The lethal problem with our title

[PAMEDIC]

I had an after-hours call the other night from a nursing care facility about one of our patients. We are their PCP and I had the phone for the evening. I was told that this patient had significantly altered mental status and was very jaundiced in the face and eyes.

I told them to either call an ambulance or take this patient to the ER. They needed to be seen right away.

 

The next morning, I get a call from the same facility saying that they walked in the patient's room and found him non-responsive and just started CPR. They had an ambulance on the way.

They never took him to the ER.

 

Why did they not send the patient to the ER last night like I instructed? They said that they had only talked to the "assistant" and were waiting on a call back from the doctor.

[sas5814]

I hope they have good legal counsel and insurance.

 

The problem wasn't with the title but with the nursing home and their lack of education on ...well healthcare.

 

I have always been ambivilent about the title change issue. Our title has never hindered me in any  way I could measure. However with the recen't hoopla here in Texas about adding anesthesia assistants to our practice act I am reconsidering. Basically what physicians are strong arming my professional association to do (and they are) is to formalize the idea that anyone who "assists" a physician is a PA. I am reconsidering my position on the name change issue.

[LKPAC]

Isn't disobeying an order from a PA a criminal offense in most states? 

[mandrew1]

I agree, this is an interesting anecdote, but not a PA problem. It's an education problem. Where do you live? This profession has been around for 50 years, how is it that health care providers don't know what a PA is by now. We're everywhere. Not convinced at all this is a "title" issue...I think it hysteria. Don't see any of this in Connecticut where PAs have thrived for years. 

 

This is an example of an isolated anecdote, not  a systemic problem because of our title.

 

[PAMEDIC]

Of course this is an isolated anecdote.

 

I think the problem is that when my patient was altered, the available RN and LPN were probably attending to the patient and had a  desk clerk or night receptionist call me. I suspect they were just ignorant of what a PA is.

[camoman1234]

Of course this is an isolated anecdote.

 

I think the problem is that when my patient was altered, the available RN and LPN were probably attending to the patient and had a  desk clerk or night receptionist call me. I suspect they were just ignorant of what a PA is.

That still does not matter. The front desk should of said to the RN, "I spoke with PAMEDIC, Dr. X's "Assistant", what should we do?" "PAMEDIC said to call 911." That is a piss poor argument and one that will not hold up in court. It is NOT the front desk ladies duty to make the determination on calling 911 when a medical provider told her too. It was the nursing staff at fault, unless the front desk never told the nurses and made that decision herself (then she will be screwed). 

[BruceBanner]

That's totally on them. They ignored medical advice. Even if not legally "autonomous", you are a licensed extension of your SP and your word is as good as his/hers.

[south]

Holy crow.  I smell CYA after the fact.  

 

You got to give it up for someone thinking of that sort of angle, though.  Wrong?  Definitely.  Evil?  Maybe.  But shrewd for sure.

 

Hey, when you're on telephone call is there a way to verify what was said?  Do you run to the patient's chart and document it?  Just curious.

[PAMEDIC]

Hey, when you're on telephone call is there a way to verify what was said?  Do you run to the patient's chart and document it?  Just curious.

 

The call wasn't recorded, but I documented everything in the chart at the time.

[Guest Paula]

I don't have that problem with my title.  I'm a PA.  The nursing homes in my area send me notes and orders to sign when on call.  

 

They address me as: Paula X , NP.

 

Now if I only had an NP license..............

 

I gave up correcting them. 

[Katera]

Our name sucks.  It always has, and it always will.  I am hopeful that this new generation of PA's will get off their butts and change it.  My generation sat on their hands paralyzed by fear while watching NP's blaze right past us.  For over 20 years I have supported "MP", Medical Practitioners.  Because that is exactly what we are.

[ventana]

interesting to pursue this legally

 

how about the PA filing legal claim against the nursing facility for not following the order - looking for formal apology and training for all staff members on the role and legal responsibility to follow the PA order?

[rpackelly]

If you feel strongly bring it up with their director of nursing, and if you don't get satisfaction there you could complain to the nursing board of your state that they did not follow a legitimate order and put a patient at risk. But you also need to know when to let it go too.

[sas5814]

Fix the problem at the lowest level. Any DON or administrator worth their salt should be concerned about this and take corrective action.

[loliz]

This is not about title. This is about a nurse and a facility completing neglecting their patient by not listening to a provider recommendations and by not seeking the appropriate level of care with a change in status. 

[SedRate]

This is not about title. This is about a nurse and a facility completing neglecting their patient by not listening to a provider recommendations and by not seeking the appropriate level of care with a change in status.

Agreed.