Workplace Violence. including threats, harassment – ANA
AZ BON Powers and Duties: Format Document.
“As long as there are financial kickbacks to physicians for ordering certain medications, procedures or exams, we have every right to question their motivations. Perhaps nurses are more universally trusted because they are not financially incentivized by their opinions or judgement. No matter the treatment, they are paid the same. No so for docs.”
“What the doctor failed to understand is that the management of complex patients like this is a team endeavor. The doctor is certainly an important part of the team, but not the only member of the team. Ultimately, it isn’t the doctor’s decision, but the patient’s decision, which can only be made with adequate information. I have found that often, the oncologist will advocate chemotherapy without offering the possibility of withholding treatment and pursuing a palliative plan of care. (It was this type of discussion, that several Republicans labelled with the unfortunate designation, “death panels.”) IN the end, what is required is PATIENT-centered care and not DOCTOR-centered care. “
— Ben Gold, MD
“To quote from Ms. Brown’s essay, “The point is, it needs to be a conversation.” Exactly.
As a physician, I’m the one who writes the treatment orders so I have the ultimate responsibility. I need to be careful not to confuse that ultimate with another, omniscience. The patient and everyone around that person, including relatives and other practitioners, have their own notions about what’s happening, and they all deserve consideration.
That requires constant conversation, a process often lacking in our rush-rush healthcare system. In my early years of practice, I tended toward the default, making important decisions without input from anyone else. The name for that is arrogance. I only began to recover when a nurse took me aside and said, “If you don’t change where you’re headed, you’re going to get where you’re going.”
Jeff Kane MD
“In 2008, The Robert Wood Johnson Foundation (RWJF) and the IOM launched a two-year initiative to respond to the need to assess and transform the nursing profession. The IOM appointed the Committee on the RWJF Initiative on the Future of Nursing, at the IOM, with the purpose of producing a report that would make recommendations for an action-oriented blueprint for the future of nursing. Through its deliberations, the committee developed four key messages:
Nurses should practice to the full extent of their education and training.
Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.
Effective workforce planning and policy making require better data collection and information infrastructure.”
When the Nurse Disagrees with the Doctor – NYT article by an RN:
“When you get down to it,” he told me, “Patients come to me for care, Theresa, not you.”
- Obama administration acknowledges that money influence clinical choices towards the more lucrative treatments.
How a Dangerous Doctor Can Keep Harming Patients
Last year we covered the outrageous spectacle in west Texas when two nurses who were appalled at a doctor’s quackish and dangerous treatments of patients got into criminal trouble when they tried to report him to the state licensing board. Eventually the nurses were vindicated, but not before they lost their jobs. Now the doctor and the criminal authorities who did his bidding in Winkler County have had their comeuppance.
But still one question remains. How could this doctor, Rolando G. Arafiles Jr., have moved from town to town in Texas, inflicting harm on patients and ultimately moving on, and the authorities have taken so long to bring him to earth?
The answer exposes the perennial conflict-of-interest flaw in any professional self-disciplinary system, where the authorities bend over backwards to find some reason to let one of their fellow doctors keep practicing.
It’s really not too different from the child sexual abuse scandal at Penn State, where a powerful authority figure, an assistant football coach, could continually inflict grievous harm on small children and his fellow football coaches like Joe Paterno looked the other way out of self-interest.
The Texas story is summed up in this Texas Observer story, which has this telling paragraph:
The more we dug into Arafiles’ past, the more a troubling circular pattern emerged. In his wanderings across Texas—from Victoria to Crane to his wilderness years as a contract doctor to, finally, Kermit—Arafiles did the same things over and over, with the same results. He moved into town. He charmed the townsfolk. He began practicing medicine that can be charitably described as questionable; less charitably as dangerous. He peddled fringe treatments of dubious medical value. He tried to turn town authority figures against anyone who challenged him. He turned litigious when challenged. Eventually, he was stopped, but not punished. He left town, he moved on to somewhere else, and he did it all over again. And perhaps he would still be doing it today had two brave nurses in Kermit not put a stop to it.