Author Beware: Don’t Make Medical People Look Like Uncaring Idiots 1/3

January 9, 2017January 8, 2017 / Jordyn Redwood / Leave a comment

I’m starting out my medical posts of the New Year truly fired up . . . and not in a good way. This title sounds harsh, doesn’t it? Sadly, it’s exactly how I feel.

If you’ve known me for any length of time, then you know I’m passionate (just slightly) about medical accuracy in novels. This is why this blog exists and a major reason was to clear up misconceptions about medical people and how they perform in their job.

teen-girl-2 Let me first state, clearly, that you can have a bad medical person in a novel. They can even be doing bad things. Criminal things. That’s what drives fiction. Tension. Conflict. However, also should the author help the reader realize, in some fashion, that the author knows this fictional medical character is doing these things inappropriately and it is not a normal medical experience. To help with this, I encourage all authors everywhere to write a medical person performing ethically as a balance in the scene or book. This is beneficial so you don’t anger every medical person out there to want to hold gas and flame to your hard earned written prose.

Professionals like to be portrayed accurately in their profession. Anyone remember how Joy Behar angered thousands of nurses? Yes, this is what writers should avoid.

What follows is an exert from a highly popular mainstream novel. This novel hit both the New York Times AND USA Today Bestseller lists. I’m not naming the book or author here and if you know what either of these are, please do not leave it in the comments section. I’m only using the quotes as a teaching points.

For background, a fourteen-year-old female (from what I can tell from the book) believes she has been raped. She’s going to Planned Parenthood for the Morning-After Pill. The rape occurred on a Friday around midnight. The character is presenting for treatment Monday after school. What follows in italics is an exert from the book.

While she examined me, she explained what the Morning-after pill was. “Not an abortion,” she reminded me twice. “If the sperm has already implanted the egg, it won’t do anything.”

Problem: Medical professionals are careful to separate opinion from medical fact. A patient might view what an abortion is differently than their medical provider and ultimately a medical provider’s job is to disseminate medical information and not their personal opinion. If it is their personal opinion, it should clearly be identified as such.

Some people view abortion as terminating a pregnancy at any stage— including just after fertilization. You will find web sites that claim the Morning-after Pill is not an abortion pill. However, you also can find two, well respected medical sites (Web MD and The Mayo Clinic) that state one of the actions of the Morning-after Pill is “keeping a fertilized egg from implanting.”

Solution: It would have been better for the medical provider in this passage to simply state the following. “The Morning-after pill works by delaying or preventing ovulation, blocking fertilization, or keeping a fertilized egg from implanting in the uterus. However, there is evidence out there that suggests that it also doesn’t keep a fertilized egg from implanting in the uterus. My personal opinion is that this is not an abortion pill.”

Given this information, a patient can then decide for themselves if this is ethically something they want to choose to do without the personal bias of the medical provider influencing their decision.

A patient should always be given opportunity to choose medically what works within their ethical framework. If the medical provider cannot support them in doing that (what is a reasonable decision) then they should refer them to a provider that can.

Next post, we’ll continue our discussion on the medical issues in this novel.

In full disclosure, I am pro-life.

What are your thoughts on this passage in how the medical provider relays the information to this fourteen-year-old girl?

What Does a Nurse Do? Part 3/3

October 14, 2016October 4, 2016 / Jordyn Redwood / Leave a comment

This week, we’ve been examining the role of the nurse at the beside. Thus far, we’ve looked at the nurse as advocate and safety net. Let’s look at the nurse/physician relationship.

Here is Part I and Part II.

I work in an emergency department. I would say that I have a symbiotic relationship with the on duty physician. One cannot survive without the other. For instance, say there aren’t any nurses to staff the ED. How well do you think that one physician could provide medical care? What if the physician falls ill? Can the nurses provide medical care? What is the difference?

A physician’s role is to diagnose illness and determine the course of treatment. A nurse’s role is to initiate the medical plan of care, monitor the patient’s response to that medical plan, and educate the patient and family regarding their illness. You can see, one without the other and the ER comes to a halt.

Can a nurse refuse to carry out a physician’s order? Let’s look at one hypothetical example: A physician orders morphine for a child at ten times the normal dose. This is clearly dangerous and could kill the patient. What would a nurse do? First, I would have a conversation with the physician about the order. I would state my concerns and the physician will likely change the order. If that doesn’t work, I would approach another physician with my concerns to see if I can get an ally in re-approaching the ordering doctor. Some professionals will better handle being questioned by a peer vs. who they might consider a subordinate. Regardless of my view of having a symbiotic relationship with the physician, some doctors do view the nurse as a subordinate to just carry out the orders as written. This is becoming more rare. If that doctor to doctor talk doesn’t work, then I would call my nurse manager. If the nurse manager agrees the situation is dangerous, she can begin to pull in the medical director who can address the issue.

Say the order isn’t dangerous but I don’t want to initiate the order. Some medications are dangerous for a pregnant nurse to give but are fine for a non-pregnant patient to receive. If I was pregnant and didn’t want to give the drug for that reason, I would ask another nurse or the physician to do it.

What if the nurse has a conscious objection? What can she do then? Thoughts?

What Does a Nurse Do? Part 2/3

October 12, 2016October 7, 2016 / Jordyn Redwood / Leave a comment

Let’s continue our discussion of what a nurse’s role really is and how you can use this to increase conflict in your manuscript.

You can find Part I here.

Last post we looked at the nurse as patient advocate. This post, we’ll look at the nurse german-shepherd-puppy as the patient’s safety net. Which dog would you rather have defending your house? The cute, furry puppy or the grown dog with the watchful eye? A strong nurse is the patient’s watchdog. I look out for my patient’s interests when they may not be able to do so.

I am often the last line of defense between everything and the patient. Let’s delve into the medication arena. The nurse gives the patient’s medications. It’s my job to ensure that what the physician orders is the correct medication for the illness, for the right patient at the right dose given the right route (by mouth, intravenously, etc…). One of the challenges in pediatrics is there is no standard dose. Every drug dose is based on the patient’s weight. I’m not going to give the same amount of morphine to a 5kg infant vs. an 80kg teen. If the patient is not weighed or their weight is entered incorrectly, this can have disastrous effects when medications are given.

german-shepherd-578929_1920 Medication errors do happen. I want to reassure you that there are a lot of safeguards in place to prevent such occurrences. Most departments are going to computer based medication ordering. This is beneficial in many ways. One, the order is typed and therefore easily read eliminating mistakes in reading handwriting. Second, most medication based ordering systems have built in safeguards that will check the prescribed dose against the patient’s weight to make sure the dose is not too high. In pediatrics specifically, all high risk medications are double checked by another nurse and co-signed on the chart. But as a good nurse functions as a safety net, so should the parent question what is being given to their child and why.

Let’s take a real life example. During my years in the pediatric ICU, I worked at a teaching hospital. At this particular institution, residents could rotate through the unit their second year. I had a second year resident order potassium, which is a potent electrolyte, at four times the recommended dose. Now, if too much potassium is given, it will cause the heart to stop beating. That’s how big this error could have been.

I approached the resident and questioned the order. He stated, “But the drug book says to give 4meq/kg/day.” I explained that the “per/day” was the key term. That the drug should be divided into four doses given every six hours, no more than 1meq/kg at one time. I told him he could order it that way, but the pharmacy wouldn’t fill it and I certainly wouldn’t give it.

Needless to say he changed the order and the drug was given correctly.

Have you ever had a medication error happen to you? How do you think it could have been prevented?

What Does A Nurse Do? Part 1/3

October 10, 2016October 4, 2016 / Jordyn Redwood / 2 Comments

I still find it interesting that many outside of healthcare don’t truly understand what a nurse does. Television, movies, and fiction all have varying takes on the subject– most of which don’t depict reality.

teen-girl What is your definition of a nurse? When you’re in contact with the medical system, what do you want a nurse to do for you? I would love to know.

My ultimate role as a nurse is to serve as an advocate for my patients. In pediatrics, that means my clients range from a newly born infant to a young adult who is most often accompanied by a parent. How can this be a source of conflict? Let’s take a look at an example of how my advocating for a child can become a source of conflict between me and the parent.

A parent presents with her teen daughter and wants her tested for drugs. The mother has concerns that her child may be experimenting and wants confirmation. Can we run a drug test that covers common drugs of abuse? Yes. Will we in this situation? Depends.

How are we going to obtain the urine specimen if the teen is not a willing participant? We would have to hold her down, pull her legs apart, and insert a catheter into her bladder. Legally, this would likely be considered assault if the teen is not having a medical emergency. A medical emergency would be something dramatic– like no pulse and no breathing. Or, the patient is unconscious and we’re trying to determine why. In this situation, the teen is not experiencing a medical emergency. The teen is awake, alert, and communicating appropriately. As a nurse, I am not going to do that to her regardless of the parent’s demands.

What are the options?

First, the physician will have a conversation with the parent and child to discern the parent’s concern. The child will be interviewed alone and asked pointed questions about their drug use. The parent may also be interviewed alone as well. The first issue is to figure out if there is a legitimate concern. If there is, will the teen willingly submit to the drug test? If so, we’ll run the drug screen. If not, in a non-emergency situation, the approach will likely be to get the family into some counseling.

However, if we do drug test the teen, we may or may not disclose the results to the parent. Whether or not this information would be released depends on the state and the age of the child.

How has a nurse advocated for you?