allow him to come back into her room again. Which is HER RIGHT as a normal, pregnant woman. Guess who is going to back her up on that right? Yes, me.
#7 - I spoke to the OB resident about the situation. She concurred that it was up to the patient whether she wanted the ED/ER resident in the room or not.
Also - if you get an OB emergency in the ED - please send her immediately to L&D.
Thankyouverymuch
"However - when you, as an ED/ER resident are in your first year, have only your med school OB experience under your belt, and are going into a normal laboring multip's room without the OB resident, and then proceed to advise the patient that she needs a c-section or her baby will die - then you bet your ass, I am going to make sure you stay out of her room."
The problem is not with any of that, all of which I agree with. The problem is when you move from the specific to the general and say things like "Ugh, our ER residents actually manage triage pts and do deliveries" "somebody needs to slap that boy silly" (I wonder how you would take that sentiment directed at yourself?) And my personal favorite, from a doctor whose job as chief resident is to supervise and train juniors, including off-service residents: "I hated the ER residents when I was chief resident of L&D. Worse than useless."
Those attitudes are part of why people are not having a good experience with ED residents. They are a self-fulfilling prophecy. ED residents know very little about labor or birth (speaking only for myself, I'm quite aware of that.) Teach us, and then we will know more.
I'd like to address your points and share my perspective on these issues:
"#1 - he scared the living SHIT out of her"
Sounds like he did. That's bad on him. However, I have also been treated like an ogre in case where I had a perfectly pleasant encounter with the patient and said nothing remotely objectionable. In my own experience, many of the OB nurses are primed to take offense from the moment I walk in the room. In the ED I have treated addicts, pregnant teenagers, rape victims, the violent and the mentally ill. I have a fairly significant body of experience as regards vulnerable, anxious, and/or angry, fearful, and hostile patients. Give me a chance.
"#3 - excuse me, where is the OB resident or the attending OB?"
We aren't tied to their apron strings. We are physicians working at our job. I wish the OB residents would teach more and explain more, but with attitudes like "ER's Mom" what do you expect?
"#4 - in this case, guess what? The L&D RN knows a hell of a lot more about OB than the ED/ER resident."
Is that supposed to shock me? I was a Basic on BLS transport, ALS transport, Critical Care Transport and then a medic in a major 911 service. I know allied health providers are smart. I don't find that threatening in any way. If you read what I said I above, I wish you would TEACH MORE. That includes OB nurses.
That will also help with the arrogance problem. If you treat a resident like they know nothing and are stupid, they are going to try and push back and prove you wrong, because you've offended their pride. If you treat your visitors like smart people who are learning a new skill, they are going to be more comfortable admitting their ignorance to you.
What I would like is a little respect despite my ignorance. My first week, they were orienting a new nurse, and this is how she was introduced: "This is XXX, she has been a nurse for a while but is new to OB, so she's orienting today." I would love to be introduced -- or even just thought of -- in that way.
[cont]
"#6 - She REFUSED to allow him to come back into her room again. Which is HER RIGHT as a normal, pregnant woman. Guess who is going to back her up on that right? Yes, me."
Again, I have no problem with this in this specific instance. But I would ask you, in situations that are perhaps less clear cut, are you giving your colleague some loyalty as well? What if it's an OB resident that offends the patient, or even the attending. Probably you you make an effort to smooth the waters and reconcile doctor and patient. That is what I do if someone complains about a nurse or another doctor (a common thing). You don't just say "Yes, they're awful, don't worry, they won't bother you again."
Maybe the ultimate outcome is the same and the doctor has lost the trust of that patient. But it makes a difference if you are trying to defuse the conflict, or content to let it blow up.
"I spoke to the OB resident about the situation."
As we see above, OB residents are not respectful of EM residents either. That's part of the problem. Both groups are validating each others' dislike and egging each other on. I feel like a lone bacteria that has wandered into the middle of a lymph node. For all the gossip, invective, backstabbing talk about each on OB, you all seem to be in perfect agreement that EM residents' aren't welcome. Sigh. Two more weeks.
"Also - if you get an OB emergency in the ED - please send her immediately to L&D."
Of course, if you knew anything about emergency medicine or had even given the matter a moment's thought, you would realize that there are many, many more emergency departments than L&D wards, and hence many OB emergencies with no obstetrician at hand. But I don't hold your ignorance of my field against you. Because it's my specialty, not yours.
Regardless of what you or I want, the RRC has decreed that we train with you. Please take my perspective not as criticism of your actions, but as an opportunity to understand our experience a little better, and perhaps cultivate a more positive dynamic in the future, to the benefit of all.
Anonymous: I agree with you on your points. You make very valid points, as stated above! I am not opposed to residents or students, however, this particular resident and how he interacted with this patient had cut quite deep (both for this patient, and for me, as her nurse). I will admit, you have given me pause, and I have worked harder and trying to be more positive towards the ER resident on the unit, and making it more of a learning experience for him.
That's really good to hear. This discussion has reminded me to re-focus on being humble and helpful and trying to check all my ego at the door. I'm sorry you had that bad experience with an EM resident; I hope it was a bad day for them and not their fundamental character.
I hope your health stuff gets better soon. See you in the trenches.
I am glad to hear you are reconsidering your views Atyourcervix. I loved my med school OB rotation. I loved the patients, residents, and attending docs. The OB RN's...not so much. Frankly because when I walked in the door the preconceived biases and obnoxious attitude towards someone they didn't know was too much. I get it that an individual med student you may have had in the past may have been obnoxious...but to turn this into obnoxious attitude against everyone that walks in the door in the short white coat? Does that make any real sense? Hence, I never seriously considered OB and now am an attending in another field. Funny thing is neither did anybody else who rotated though that university L and D seriously consider OB. Who loses in the end?
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