About a month after the unpleasant incident in the ICU, I was on call for the acute pain service.
At the CofE, all patients who are receiving patient controlled analgesia (PCA) have to have the orders written by anaesthesia and are rounded on daily by the acute pain service. In addition, any problems like inadequate analgesia and side effects are also dealt with by the APS, 24 hours a day, 7 days a week. Further the staff anaesthesiologist on the APS, not the resident fields all the calls.
When the service started in the early 1990s the only way PCA could be sold to the surgeons and nurses was to have this arrangement. It was also felt that the additional after hours calls would be an unacceptable burden on the residents so the staff took the calls. This is probably the only service at the CofE where you make a page and a staff physician calls back. The other reason for this arrangement is financial. In order to make it worthwhile financially it is necessary to bill for consults and visits on otherwise uncomplicated PCA cases.
For practical purposes the PCA orders are written by the anaesthesiologist who does the case and rounded on the the APS doctor. ICU cases are different in that PCA orders are normally not written and the patient is often not started on PCA until days after their surgery when they are stable and ready to be extubated. This means that the APS may be called at awkward times to start somebody on PCA. Most of us, would phone in orders rather than making a special visit to the hospital. It is relatively safe, ICU patients are usually still on a ventilator, have full monitoring and one on one nursing.
So it was that one evening after I had left the hospital I got a call from the ICU about a face-off patient, who they wanted to start on PCA. I phoned, identified myself, asked the nurse some questions about the patient and start to give verbal orders. At that point she asked me "are you giving my orders". I am a bit sarcastic and said, "No I have nothing better to do than phone you.....of course I am giving you orders". I gave the orders, she repeated them back to me. She then asked if I had anything to add and I said no and hung up. We rounded on the patient the next morning and there were no problems.
Why do I even remember this case?
Two weeks later I was forwarded a letter of complaint from the nurse. In it she complained that:
1. I failed to identify myself (how did she know who to complain about).
2. I made her answer questions about the patient on the phone.
3. I gave verbal orders on a patient I didn't know anything about.
4. I was sarcastic (guilty)
5. I almost made her cry.
6. When she asked if I had anything else to add, I simply said no. (guilty).
7. That I still had a grudge against ICU because of the incident I had been involved in weeks earlier. (Not true I am always nasty on the phone)
Now when I read the letter, I couldn't even remember the conversation, but by checking the time and date against my day timer, and because the phone call happened while I was waiting for medical appointment I was able to put together the conversation.
I wrote a letter to my chief stating that I felt that what I had done was both common and good medical practice; that I had not intended to threaten or belittle her and that under the circumstances I did not see any need to apologize.
A couple of days I got a phone call from my very "supportive" chief. This gist of the conversation was, "I see your point BH but this is a sexual harassment complaint and you know you can't win those so you better apologize".
Now the ludicrous thing about this was that the nurse also had to apologize to me for saying that I had acted as I had because of an old grudge against the ICU. So even after writing my letter of apology, the apology score was still BH 2 ICU 1.
Now this was the last year I was at the CofE and I had started to look at other hospitals by that time. Curiously I remember that around that time, I had decided that despite everything I figured I would just stay at the CofE. After this event, I told my chief that this was the last straw and I would be leaving. It was less the complaint, than the complete reluctance of him to support me that really pissed me off.
A month later I got an offer from another hospital and I no longer work at the CofE.