It endangers patients when nurses don't tell doctors about abnormal findings

 

It's up to doctors to diagnose and treat patients, but they can't do their job when nurses hold back important clinical information

 
September 27, 2018

I spent several hours today at a hospital conference room in the northwest Houston/Willowbrook area for the depositions of two registered nurses.

As with almost every nursing deposition, one of the major topics of questioning was what the nurses knew about the patient’s condition and what they should have communicated to the attending physician. In this particular case, the focus was on what the nurses should have told the orthopedic surgeon about new abnormal findings in a patient who was still hospitalized after a lumbar back surgery.

The medical records show that one of the registered nurses was aware of new lower extremity numbness, two new episodes of urinary retention (being unable to void urine on your own), and new lower extremity motor weakness on both sides.

According to the medical records and deposition testimony, the nurse waited over seven hours after she knew that the patient had new urinary retention before calling the surgeon.  During that same call, the nurse told the surgeon about the patient’s complaint of new numbness below the waist but chose not to mention her findings of lower extremity motor weakness.

When I asked her why she didn’t tell the doctor about all the abnormal findings she was aware of, she said that it’s her practice to only share things that she finds “significant.” When I pressed her, she elaborated that “significant,” to her, means findings that she’s not used to seeing in post-operative patients.

It’s hard to understand how assessing motor strength is significant enough to be included in the mandatory nursing neurological checks, but not significant enough for a nurse to tell the doctor about. With this type of logic, a good chunk of her assessments would be little more than busy-work—why even bother to do them?

I think the hospital—the nurses’ employer—is trying to have its case and eat it to.

On the one hand, they’ll argue until they’re blue in the face that nurses cannot make a medical diagnosis, a task that is a physician responsibility. It’s up to the nursing staff to make assessments and notify a physician of abnormalities. If you believe what hospitals say, that’s the end of nursing responsibilities.

On the other hand, the hospital also argues that its nurses get to decide what new clinical abnormalities to report to the doctor, and what findings to hold back.

The absurdity of these inconsistent positions will slap you in the face. At one point in the deposition, the nurse conceded that the doctor couldn’t use and consider abnormal clinical information that she didn’t report to him. In this case, it ended up being another neurological abnormality, bilateral lower extremity motor weakness, on top of two others, urinary retention and numbness.

Two words come to mind when I think of how you can protect your or a loved on during a hospitalization: Be talkative. Don’t rely on your nurse to tell your physician or surgeon and other healthcare providers about new developments in your signs and symptoms. Be talkative and tell them yourself!

Take notes in a journal to make sure you remember everything and when a new doctor or nurse comes in the room, update them with everything that has been going on, particularly new or increased pain, impairments, and symptoms.

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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against Houston Methodist Willowbrook and other hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.

Robert Painter

Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.

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