Blog | Thursday, March 12, 2015

Is your doctor 'aware'?


Every doctor understands what the phrase “doctor aware” means. This is the phrase that hospital nurses record in their nurses' notes when they have notified the doctor, usually by phone, on a patient's issue. Once the “doctor is aware,” the nurse is in the clear and has transferred responsibility for the issue to the physician.

Here are some samples of doctor awareness.
Phone Call Notification: Nursing Record
Doctor, Mrs. Leadbelly just vomited. Doctor aware!
Doctor, Mr. Wobbly is dizzy. Doctor aware!
Doctor, the ultrasound showed a gallstone. Doctor aware!
Doctor, Mrs. Hothead has a fever. Doctor aware!

Physicians often roll our eyes over these conversations. Some of these notifications are communicated in the middle of the night about patients we do not know. Although we can't usually address the abnormal finding directly at that time, nor do we often need to, once we have been made “aware,” the responsibility of the entire case is now ours. For example, if we are awakened by a nurse asking if she can give antacids to quell a patient's heartburn, we are likely to agree with this seemingly reasonable recommendation. The chart will record that we are “aware.” If that “heartburn” turns out to be a harbinger of a more serious condition, then the physician will be liable for his action.

Before you pounce on this doctor accusing him of haste and sloppiness, keep in mind that we handle hundreds of these calls every year. If we were to run to the hospital on every one of these calls to see the patients personally, we'd have to live in the hospital like a medical intern.

A standing joke between physicians and nurses is after a nurse reports an abnormality to the doctor, the physician wryly responds, “I am not aware!”

One particular vexing example of this is when a nurse calls me at 8 p.m. as the attending physician wants me to approve that the patient can be discharged home. Often, one of my partners has seen this hospitalized patient during daylight hours. As I have no knowledge of the particular patient, I am reluctant to sign off on the after-hours hospital discharge, which would force me to accept enormous responsibility on the appropriateness of sending the patient home. In the most recent example of this, I told the nurse that I cannot clear the patient as I was not involved in the case. The attending physician must make his own independent decision if his patient can be sent home. Of course, the attending doctor who is asking me to approve hospital discharge is engaging in the same “Dr. Aware” procedure at the physician level. Familiar with the concept of CYA?

We do the same thing with our patients. When patients reject our medical advice, guess what phrase we enter into the record.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.