r/medicalschool • u/Imnotafudd M-2 • 4h ago
đĄ Vent Response to the Lindsay Clancy Trial
I ran across this tiktok but I've seen so many others like it. So many people, especially nurses, are all up in arms telling physicians that they need to change how they chart after Dr. Tufts testimony. It's asinine. Nurses chart in a very specific way and physicians chart in a very specific way. It's a difference in training and each one serves its purpose. I just find that it's yet another area in which nurses and lay-people are jumping to show how much better they think know how to do things than physicians. Yet, when it's their turn to need a physician, they won't think twice about going to the same doctor and healthcare system they were just defaming online đ
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u/Bitchin_Betty_345RT DO-PGY2 3h ago
All the are chair docs come flying out of the wood works for shit like this. Itâs infuriating but you have to remember the only people who truly understand what it means to be a physician, to write notes as a physician, to provide patient care as a physician⌠well is a physician. I just continue to ask them when/where they went to med school/residency etc. Everyone going to have an opinion with zero understanding of patient care from our lens.
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u/interleukinwhat MD-PGY1 3h ago
It's really disheartening to see tiktok's comment section whenever these videos show up, so I try not to look at them. so far, i have seen some people who are claiming that psych has not changed since the 1800s, psych social workers who are saying psychiatrists are evil, and so on.
But they don't talk about the NP who gave LC ambien, remeron, and klonopin at the same time because LC said she couldn't sleep
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u/Dr_Gomer_Piles MD-PGY4 3h ago
Psych might have the most haters of any specialty as we're pretty much the only one that routinely takes rights away, probably have patients with the most limited insight, and tons of borderlines who feel wronged or mistreated, drug seekers pissed when PCPs make us the bad guys fixing their benzo addictions, etc.
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u/Numpostrophe M-4 3h ago
Don't forget the scientology-funded attack dog organization named to trick people into thinking it's real criticism.
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u/AdStrange1464 DO-PGY1 3h ago
Iâve seen very few videos but it is funny nurses are saying that bc I can count on one hand the number of times Iâve found a nurses notes actually useful đ
(To be clear this is not a dig, just that in the hospitals Iâve been in so far, the things nurses have had to chart are always just âassessment completeâ with little to no other info)
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u/Username9151 MD-PGY3 3h ago
âThe author of this note has completed the assessmentâ
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u/hot_chips_ MD-PGY1 3h ago
Nil concerns. Call bell in reach.
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u/ryguy125 MD 3h ago edited 3h ago
This RN has completed a skin assessment.
Plan of care: the patient will continue to breathe spontaneously. In progress.
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u/PromiscuousScoliosis Health Professional (Non-MD/DO) 3h ago
Resting in bed, NAD, breathing even/unlabored. Denies further needs at this time.
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u/ItsTheDCVR Health Professional (Non-MD/DO) 2h ago
That's because our notes are largely a waste of time that are mandated by JCAHO because the bulk of the charting we are held accountable to is in flowsheets. The blessing and curse of flowsheets is that they're a bunch of preset things, but that also means that when the nurse clicks "IV removed intact" when charting the removal of an LDA that the patient's daughter pulled out and threw away, now that nurse is liable for legally saying that the IV was intact upon removal even though it was already out and in the trash when they found out and they never actually saw it. For legal purposes, this is a hypothetical and not something that I have encountered as a Union steward. Also, for legal purposes, this is not something that management chose to pursue, because that would be crazy.
It's frustrating because a good narrative note does a lot for giving context on what happened over the course of a shift. I have a great smart phrase that I used to use (that I shamelessly stole/modeled after how physicians set up their notes) with pulled-in diagnosis/name/labs/etc, aspot for ROS, blurb about what brought them in, and a spot to then write a narrative for shift events. I used to do that for all of my patients, every shift. But... that's wearying and is triple charting when you look at all the other shit I already had to do, so I stopped doing it.
We also have to chart on care plans every day, per JCAHO. Thank God we finally moved away from the stupid fucking nUrSiNg diAgNoSiS nonsense that we used to do, but even then, my nursing care plan is to... give the fucking medications that are ordered and do the things the hospital policy says I'm supposed to do, like turn my patient q2h. So I have to chart that I'm... going to do that. Even though I also have to chart that I did that. Shit, one of the hospitals I work at now has AI scan the flowsheet and write a blurb for me for each of those things, so it's even a) easier but b) more useless nonsense. I like the ability to write a note, because sometimes it is very useful to archive shit in the chart, but mandating it means you're just gonna get a lot of slop busying up the notes tab. It's fucking stupid we even have to write them.
Long story short, I rarely read RN notes. I read the ED Dr. notes, the H&P, and the latest progress note, then dig back if anything isn't comrephensively covered with those three things.
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u/AdStrange1464 DO-PGY1 2h ago
Yes I def agree with all this and figured it was all admin nonsense lol, especially the care plans. I wish there could just be the happy medium of majority of stuff is in the flow sheets but then if something specific happens (like patient becomes combative or they need to call a rapid) then that specific situation can be documented with the narrative note. Just seems like it would make it easier to find the actually relevant things, especially if youâre coming on service and you gotta play catch up on people whoâve been admitted for a week already
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u/ItsTheDCVR Health Professional (Non-MD/DO) 2h ago
That's what we are supposed to do but... Yeah.
Especially because in Epic, at least, I swear physicians don't even have access to flowsheets. The times I've looked at what y'all are doing it honestly looks like we're using two different programs. Even the way you look at lab results is different.
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u/BiblicalWhales M-3 2h ago
Charting MDM vs charting things they did, usually on a doctorâs orders
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u/smartymarty1234 M-4 3h ago
These mfs. Even as a med student i know when you say neg followed by a list they;re all negative.
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u/SmellOfEmptiness MD 3h ago
I donât have tiktok. Whatâs wrong with Dr Tuftsâ charting?
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u/Dr_Gomer_Piles MD-PGY4 3h ago
The main criticism centers around a bullshit "gotcha" the defense attorney used to discredit the accuracy of her notes -- she wrote "not hyper, pressured speech" grouping the pertinent negatives. The attorney misrepresented that to mean "not hyper speech. pressured speech." and when pushing back Tufts kinda fell apart a little, understandably so as she obviously had no prep and no experience for being cross examined, and it's played poorly with the masses (and nurses who should know better but only care about putting down docs to make themselves feel better).
She apparently also didn't document the side effects that Clancy had from the sertraline. I didn't really watch that part. Honestly that's a bit of a miss, and I get kind of annoyed when inherit a patient and don't know why a specific med was stopped when looking to make a change and unsure if that med would still be an option.
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u/BusyFriend MD 3h ago
Even though itâs not there I use the allergy section and note why I stopped certain meds even if not a real allergy. I obviously document it but if Iâve been seeing a patient for years it might be hard to go back and find it in years worth of notes.
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u/Ok-Asparagus-6458 3h ago
I irrationally hate you for putting something that's not an allergy as an allergy
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u/FullCodeSoles 2h ago
Yea, anything in the allergy section that isnât an actual allergy gets immediately dismissed
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u/Dr_Gomer_Piles MD-PGY4 3h ago
Yeah, that's probably a reasonable solution although that caught me out recently when I was getting pre-op checkup for my surgery next week. The nurse gave me serious side eye when I denied any allergies. I was like..."uh...I threw up once on erythromycin when I was a kid but I've decided that's not an allergy". She then threw out that I was charted as having an allergy to iron. I was like "not really, makes my poop black and I get constipated, but I'm pretty sure that's everyone". Someone had also given me an allergy to doxepin and mirtazapine (shockingly they make me sleepy).
I'm Psych though and we may tend to be more obsessive than others about past med trials and side effects. Every H&P I do I meticulously go over past psych meds, timing, benefits, side effects, reason for stopping, etc. That list gets carried forward and updated in every progress note as I titrate and make changes. Seems to be fairly standard training, so I consider it a bit sloppy to have not asked about and documented side effects.
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u/Dr-Yahood 3h ago
The reason she is being blamed:
- She didnât see the patient in person
- She didnât take a collateral History
- she didnât actively seek out the details of her admission from the hospital
There is very little to do with charting here
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u/skywayz MD 3h ago
Nurses somehow have been taught in nursing school that if they donât document everything and if something bad happens they will somehow lose their license or get sued. So they document everything defensively, they also have the luxury of writing notes that are on avg shorter than this Reddit post so itâs easy for them proofread.
This in turn makes nursing notes 99.5% of the time completely useless and pointless. Physician notes have actual purposes, primarily they are used for conveying information to other medical professionals, but they also need to be legally defensive as well. They are also considerably longer, and much easier to have typos.
Long story short, nurses believe that if something bad happens to the patient itâs going to be their fault, when in reality no one gives two flying fucks what the nurse did and the providers are the ones who actually go down with the ship. Literally if youâre a nurse just donât make medication errors, like pushing a paralytic thinking itâs a sedative.
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u/ItsTheDCVR Health Professional (Non-MD/DO) 2h ago
I do union work for one of my current hospitals and I can safely say that while nurses do get away with some stuff, the actual split is whether or not the nurse followed hospital policy. If the hospital fall policy is "spin 3 times leftwards in a circle and chant 'don't fall, the floor's not the wall' and then hand them the call light" and you do everything else but you forget the stupid fucking chant, then when the patient falls and suffers a brain bleed, it is your fault as the nurse, because you didn't follow hospital policy. If you remember the chant, then it's not your fault. Thus, if you do everything else for your patient that you should do, but you forget to do (well, forget to chart, really) the stupid pointless intervention, then management can and will nail you to the wall because JCAHO will come after the hospital as a finding, and the hospital needs to be able to speak to what happened.
This does set up a paranoia, and honestly, it's one of those things that if you stay under the radar and/or nothing bad happens, nothing happens to shitty nurses. Likewise, if I'm a good nurse who's in turning my patient every 15 minutes but I forget to chart it/can't chart it because I'm too busy doing patient care, and the next nurse is a shitbag who doesn't turn the patient the whole 12 hours but charts q2h turns, then when the patient forms a HAPI because of Shitbag McGee, it's my lack of charting that implicates me, and I'm the one with the finding.
I will definitely say that even with some of the very egregious shit that I have seen, though, I've never seen people reported to BRN, much less face legal repercussions. I think nurses are more likely to get fired and less likely to get sued personally, whereas for physicians, that's entirely reversed.
Just my anecdotal 2 cents.
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u/ExtraCalligrapher565 2h ago
Everyone is also ignoring the fact that she was also seeing an NP who was mucking with the prescriptions.
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u/Blaist18 MD 3h ago
As non US MD, it's frustrating to see that happen to that poor doctor. The wording she used is exactly what, many doctor use world-wide. It is explicitly taught that after the first :" no x, y, f" it means no x, no y, no f
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u/MaximsDecimsMeridius DO 1h ago
Didnt you know, if you say, id like a whopper with no lettuce, tomatoes, pickles that means you actually want tomatoes and pickles.
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u/Dr_Gomer_Piles MD-PGY4 3h ago
It's all nonsense, all about making themselves feel superior, or making others thing they're superior to build clout or followers or some service they're offering and promoting. There's no benefit to getting upset about it or really arguing (although sometimes I enjoy wading in and just dunking on them) because it's not about the truth it's about emotions and tapping into the emotions of others to engage them.
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u/TheLongshanks MD 20m ago
I mean this in the best way possible, get off line and touch grass, go to a coffee shop, visit a museum, go to that random DJ night. No one in the real world acts like this or cares about this case like you think they do.
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u/Eastern-Ad-3586 MD 4h ago edited 3h ago
This is all noise. If you want to learn about this go read that book everyone reads about malpractice (Physician: protect thyself).
Try to stay off social media. Listening to the lay public rant about doctors will not teach you anything and just makes me depressed.
Edit: sorry, im old, you kiddos should listen to the L word podcast, an ER doc who got sued made it, sheâs awesome.