"The Disruptive Behavior of Doctors" - page 3
I am currently reading a book on nursing careers that talks about "the disruptive behavior of doctors." I'm sure we all have stories! Can you tell me of ways in which doctors' behaviors have made... Read More
Apr 29, '09Talk about disruptive? When I first started working as a nurse in the late 70's, I worked at a very small hospital in my hometown. Except for two or three docs, the rest were, jerks and demanded I turn all my attention to them whenever they came on the floor. I had trouble with three of them trying to get me to go out with them (I was married with three children), and making sexual advancements towards me almost every day. One of the surgeons actually came into a pts. room, while I was helping the aide with a dying pt., and wrapped his arms around me from the back. I told him to get out, which he did, laughing. Whenever I called him about a pt. he would ask me personal questions and make remarks about my appearance such as: are you wearing a dress to show off your pretty legs? I reported all these behaviors to the Director and all she would say was: "Oh, just ignore them." I stayed there about 8 months. I was so angry and almost left nursing, but I decided to find another job and leave. It was the best decision I ever made. I have never found another work place as bad as that one was. My favorite place to work was the Cleveland Clinic Hospital.
Apr 29, '09It is policy at our hospital that when we take a telephone order we are to read it back and to write under our order that we read it back. The policy is in place to avoid those kind of issues. I had a problem with an order I took on a 5 month old for chloral hydrate for a procedure. The director of medical records called me one day saying that the pediatrician said that she did not give that order. I informed the director that she did give the order and I repeated it back. I also told her that I am not in the habit of making up orders. I have not heard another thing about it.
Apr 29, '09I think the new JCAHO rule on disruptive behavior will force more hospitals to create and enforce policies that address any and all disruptive behavior.[/quote]
Could you eleborate on this rule. I don't think I have heard about this.
Apr 29, '09I think from my experience that if labs, etc. were on the chart in a more timely manner when possible, by the designated staff member, it might eliminate some of the requests. I know that nurses have many demands on their time. I worked on med-surg for 11 1/2 years. But I feel it is part of the nurses' job to work with the doctor to help facilitate the patient's care. Whether that be the floor nurse or the charge nurse as appropriate. After all who knows the patient better than you the bedside nurse. However interacting with the doctor should not be detrimental to your patient care. You are the gate keeper. We should be advocates for our patients.
Apr 29, '09I think that overall, docs have improved since the '70s when if they walked into a nurses station, the nurse automatically stood to give up her chair. I've worked with docs who threw trays of surgical instruments (including sharps) at you, tore up charts and cussed you out for trying to confirm an order. Now I work in home health and was doing diabetic management. The pt was under the care of an endocrinologist. The order read if BS > than 400, call physician. I phoned him and was thoroughly cussed out and told told to call her PCP and the phone was slammed down. His receptionist reminded me of a nazi and was just as disagreeable as he was. I "assumed" that since he wrote the orders, he was the doc who needed to be called. Never assume! My supervisors had no better luck with these pathetic excuses for health care "professionals" and I use the term loosely. On the other hand, I've dealt with Wound Care specialists who were always more than happy to speak to me and revise orders to expedite patient healing. The endocrinologist was the worst doc I've dealt with in many, many years. It sure blows the mood of the whole day when you get one like him.
Apr 29, '09We do not tolerate disruptive behaviors from anyone, in our facility. We have defined service standards to which everyone is trained and held accountable. We also add these behaviors to our evaluation process. 50% of the evaluation is based on the essential functions of the job and 50 % is based on essential behaviors. It's not enough to be a "good nurse", if you are a "bad person". We take these very seriously. We also have addressed the medical staff and their behavioral expectations. We have very good medical directors of our specialties so if there is a disruptive physician, they are dealt with through the medical staff services department and ongoing issues could result in loss of privileges. Also, if we have patients and families who have ongoing abuse issues towards the staff (many times these are repeat patients with repeated behaviors), our CEO will send them a letter after discharge "Inviting" them to seek treatment elsewhere, in the future. Not at our hospital. The key is having the support of your CEO, physician group and DON in developing and maintaining a culture of respect.
The Joint Commission has addressed this. In July of 2008, TJC issued a sentinel event alert (#40) entitled "Behaviors that Undermine a Culture of Safety". Part of that alert indicates:
There is skills-based training and coaching for all leaders and managers in relationship-building and collaborative practice, including skills for giving feedback on unprofessional behavior, and conflict resolution.
This is pretty clear in it's intent. Also, hospital management should encourage a culture of support to hospital staff which allows them to set boundaries with what they will accept from physicians and other personnel. Of course, this boundary setting would have to be done firmly and politely and in a way that de-escalates the situation....not escalates it.
Apr 30, '09Quote from morteAm seriously considering it.Did you sue the arse?
Apr 30, '09Quote from BoomerRNTalk about disruptive? When I first started working as a nurse in the late 70's, I worked at a very small hospital in my hometown. Except for two or three docs, the rest were, jerks and demanded I turn all my attention to them whenever they came on the floor. I had trouble with three of them trying to get me to go out with them (I was married with three children), and making sexual advancements towards me almost every day. One of the surgeons actually came into a pts. room, while I was helping the aide with a dying pt., and wrapped his arms around me from the back. I told him to get out, which he did, laughing. Whenever I called him about a pt. he would ask me personal questions and make remarks about my appearance such as: are you wearing a dress to show off your pretty legs? I reported all these behaviors to the Director and all she would say was: "Oh, just ignore them." I stayed there about 8 months. I was so angry and almost left nursing, but I decided to find another job and leave. It was the best decision I ever made. .
This behavior isn't limited to doctors . . . . . . your description fits a manager I worked for at a computer company in the 1980's . . . he came up behind me while I was typing and put his arms around me and his hands on my breasts. I sat there frozen - scared - I was young. :icon_roll I think he sensed I was afraid because he walked away. But when I complained about his behavior to his boss, the guy chuckled and said "What do you expect, you are an attractive woman". Well, I guess I should come to work with a bag over my head and wearing a burlap sack. I quit - but it took me a week.
Apr 30, '09Although most of the doctors are finally starting to look up their labs, etc. on the computer, there
are always a few who ask. Once we became computerized and the doc persisted to ask us for
previously documented information, we complained to our Nurse Mgr who took our complaints to
the Medical Staff director who directed to docs and also provided them with training to look up this
information. We still have a doc who writes an order to call with lab values, however, our Nurse mgr.
states "do not call with normal labs" as they have the ability to look up this information. We are very busy
nurses looking after several patient's needs at the same time, however, the Docs see one patient at a time.
One Doc pulled a phone out of the wall because the dictation was not working correctly, scaring many people
who were in the vacinity at the time. He was sent a bill for the phone and I hope disciplined, but why do
these doctors keep getting away with this type of behavior?
Apr 30, '09I have worked with polite and disruptive doctors. If I need to call a doctor in the middle of the night because of a change in a pt.'s condition, the last thing I'm going to be concerned about is if the doctor is going to "chew" me out for bothering him! To me, that's the worst thing that could happen!
I look at the bright side and think "at least I have not, as of yet, worked with a Dr. House!
May 1, '09in the first or i worked in, in the '80's, there was a "good old boy" system in place. most of the docs had graduated from the same med school, because there weren't that many to choose from when they went to school. these were the docs who had been brought up to believe that a nurse instantly yielded a chair for the doc when he appeared. there were no female surgeons at my hospital.
they were allowed to have tantrums, to throw things, to yell at the staff, and only once did anyone pay the price for their own crappy behavior. the open heart team walked off after one surgeon, reknowned for his rudeness, short temper and throwing things, threw a dirty scalpel in the general direction of the circulator. it missed her by inches. he had his or rights suspended for 6 months.
i was screamed at by an anesthesiologist with whom i thought i'd been friends with(for 6 years), one day when i took a patient to the or in his absence. you see, he always had a meeting on that day of the week, so i broke the unwritten rule. however, according to my bosses, the patient had to be in the room by x time- so i did what my bosses had declared as policy. i was called from the or into the nurse managers office. there, with my director and the nurse manager in the room, the doc just absolutely savaged me verbally, with their looking on and not a single word was spoken in my defense. nope, they added to it. i was reduced to tears; the idea that my "friend" would turn on me like a wolf as well as not having any backup from my chain of command just knocked my legs out from under me.
i cried for three hours before i could go back into his room. i made a vow that i would not speak to him at all, except when it came to patient care, ever again. i kept it, too. he knew why i wouldn't speak to him(he made some comment to another doc about not ******* me off cos i'd never give him the time of day again.
i worked at a military hospital- guess what; the uniform code of military justice prevented most of that kind of behavior, from the military side, but we did have a couple civilian docs, one of whom i'd worked with before and despised, who loved to yell and scream. well, the military may take it's time, but they decided not to renew his contract. generally, we treated each other with friendly regard, and with formality as demanded by military protocol. that was actually a very nice experience, once we got rid of bigmouth.
currently, i work at a large university hospital. most of the docs are great to work with. it's a very family oriented place, somehow, plus we have a code of conduct that we have to sign every year, that states that everyone is treated with respect. recently, we got a new peds surgeon, who yells at everyone, all the time. mostly he works over in the women/children's hospital, and they just take it. the other night he had to work over in the main or and he kicked up a fuss about having to work there, that he didn't have a peds team, that his setup was completely different...and so on and so on. the circulator took it personally when he started shouting something about, "you g-d nurses! it's all your fault." now in an or, there are at least four people in the room; the scrub, circulator, anesthesia and surgeon. in a big place with residents etc, there were probably more people than that.
the nurse filled out an incident reoport. our immediate boss tried to brush it off. said she'd have a meeting with the doc. then would give no details of the meetings result with the doc to the nurse. she told our manager that she was going above her head, to risk management and the code of conduct folks. no one likes this doc and he seems to hate it here. he keeps saying it, anyway. all of us want him to get, because our doctors do not treat us like that. granted they can get frustrated at the situation they find themselves in, and then they do some impersonal yelling, however, that happens. it's not an attack at a personal level. that we all understand, considering the kind of cases they do(try a 14 hour case).
but at another hospital, a nurse and a scrub sued a surgeon for sexual harrassment and won.
if we stand up for ourselves and take it out of the department level, up to the risk management/employee relations folks, they will take an interest in what we have to say. but if we accept our department managers to take care of those kinds of issues, most of the time, you'll be sadly mistaken.
if something like that happens, and there are documented witnesses, fill out an incident report and take it to your chain of command, and then go higher. we are not slaves, nor are we stupid, but many of us just seem to allow the docs to carry on this way. we need to be both pro-active and re-active to shoddy treatment. if that doc in india had assaulted me, i would have called the cops and sued him for assault and battery- and would have won. might have even sued the hospital for employing such a jackass.
May 2, '09I had such a bad experience with a particular doc in the ER as a nursing student (I was working there as a nurse tech). This doc would belittle me in front of everyone and anyone, including patient's. :icon_roll As nurse techs, we had to alternate between working in the ER and urgent care. If I was assigned to uc with him, he would ask other docs RIGHT in front of me and everyone else, if they would switch with him!!! I used to go in the locker room and cry about it, I had and still have no idea what I ever did to him to make him treat me as he did. I complained to my nurse manager and she said that a lot of the nurses had complained about him but that her hands were tied because the chief ER doc liked him! I LOVED working in the ER/UC but dreaded going in to work because of him. I was eventually offered a nursing position (upon graduation) in the ER (which back than was not usually offered to new grads) but refused because I would have to work with him. I regret that decision now!!!!
May 2, '09Quote from StNeotserOMG, I LOVE that you wrote his order verbatim...that's awesome!! What a jerk.I picked up a shift on another floor a couple of weeks ago. Our "nurses station" comprises of two chairs and a four foot desk and I was discussing a patient history/family problems etc with a care manager. Unidentified person (doctor) breezes in and says "One of you has to get up, I'm going to be writing orders here" Why? Really why? There are also available chairs in the med room he could have sat. I spend about three quarters of my day standing up. However, this is just disrespect, but the disrespect started with the arsehole who designed the nurses station this way because he was "tired of seeing nurses sitting on their asses" Oh really? So now when you have about ten people during the day, PT's MD's nurses, PA's, Social workers at any one given time vying for privacy and space to talk about patients it doesn't work.
The dilemma at night when you know damned well that you need to call the doctor, however, you know this doctor will start yelling and screaming. Same screaming doctor has given me an order to "Do whatever the f- you want" which I wrote verbatim. Patient ended up in ICU and dying so it was not one of those "You were rude and didn't need to call him" issues.