Malcolm Needs ☆ Posted February 3, 2011 Share Posted February 3, 2011 Seems like there is a need for them also to be taught basic good manners and the fact that they would get better service, and more help, if they treated other people like human beings and recognised their specialist knowledge.It's great living on this other planet!!!!!!!!!!!!!!!!!! Link to comment Share on other sites More sharing options...
Deny Morlino Posted February 3, 2011 Share Posted February 3, 2011 Personally I prefer dealing with the physicians who failed the "God 101 class" . This group is at least more apt to listen and then decide ranther than to assume they know everything. I think I am beginning to see a trend of the younger docs listening more to the "specialist" front line workers. Some are actually rather down-to-earth. Hang in there and keep chipping away at the block of arrogance a little at a time. I try really hard to kill them with kindness and refuse to lower myself to the bad attitudes experienced from some quarters. Malcolm Needs 1 Link to comment Share on other sites More sharing options...
BankerGirl Posted February 3, 2011 Share Posted February 3, 2011 Wow, this Thread is still alive! I have not been able to login for some reason but finally made it. Just had to share "yet again" what has been 1 of the common themes on this Thread.One of my Techs. just received a call from a surgeon asking for blood for his patient (as is all too frequent, we received the specimen and orders at the last minute; then they scream because the blood is not ready). The Antibody Screen was positive. The Tech. tried to explain that, and that this would result in a delay in blood. His response? Then send me the universal donor! When she tried to explain to him why that would not help, he was incredibly rude and told her she did not know what she was talking about! She told him to call our Medical Director. A few minutes later, the Medical Director walked in. This surgeon had been extremely rude to him also. I have taught enough residents and fellows in my career to know how little of Lab training they get in Medical School; and then the limited bench level training they get in the Transfusion Service. But it just seems like this very basic principle should be explained better in Medical School. I mean how can they really sign a form saying they need uncrossmatched blood and they "accept responsibility," when they do not even understand the ramifications of what they are asking for?!AaaahhhhThanks, I feel better now. Brenda Hutson, CLS(ASCP)SBBWow! I have been treated rudely by physicians frequently over my 20+ year career, but they are usually smart enough to be, at the least, civil to their peers! As for the knowledge factor, I completely agree. We have an ED physician who decided he needed to give one unit of plasma to a patient with a cranial bleed while she was being transfered to another facility. They were transfering her in 10 minutes, and when I told the nurse that it would be 25 minutes until we could have that ready, she wanted it sent up "as is" so they could thaw it en route. Can you imagine how long it would take to thaw a unit of plasma in an ambulance? Link to comment Share on other sites More sharing options...
tbostock Posted February 3, 2011 Share Posted February 3, 2011 I usually forward the "screamers" to my Medical Director. He then comes back and tells me how pleasant the doc was with him...go figure. Link to comment Share on other sites More sharing options...
PammyDQ Posted February 3, 2011 Share Posted February 3, 2011 It's a universal problem with the occasional uneducated and/or rude physician. If you were rude to him, there surely would be an incident report filed against you. Physicians are NOT exempt from formal complaints being filed against them...and I know from experience when it is done it sure does tame them! If he was willing to sign for emergency release blood I would include in big bold letters UNIT IS LIKELY INCOMPATIBLE with patient...I've seen plenty of docs suddenly realize their situation is not as urgent as they initially thought when they have to sign for responsibility, even after they were screaming they needed it immediately. Link to comment Share on other sites More sharing options...
L106 Posted February 3, 2011 Share Posted February 3, 2011 Wow, this Thread is still alive! I have not been able to login for some reason but finally made it. Just had to share "yet again" what has been 1 of the common themes on this Thread.One of my Techs. just received a call from a surgeon asking for blood for his patient (as is all too frequent, we received the specimen and orders at the last minute; then they scream because the blood is not ready). The Antibody Screen was positive. The Tech. tried to explain that, and that this would result in a delay in blood. His response? Then send me the universal donor! When she tried to explain to him why that would not help, he was incredibly rude and told her she did not know what she was talking about! She told him to call our Medical Director. A few minutes later, the Medical Director walked in. This surgeon had been extremely rude to him also. I have taught enough residents and fellows in my career to know how little of Lab training they get in Medical School; and then the limited bench level training they get in the Transfusion Service. But it just seems like this very basic principle should be explained better in Medical School. I mean how can they really sign a form saying they need uncrossmatched blood and they "accept responsibility," when they do not even understand the ramifications of what they are asking for?!AaaahhhhThanks, I feel better now. Brenda Hutson, CLS(ASCP)SBBThis very same situation happened to me two weeks ago involving a surgeon demanding blood to be issued immediately to a patient with an antibody (although he was not rude to me, but he just didn't "get it".) Our Medical Director got the surgeon on the phone to make sure he understood the risk of transfusing incompatible blood, but the surgeon just kept asking if the blood was "group & type specific" (ie: obviously he still didn't grasp the concept of "incompatible".)P.S. Fortunately, the patient seem to tolerate the transfusions without any obvious problem. Sure made me nervous, though! Link to comment Share on other sites More sharing options...
Brenda K Hutson Posted February 3, 2011 Author Share Posted February 3, 2011 It seems that every Hospital has at least one such Physician; the arrogant, angry MD who thinks that when they say jump, you ask how high! Sorry, I don't work like that; I will educate them whether they like it or not. I am planning to type up a letter, educating this Physician on the difference between "universal donor; i.e. O NEG" and red cell antibodies. Then I am going to find an avenue to pass on that education to all of the Physicians in my Hospital in that I know from experience that too many of them just do not understand this basic concept; and it is dangerous for the patient! Brenda Hutson:rolleyes:Seems like there is a need for them also to be taught basic good manners and the fact that they would get better service, and more help, if they treated other people like human beings and recognised their specialist knowledge.It's great living on this other planet!!!!!!!!!!!!!!!!!! Link to comment Share on other sites More sharing options...
Deny Morlino Posted February 3, 2011 Share Posted February 3, 2011 Carry that torch Brenda. It is a tough job, but your patient population will be safer with the physicians educated. Hang in there. Link to comment Share on other sites More sharing options...
John C. Staley Posted February 3, 2011 Share Posted February 3, 2011 Over the years I have discovered that neither common courtesy nor common sense are all that common. Especially when dealing with physicians. Nurses can be almost as bad. It's the old "a little knowledge and be dangerous" thing.There is on saving grace, if you get the ABO right MOST patients with survive the transfusion event and incompatible blood can be better than no blood. I have also noticed that most physician will re-evaluate the urgency when they have to sign taking responsibility. Amazing how that works but there final words are usually; We can wait but hurry as fast as you can." Link to comment Share on other sites More sharing options...
Barb Thompson Posted February 4, 2011 Share Posted February 4, 2011 I had a doctor order 1 unit of cryo on a patient (adult). The night tech thawed it and it was transfused. The doc didn't understand why the fibrinogen didn't go up, so he ordered another unit. This time, it was day shift, and he had to deal with me. He insisted that the patient had received 2 units of cryo 2 weeks ago, and did just fine. I tried to explain that those previous units were pools. He just didn't get it. Kept insisting that 2 were enough, and he didn't need any more. I went to the pathologist, who then talked to the doctor, but he still insisted on 2 units. I finally said the magic words....that the patient had received 20 units, not 2. I think the light bulb turned on. Link to comment Share on other sites More sharing options...
jcdayaz Posted February 4, 2011 Share Posted February 4, 2011 Personally I prefer dealing with the physicians who failed the "God 101 class" . This group is at least more apt to listen and then decide ranther than to assume they know everything. I think I am beginning to see a trend of the younger docs listening more to the "specialist" front line workers. Some are actually rather down-to-earth. Hang in there and keep chipping away at the block of arrogance a little at a time. I try really hard to kill them with kindness and refuse to lower myself to the bad attitudes experienced from some quarters.I LOVE the "God 101 class" statement you made!!! Kudos to you Deny!!!!!The very unfortunate fact is that it is all too common. Link to comment Share on other sites More sharing options...
Deny Morlino Posted February 4, 2011 Share Posted February 4, 2011 I had a doctor order 1 unit of cryo on a patient (adult). The night tech thawed it and it was transfused. The doc didn't understand why the fibrinogen didn't go up, so he ordered another unit. This time, it was day shift, and he had to deal with me. He insisted that the patient had received 2 units of cryo 2 weeks ago, and did just fine. I tried to explain that those previous units were pools. He just didn't get it. Kept insisting that 2 were enough, and he didn't need any more. I went to the pathologist, who then talked to the doctor, but he still insisted on 2 units. I finally said the magic words....that the patient had received 20 units, not 2. I think the light bulb turned on.I think sometimes we are our own worst enemies within the industry. Platelets are a common point of confusion as well. When the physician orders an "eight pack" of platelets we convert to a pheresis unit. The physician's tend to be set in their ways as they have huge volumes of info to retain. Sometimes the best you can do is as you said Barb, change it into their terms of understanding and see if the light bulb comes on. I do not envy physicians. Link to comment Share on other sites More sharing options...
Eoin Posted February 4, 2011 Share Posted February 4, 2011 Ah yes - The God syndrome is decreasing now though - not nearly as prevalent as years ago. We have a dignity clause in our quality statement for the hosp, and they are not immune from that. They have been reported, but it doesn't help with cooperation into the future I have found.For you oldies I remember when we changed from whole blood (in bottles) to packed cells and a trauma specialist wanted 20 units of whole blood. I told him we could only supply packed cells and he screamed at me that the patient was bleeding whole blood not f))& packed cells. I got the chief of anaesthesia to tell him the benefits of controlling bleeding with products - never heard from him again. Never apologised either.CheersEoin Link to comment Share on other sites More sharing options...
BankerGirl Posted February 4, 2011 Share Posted February 4, 2011 We have had two patients that received one unit of Cryo on night shift recently. Neither one of them had fibrinogen levels done post-transfusion, and only one had a level done prior (it was 457). I am sure that the cryo did no good for these patients, but since there were never any fibrinogen levels done after, I will never convince the physicians of this. One patient miraculously survived, but the other one, unfortunately, did not, although he hung on for another 2 weeks, draining our FFP and RC inventory in the process. Link to comment Share on other sites More sharing options...
jcdayaz Posted February 5, 2011 Share Posted February 5, 2011 Wow, this Thread is still alive! I have not been able to login for some reason but finally made it.I have taught enough residents and fellows in my career to know how little of Lab training they get in Medical School; and then the limited bench level training they get in the Transfusion Service. But it just seems like this very basic principle should be explained better in Medical School. Brenda Hutson, CLS(ASCP)SBBYOU HIT THE NAIL ON THE HEAD WITH THIS STATEMENT!! It seems, unfortunately like a large percentage of physicians graduated from Deny's "God 101 class"(see her previous post). Unfortunately often times they don't know and/or recognize that they don't KNOW the appropriate treatment for their patient--even after we tell them(well, strongly suggest) the treatment that needs to be used.Funny thing....When my Blood Banker friends come to my house we always eventually end up discussing blood bank issues. Even my own husband doesn't get it!!!! Not surprising I know, but he will debate and argue and etc until we just shake our heads and know that there is no hope. Oh my, the patience it takes to be a blood banker and married to a physician is UNBELIEVABLECALGON, TAKE ME AWAY!!!!! Link to comment Share on other sites More sharing options...
Deny Morlino Posted February 7, 2011 Share Posted February 7, 2011 Funny thing....When my Blood Banker friends come to my house we always eventually end up discussing blood bank issues. Even my own husband doesn't get it!!!! Not surprising I know, but he will debate and argue and etc until we just shake our heads and know that there is no hope. Oh my, the patience it takes to be a blood banker and married to a physician is UNBELIEVABLECALGON, TAKE ME AWAY!!!!!Kudos for your patience!! Link to comment Share on other sites More sharing options...
Brenda K Hutson Posted February 7, 2011 Author Share Posted February 7, 2011 Boy isn't that the truth! Their patient is dying...until they have to sign the form to receive uncrossmatched blood! But then it just changes to; "if my patient dies, it will be all your fault!" Brenda Hutson C. Staley;34815]Over the years I have discovered that neither common courtesy nor common sense are all that common. Especially when dealing with physicians. Nurses can be almost as bad. It's the old "a little knowledge and be dangerous" thing.There is on saving grace, if you get the ABO right MOST patients with survive the transfusion event and incompatible blood can be better than no blood. I have also noticed that most physician will re-evaluate the urgency when they have to sign taking responsibility. Amazing how that works but there final words are usually; We can wait but hurry as fast as you can." :crazy: Link to comment Share on other sites More sharing options...
Brenda K Hutson Posted February 7, 2011 Author Share Posted February 7, 2011 I have certainly been fortunate over the years to have those Physicians who "admit" this is not their area of expertise; and they are grateful for any assistance you can give them. Brenda HutsonPersonally I prefer dealing with the physicians who failed the "God 101 class" . This group is at least more apt to listen and then decide ranther than to assume they know everything. I think I am beginning to see a trend of the younger docs listening more to the "specialist" front line workers. Some are actually rather down-to-earth. Hang in there and keep chipping away at the block of arrogance a little at a time. I try really hard to kill them with kindness and refuse to lower myself to the bad attitudes experienced from some quarters. Link to comment Share on other sites More sharing options...
Brenda K Hutson Posted February 7, 2011 Author Share Posted February 7, 2011 I received a phone call at home one evening from one of the PM Techs. The Critical Care Unit had ordered 10 units of platelets; but we only store platelet apheresis. Two Techs. tried in vain to get the Nurse to understand why there was no way in ......that we were going to give them 10 apheresis! She still would not back down; she said the doctor ordered it, and that is what I want. So, they called me. I called the Nurse and explained it "again;" adding that we would not be a participant in having her patient end up with a problem at the other end of the spectrum from receiving too many platelets, and that she was welcome to have the Physician call me. They finally took 2 platelet apheresis.Brenda Hutson I think sometimes we are our own worst enemies within the industry. Platelets are a common point of confusion as well. When the physician orders an "eight pack" of platelets we convert to a pheresis unit. The physician's tend to be set in their ways as they have huge volumes of info to retain. Sometimes the best you can do is as you said Barb, change it into their terms of understanding and see if the light bulb comes on. I do not envy physicians. Link to comment Share on other sites More sharing options...
Deny Morlino Posted February 7, 2011 Share Posted February 7, 2011 I received a phone call at home one evening from one of the PM Techs. The Critical Care Unit had ordered 10 units of platelets; but we only store platelet apheresis. Two Techs. tried in vain to get the Nurse to understand why there was no way in ......that we were going to give them 10 apheresis! She still would not back down; she said the doctor ordered it, and that is what I want. Have you seen a trend of nurses seeming more confident in questioning orders they find "illogical" for lack of a better term? I am finding less and less of the stand you mentioned. I think the physicians are beginning to work better with a team mentality. Either that or I am mellowing an aweful lot Link to comment Share on other sites More sharing options...
TeachBB Posted February 8, 2011 Share Posted February 8, 2011 should we run this leukocyte pheresis through a leukocyte filter?You know what would be a really fun Thread on here sometime: The funniest and/or scariest remarks we have heard from Hospital staff. We could call it "Just For Fun." Here is mine, just for fun (and it is not Blood Bank oriented; I will think more on that):A Physician calling at one Hospital (called the wrong dept.) asking: Is it ok if I draw the Peak and Trough at the same time (drug levels). The Tech. responded: I am going to hang up now and I want you to think about that for a minute.Brenda Hutson, CLS(ASCP)SBB :D:D Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted February 8, 2011 Share Posted February 8, 2011 should we run this leukocyte pheresis through a leukocyte filter?Wonderful!Once had someone ask if a bag of bone marrow for a transplant should be irradiated!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Link to comment Share on other sites More sharing options...
L106 Posted February 8, 2011 Share Posted February 8, 2011 Yeah, they've really got a clear concept of things, don't they, Malcolm?Donna Link to comment Share on other sites More sharing options...
tbostock Posted February 8, 2011 Share Posted February 8, 2011 Had to try to convince an OB/Gyn doc that there is such a thing as a Weak D. She had never heard of it, so clearly I must be making it up. Tried to explain to her that it was her choice whether to administer RhIg (due to the potential of partial D having the ability to still make anti-D). That confused her even more and made her more angry. 15 minutes later she requested the RhIg...she must have Googled it or something. LOL Link to comment Share on other sites More sharing options...
John C. Staley Posted February 8, 2011 Share Posted February 8, 2011 I can't remember if this has been brought up, but back in the early '80s when we received our first IBM 2991 cell washer the docs decided that this was the universal solution to all problems related to finding blood for their patients.Me: Your patient has an antibody we are having problems identifying.Doc: Well wash the blood then!Me: We need to give your Rh neg patient Rh pos cells.Doc: Well wash the blood then!I'm sure you see the pattern. Link to comment Share on other sites More sharing options...
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