Has anyone encountered a situation like this?
At my clinic, our providers generally don't offer second opinions on treatments or decisions made by their colleagues within the practice, as a matter of professional courtesy and mutual respect. If a patient requests a second opinion, they are encouraged to ask their PCP for a referral to another facility. Similarly, when we receive a request for a second opinion from a patient seen at an external facility, our providers are respectful of that other provider's decisions. For example, an APP will defer to one of our MDs when asked to opine on treatment provided by an external MD.
I recently implemented a new RN protocol allowing nurses to order a hearing test when a patient reports new and sudden hearing loss. Since hearing loss cannot be definitively confirmed or ruled out without testing, I always report these orders to the patient's provider as part of the workflow. However, I've noticed that some providers occasionally respond by stating the test is unnecessary, which leaves me in the uncomfortable position of contacting the patient to cancel the test. This can be especially awkward if the patient feels strongly about the test because they've experienced a subjective change in their hearing.
I'm curious if others have experienced situations where following RN protocols or guidelines has been overridden by a provider. I understand the rationale for vetoing tests when they pose risks to the patient, but in cases where the tests are non-invasive, it feels less clear. Thoughts?
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Ingrid Hawkinson
RN, MSN, AMB-BC
UCSF Otolaryngology
San Francisco CA
415-353-2148
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