Confrontation

Vignette #4 considers physician impairment and physician to physician relationships: Actors: Confronting physician (Larry), impaired physician (David) Scene: Larry and David are in the surgeon’s locker room. David has a towel over his shoulder. Larry: Hey Dave. Have you got a minute? David: Yeah, sure Larry. What’s up? Larry: Uh, Dave, this isn’t an easy subject for me to bring up, but I know you are using drugs. David: Whoa Larry! Where did that come from? Nothing could be further from the truth. Larry: That case we just finished. I agree it was difficult, but you were jumpy as a cat on coals. David: That was just it. The case was a bear. Six hours into the case… the clotting factors were depleted. Everything just bled and bled and bled. It was very frustrating. Of course, I was jumpy. Larry extends his hand with a capsule in his palm: Dave, this fell out of your pocket in the locker room last week. I took it to our hospital pharmacist. She tells me it's a type of meth-amphetamine. What are you thinking? Dave in defensive posture: Nah! That pill could belong to anyone. Larry: Cut the crap, Dave. I'm your friend, but I have to go to the Medical Director if you don’t come clean. David: OK, I take them once in awhile. It’s not like I’m addicted or anything. You know the divorce and all. I don’t sleep at night. Then I have to be alert here at work. You know the ridiculous hours we put in here. You’ve got to cut me some slack. Keep it quiet, and I’ll clean up my act. Action freezes to signal the end of the vignette. Questions for the small groups: How can you respond to an impaired physician? What are the characteristics of a stressed physician? What prevents us from offering help? How do you recognize the right time to approach another physician? To what extent are we responsible for our fellow physicians? Can you think of a successful intervention? Without disclosing identities, can you say why it worked well. Questions for the large group: What was the most important concept that you discovered during your conversation? Can you name one thing that you will do personally to help your colleagues?

Staff Abuse

Vignette #3 examines staff abuse and physician to staff relationships: Actor: Nurse Scene: The nurse is on the telephone. Nurse: Yes, and could you send over the Amoxicillin for 408. 410’s IV’s were changed to D5 and half normal saline with 30 milliequivalents of potassium chloride. Yeah…same rate. Nurse hangs up. She speaks to herself: Oopsie! The 2 a.m. sugar on 411 wasn’t called to the doc. Let’s see. Who’s her doc. (She consults her notes.) Oh Jeez, not him. Maybe I could call his partner instead. Maybe he won’t come in today until AFTER the shift change, and I can just let this one slide. Maybe the sugar is OK and it won’t matter that it was called two hours late. (She again consults her notes.) That’s not going to fly. The sugar was 63. This is nuts. I’ve got to call him. Nurse dials the phone and pauses as phone rings: Oh, hello, Dr. Whinnery. Sorry to wake you. I meant to call earlier with Mr. McKnight’s 2 a.m. blood sugar, but we've been swamped tonight with several admissions, staffing is low, one nurse went home sick, there were several codes, and one patient went into DT's. Nurse winces and pulls phone suddenly away from her ear then freezes momentarily to mark the end of the vignette. Some questions to stimulate small group discussion for the third vignette are: What’s happening for the nurse? What does she need? What does the physician need? How can they supply each other’s needs? How can a physician determine what the underlying issues are for the nurse? Is the physician responsible to detect those issues? Can you cite a similar situation that was handled well? Some questions for the larger group discussion: On our staff today how do you see physicians serving the needs of nurses and staff? In an ideal medical staff how would physicians serve the support staff? What would it take to reach the ideal?