Expert: Deb RN - 7/20/2011

Question
QUESTION: Thanks for reading my question. I'm a 50 year old guy who has pretty much avoided medical care on a routine basis, preferring to use the local Doc-in-a-Box (Urgi care) for anything pressing.  I work as a physicist (nuclear med applications) and although my title is "doctor", I'm pretty unfamiliar with being a patient and with the medical-care delivery system in general.  I recently got a PCP (she's great) and she ordered a bunch of much-overdue tests, including the colonoscopy that is causing me problems.  When I scheduled the test I was told that I could ask questions regarding the possible sedation on the day of the test and that an anesthesiologist would be doing the sedation.  On the day of the test, I ask to speak with the promised anesthesiologist regarding avoiding a drug (Versed) that I had a terrible previous reaction to at the dentist....long story short, I wait a long time before they tell me that they don't have an anesthesiologist working that day, but that I can ask the nurse who does the sedation.   She basically tries to dismiss my concerns and says that "everyone gets Versed without problems" and gets annoyed when I tell her that I definately don't want Versed.  She tells me that Versed is part of a "balanced" sedation that they always use etc, etc and that she know better than me and the sedation is her job (she's a CRNA)...She's evasive when I ask her directly if she will make sure that I don't get this drug; finally she agrees (sort of). I put "no Versed" on the consent and ask her to sign it and she flips out; saying that I should trust her.  If she would have given me a straight answer; I would not have modified the consent.  The doctor joins the discussion; the CRNA tells him that: "he wants to design his own sedation"...even after the doctor tells the CRNA: "his records show that he got admitted for a Versed reaction" she still refuses to guarantee that I won't get this drug!  The doctor finally told the CRNA "no Versed, obviously" and she stormed out, only to return and sign the consent adding: "this isn't my idea, but have it your way".  I was polite, but it became obvious that nobody (especially the CRNA who was supposed to do my sedation was on my side); so I told them that I wasn't comfortable with their "care" and asked the CRNA to remove my IV; she said that I couldn't cancel the procedure (she was called in and wanted paid, according to another nurse)...I excused myself to the bathroom, grabbed my clothes and changed. I removed the IV and placed the cannula in a sharps box and headed for the door; the CRNA met me and yelled at me to "get back in there, you are MY patient".....I asked for a bandaid (didn't get one) and left.  Sorry this is so long; I swear it's all true.  What did I do wrong in this situation?  Isn't someone supposed  to advocate for the patient's welfare?  I'll never go back there (despite receiving several calls from them to return); I want to reschedule at another facility but hope to avoid a repeat problem. I like my new PCP and don't want to appear to be a problem patient.  In fairness, I must state that the CRNA called to apologize; I told her that I can't get past the fact that she tried to bully me into possibly accepting a non-essential drug that hospitalized me in the past......and I'm supposed to trust such a person?  thanks

ANSWER: Hello Tp,
I am appalled and aghast at the treatment you received at that facility.   The CRNA was absolutely and completely out of line.   The CRNA that treated you in such a manner and spoke to you so rudely and unprofessionally should be FIRED immediately - no excuses accepted, no second chances allowed for her.   I do hope that you send a copy of this post or a letter describing your experience to the facility administrator.
Thank you for standing up for your rights.   Thank you for speaking up and refusing improper treatment.   I wish every patient would do the same if in a similar situation.   Please do not question your actions.   You did everything right.   
To answer your question ... of course you should not trust that person.  I hope you never meet another health care professional like that.   Thankfully, those folks are few and far between.  Please discuss this experience with your PCP.   I'm sure she will advocate for you PRIOR to your next procedure appointment.
Good luck,
Deb  

---------- FOLLOW-UP ----------

QUESTION: Thanks for a concise and lightning-fast response; I'm going to try rescheduling the colonoscopy (I'm very high risk).  The physician called me and basically agreed with your comments; however he did mention that the CRNA were a contract service and that while most are professional, some do their jobs "carwash fashion" are concentrate mainly on running patients thru the facility quickly with little regard to patient concerns.  He told me that an anesthesiologist was available (and that is who he would want to do his own sedation for a colonoscopy), but that she was booked many months in advance and that since I had bleeding that I shouldn't wait that long.  This doctor is the best in town and I want him to do the test, but obviously I don't want a CRNA. I'm willing to bear the procedure unsedated (as long as nobody is yelling at me like my last visit) and the doctor says that it can be done without drugs (no CRNA.. and the CRNA's final comment was: sure, get the test without a CRNA, but be prepared to have your "screening colonoscopy" become a "screaming colonoscopy"....). So one more question if I may: since I'll never trust CRNA (or probably any anesthesia for that matter) ever again anyway; what do you think of geting one without drugs?  Ever hear of anyone doing that?  Again, thanks for answering my long-winded questions, I value your opinions a lot more than those of anyone at the local endo center. Thanks

Answer
Hi,
I haven't heard of anyone having a colonoscopy without sedation, however when I had a colonoscopy, the sedation was ineffective and I was awake during the entire procedure.   I had warned the doctor and CRNA that anesthetics don't work well for me but they brushed off my concerns.   They said, "Don't worry.  We know what we're doing".   They were surprised when I was able to converse with them throughout the procedure and comment on everything I saw on the monitor.   I didn't experience much discomfort though, and that was fortunate for me.   I felt a little bit of discomfort during the test, but I wouldn't call it pain.   So, I personally wouldn't be afraid of having the procedure without any anesthesia.   I don't promise that your experience would be the same, though.   I suggest that you ask for something other than Versed - there are other very effective sedation meds.   If you list Versed as an allergy, the staff actually has no choice but to use alternative medications.   I do hope that you schedule the colonoscopy and have a safe and comfortable procedure.
Good luck,
Deb