confused resident
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CINCINNATI, OH – Emdee Awahray, an intern covering the general medicine floor overnight, has disputed the claim made by an RN in her overnight documentation note.  The RN, who wished not to be identified, wrote at 0500, “Patient with blood glucose of 120.  MD aware.  Patient with BP 120/80.  MD aware.  Patient requesting to speak to physician regarding normal blood glucose and blood pressure.  MD aware.”

confused resident
“I would argue that I wasn’t aware”

When the patient complained to the attending on 0600 rounds that he had not been seen at 0500 when he had asked to speak to with a physician regarding his normal vital signs, the attending was perplexed.  The nurse’s documentation was certainly clear: “MD aware” was written at the end of every sentence, in bold italicized type.

When questioned, however, the intern could neither confirm nor deny that he was, in fact, aware.  “Awareness is a complex philosophical phenomenon.”  He went on to report that, from a very basic standpoint, the nurse had not even assessed his level of consciousness with standard alert and orientation questioning, after sending out each page.  Awahray cited Descartes, the ancients, as well as Brentanian Theory, in his lengthy explanation of what awareness really entails.

“Did I read my pager?  Yes.  Did I respond in the affirmative?  Indeed.  But true awareness?  That’s another thing entirely.”

The attending had to agree, as the intern’s argument was evidence-based, with a literature review.  Nurse management was wary, but ultimately agreed that future documentation should require at least a short neuro exam to prove that the MD was, at least in some real sense, aware.

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