Does MD really stand for Mad Diva?

Dayray, RN · Nov 30, 2005

Doctors have to be reminded that they are not demi gods from time to time. A direct approach is rarely effective and as many can attest documenting anything short of violence or sexual harassment is useless. So I choose to be more diplomatic, maybe even passive aggressive in my approach.

I.e.

Doctor yells at me over the phone "I'm sorry I can't hear you" click. I page them again, doctor yells at me again "I'm sorry I can't hear you" click.

I did this once and on the 4th page got orders in a civil tone.

Doctor yells at me at the desk. I sit quietly listen and don’t respond. Later that night (about 2 am) I page them. They call back and I answer "I'm sorry no one here paged you" 15 min later (just enough time for them to drift off again) page them again "I'm sorry no one here paged you". Wait an hour rinse repeat. They get the idea.

Once I had an MDA yell at me in front of a patient. He was having trouble placing an epidural. He had been able to give her an interthical so she was comfortable but he was unable to get the catheter to thread in. He was getting ready to make his 3rd attempt when my patient gave a subtle but unmistakable look (she was complete) I knew she was even though she didn’t say anything. So I tell the MDA "I think I should check her cervix before you try again" He yelled "Why! I don’t see any indication she is about to deliver do you?" I said "your the doctor" 30 seconds later she let out a little grunt and he said "ok go ahead and check her" as I caught her baby I said "are you sure it's okay ...... Doctor?" He has never yelled at me again.

Called a doc for urine output of less then 30 cc an hour x 2 hours. "He tells me this something that could have waited until mourning!" I said "it's common practice to inform the MD when output is less then 30cc for 2 hours" He says "just don’t call me anymore!" I wrote it as an order. He came in the next day and threw a fit but hasn’t given me crap since

I once had a doctor yell at me for transferring his patient to post partum before he had given me the order so the next night I paged him and asked for an order for a water picture, then later for ambulation orders. He yelled at me and I said "well I don't want to do anything without an order" He was silent for a moment and then apologized for yelling at me the day before.

The same type of approach works with nurse mangers. Your manager was so out of line. As an RN you should never take crap from an employer. You can get a job anywhere. I have only had one situation with a manager that was similar to that one. I listened, took a breath and just said, "I understand that is the way you see things. Please consider this my 2 weeks notice I will give you a written letter tomorrow." The situation was rectified and I received an apology when I came in to give my written letter.

Always remain calm and speak matter a factly. Sometimes just staring blankly is effective. As nurses the hospital sees us as expendable so you will rarely be backed up in a confrontation with a doc. Yet we don't deserve to take abuse for simply doing our jobs. We have to find ways to defend ourselves. Just make sure that it's done in a way that doesn’t harm anyone. Make it so the doctor and you both know what is going on but that they can't prove you were doing anything to them. If they try to call you on it, don't admit to it just play dumb.

NurseLatteDNP, MSN, DNP, RN · Nov 30, 2005

Doctors have to be reminded that they are not demi gods from time to time. A direct approach is rarely effective and as many can attest documenting anything short of violence or sexual harassment is useless. So I choose to be more diplomatic, maybe even passive aggressive in my approach.
I.e.
Doctor yells at me over the phone "I'm sorry I can't hear you" click. I page them again, doctor yells at me again "I'm sorry I can't hear you" click.
I did this once and on the 4th page got orders in a civil tone.
Doctor yells at me at the desk. I sit quietly listen and don't respond. Later that night (about 2 am) I page them. They call back and I answer "I'm sorry no one here paged you" 15 min later (just enough time for them to drift off again) page them again "I'm sorry no one here paged you". Wait an hour rinse repeat. They get the idea.
Once I had an MDA yell at me in front of a patient. He was having trouble placing an epidural. He had been able to give her an interthical so she was comfortable but he was unable to get the catheter to thread in. He was getting ready to make his 3rd attempt when my patient gave a subtle but unmistakable look (she was complete) I knew she was even though she didn't say anything. So I tell the MDA "I think I should check her cervix before you try again" He yelled "Why! I don't see any indication she is about to deliver do you?" I said "your the doctor" 30 seconds later she let out a little grunt and he said "ok go ahead and check her" as I caught her baby I said "are you sure it's okay ...... Doctor?" He has never yelled at me again.
Called a doc for urine output of less then 30 cc an hour x 2 hours. "He tells me this something that could have waited until mourning!" I said "it's common practice to inform the MD when output is less then 30cc for 2 hours" He says "just don't call me anymore!" I wrote it as an order. He came in the next day and threw a fit but hasn't given me crap since
I once had a doctor yell at me for transferring his patient to post partum before he had given me the order so the next night I paged him and asked for an order for a water picture, then later for ambulation orders. He yelled at me and I said "well I don't want to do anything without an order" He was silent for a moment and then apologized for yelling at me the day before.
The same type of approach works with nurse mangers. Your manager was so out of line. As an RN you should never take crap from an employer. You can get a job anywhere. I have only had one situation with a manager that was similar to that one. I listened, took a breath and just said, "I understand that is the way you see things. Please consider this my 2 weeks notice I will give you a written letter tomorrow." The situation was rectified and I received an apology when I came in to give my written letter.
Always remain calm and speak matter a factly. Sometimes just staring blankly is effective. As nurses the hospital sees us as expendable so you will rarely be backed up in a confrontation with a doc. Yet we don't deserve to take abuse for simply doing our jobs. We have to find ways to defend ourselves. Just make sure that it's done in a way that doesn't harm anyone. Make it so the doctor and you both know what is going on but that they can't prove you were doing anything to them. If they try to call you on it, don't admit to it just play dumb.

I just love this. :chuckle I almost want to print it off, so I can look up the ideas in case I need them one day.

kadokin, ASN, RN · Nov 30, 2005

My:twocents:

-Doctors are human beings. Does that mean we have to take abuse from them, no. Does it mean they sometimes have difficult personalities, yes.

-No one can make you feel inferior w/o your permission.

-SILENCE SPEAKS VOLUMES. I often use the afore-mentioned technique of sitting quietly while a physician or other fool is having a melt-down. Keep quiet long enough and MOST people start to feel pretty contrite when the only thing they can hear is themselves, acting stupid. Sometime, they are just venting in a delayed reaction to something that has nothing to do w/the current situation. They often will fondly remember someone who just let them rant w/o judgement.

-It is your job to notify the physician of any change in pt. status. 2AM, 2BAD. They may not like it at first, but they really will be grateful if they can keep a bad situation from getting worse, or litigious.

-DOCUMENT, DOCUMENT, DOCUMENT

-Don't know if this is always a good idea, but it usually works for me. NEVER apologise for calling a physician w/a change in pt. status. It wastes time, and makes you look uncertain. There is a very good reason why you are calling the MD. You wouldn't be taking time out of your own busy schedule to do it if there wasn't. Be as concise as possible, just the facts ma'am.

-If you cannnot handle the nasty behavior (especially if you are being berated/insulted in public), you can always walk away. It works a lot like the silence thing. Of course, if md is in the midst of giving you orders, pertinent information, you should stay for that.

-Kill them w/kindness. There is a notoriously nasty doc where I work that can never be pleased. Nevertheless, I do my best to be courteous and accomodating and non-emotional (unlike him) when I have to deal w/him. It is such a hoot to see the look on his face when I DON'T REACT to his baiting and belittling. He just DOES NOT KNOW HOW TO DEAL WITH PEOPLE WHO REFUSE TO TAKE THE DEFENSIVE.

-Sorry for this, but, they have their own issues, too. Many are forced to take ever-increasing pt. loads just to pay the bills and they are busy, busy, busy.

-Take it all w/a grain of salt (sprinkled on the rim of a margarita if necessary).

kadokin, ASN, RN · Nov 30, 2005

MD stands for "ME DOCTOR"
Have to say, being male I do not get the same tudes from these arrogant children doctors. Plus, being a retired cop, I relish the chance to show them how some people simply find it impossible to be impressed by them.
Most docs do not know my history, and man is it funny to see them look at me when I smile at them and their tantrums.
But that is only because I have experiences in dealing with all kinds of people. The more we do it, the better we get. Just know that you are most likely a ton better in the personality and likeability department. That makes for wider smiles just as we fall asleep at night. :)
PS, out of 1000 med students on graduation day, the one with the lowest score is still called doctor! Seems you met that one :)

:yeahthat:

OliveVinesRN · Dec 1, 2005

Hello, everybody, I'm back again.

Well, we had the staff meeting. And I am sad to say that nothing will change for us. The Nurse Supervisor basically said "Well, that's just the way it is" and "every hospital I've worked for has the same kind of doctors, they're everywhere" and finally, "The most important thing is for you all to act professional even when they (doctors) don't"

:bluecry1: So, sadly, we are back to square one. And I resent the lack of initiative the nurse supervisors have on the issue. It's like when doctors behave badly, it's the standard, not the exception. And nurses are expected to hold their cool no matter what goes down. I guess we are not suppposed to matter. We are only there to please everyone and self-sacrifice. I feel more like a waitress working hard for a tip than a nurse. This is not what i expected in nursing.

But, hey, at least I can say that I took a stand. My next move will be out of the door if they continue to ignore the issues that make our job all the harder. It's not as if we don't have enough to deal with.

Thank you, everyone, for responding and saying such encouraging words. God bless each and every one of you.

mitchsmom · Dec 1, 2005

Hello, everybody, I'm back again.
Well, we had the staff meeting. And I am sad to say that nothing will change for us. The Nurse Supervisor basically said "Well, that's just the way it is" and "every hospital I've worked for has the same kind of doctors, they're everywhere" and finally, "The most important thing is for you all to act professional even when they (doctors) don't"
So, sadly, we are back to square one. And I resent the lack of initiative the nurse supervisors have on the issue. It's like when doctors behave badly, it's the standard, not the exception. And nurses are expected to hold their cool no matter what goes down. I guess we are not suppposed to matter. We are only there to please everyone and self-sacrifice. I feel more like a waitress working hard for a tip than a nurse. This is not what i expected in nursing.
But, hey, at least I can say that I took a stand. My next move will be out of the door if they continue to ignore the issues that make our job all the harder. It's not as if we don't have enough to deal with.
Thank you, everyone, for responding and saying such encouraging words. God bless each and every one of you.

That stinks. I hope you are at a point that you will be able to move on to somewhere that you can work with mutual respect if things don't improve.

((hugs))

Bipley · Dec 1, 2005

Hello, everybody, I'm back again.
Well, we had the staff meeting. And I am sad to say that nothing will change for us. The Nurse Supervisor basically said "Well, that's just the way it is" and "every hospital I've worked for has the same kind of doctors, they're everywhere" and finally, "The most important thing is for you all to act professional even when they (doctors) don't"
So, sadly, we are back to square one. And I resent the lack of initiative the nurse supervisors have on the issue. It's like when doctors behave badly, it's the standard, not the exception. And nurses are expected to hold their cool no matter what goes down. I guess we are not suppposed to matter. We are only there to please everyone and self-sacrifice. I feel more like a waitress working hard for a tip than a nurse. This is not what i expected in nursing.
But, hey, at least I can say that I took a stand. My next move will be out of the door if they continue to ignore the issues that make our job all the harder. It's not as if we don't have enough to deal with.
Thank you, everyone, for responding and saying such encouraging words. God bless each and every one of you.

I'm sorry they aren't taking care of their nurses there.

I do have a suggestion for you. Look around and see how other hospitals are. I used to work for Mayo in Scottsdale, Arizona and things were MUCH different there vs. any other place I have ever been.

Example, at least every 30-60 days we were emailed an employee survey. It asked all kinds of quetions. You could respond using your name or you could decline to give your name. We were asked questions such as ... what did we suggest to improve patient care, patient satisfaction, etc, we were asked if there was equipment we needed but were lacking, and we were also asked how we were treated by the docs.

At your typical hospital the hospital is thankful to have doctors. At Mayo the doctors are thankful to be permitted to practice at Mayo. Docs at Mayo are employees just like everyone else. They are NOT extra super duper special, they are employees like everyone else.

If people started complaining about a doc, he found his butt hauled into the Chiefs office to explain his actions. If things didn't improve, he was let go. Same with the NPs, PA-Cs, etc. Honestly, I don't know if they ever followed through and actually got rid of a nasty doc however I never had the kinds of problems I have had at every other hospital such as what you describe.

We were expected to treat one another with the same respect we did our patients and that included the medical staff.

We were not forced to submit our surveys but it was strongly encouraged. If you submitted your survey you would get a coupon (printed from the computer) for a free Dove Bar or some other fattening food at the cafiteria.

Life is much different at Mayo, we weren't ever begging for supplies. If our par wasn't high enough we asked that it be raised. If we ran out of something such as IV start kits we called Central Supply and they brought them up immediately.

My point is that there really are good hospitals out there that care about their staff. Mayo certainly has their share of problems just like *any* large organization. But the typical problems at most hospitals are much better at Mayo.

SmilingBluEyes · Dec 1, 2005

Not so sure passive-aggressive actions are the way to handle docs, dayray. I find a more direct and professional approach works better. But that is just me.

lindarn · Dec 1, 2005

I apoligize that my entire post did not come through. What meant to say was,

MD = MIGHTY DEITY

Also, to comment about the above disrespect that the nurses were supposed to put up with- DOCUMENT DOCUMENT DOCUMENT. Then send copies to administration, the Board of Medicine, and the Board of Nursing, in case you are the victim of retation by the hospital. I would also consult with an employment attorney, and get advice on where to go from there.

I have been told by the Board of Medicine here, that tooo often something goes haywire, the you know what hits the fan, and everyone wants to know why they don't discipline the doctors. They told me that it is difficult to really discipline them, because, like us, their license is their livelihood. They would prefer that nurses write letters to them when doctors behave llike that, and then they can start a "paper trail" on them. Too often, something happens, people call the Board of Medicine, and as far as they know, "Mr. Obnoxious MD", is a model citizen. They have no documentation about them. That is your only weapon. Use it. Also, start refering to you work place as a "hostile work environment".

Lindarn, RN, BSN, CCRN

Spokane, Washington

hipab4hands · Dec 1, 2005

I'm with you. I had to page a dr. late at night. The patient insisted that he was being treated by an Ortho dr. for his injury. I checked my computer and confirmed that the patient was being followed by Ortho. When I got the on call dr. on the line, he started to yell at me, because the patient was actually on the Podiatry service. I tried to explained to the dr. that the computer indicated that the patient was being seen by Ortho and I had no other information to indicate otherwise.

The dr. yelled that this happens all the time and that he was tired of it. I was very straightforward, suggested that maybe he should talk with with dept head about getting the computer codes change, so that we can distinguish between Ortho and Podiatry patients, when we look in the computer.

I explained to him that yelling at me was not going to stop the problem and he needed to deal with his own department, if he felt that strongly about it.

LeahJet, ASN, RN · Dec 1, 2005

Make it so the doctor and you both know what is going on but that they can't prove you were doing anything to them. If they try to call you on it, don't admit to it just play dumb.

I have a ~gift~, if you will, of doing this very thing. I can cut a doctor down a couple of notches...all with a smile on my face. Maybe the southern thing helps.

For instance, a urologist was doing a consult in the ER and he was pitching himself a little fit because a certain thing was not where it was supposed to be. I just treated him like the 5 year old he was acting like. "Well, bless your heart, you're just all upset over this, aren't you? Hold on a minute and I'll help you... it's going to be ok" He just stood there redfaced and confounded and my co-workers were running for cover to let their snickers loose.

Whenever you respond to their infantile tirades, be sure you say and act in a way that would make them sound totally ridiculous if they complained about you. "She said bless my heart and said I was upset!!" At the very most, he could say I was being condescending....~sigh~ isn't that a nice reversal of fortune?

ERNurse752, RN · Dec 1, 2005

I have a ~gift~, if you will, of doing this very thing. I can cut a doctor down a couple of notches...all with a smile on my face. Maybe the southern thing helps.
For instance, a urologist was doing a consult in the ER and he was pitching himself a little fit because a certain thing was not where it was supposed to be. I just treated him like the 5 year old he was acting like. "Well, bless your heart, you're just all upset over this, aren't you? Hold on a minute and I'll help you... it's going to be ok" He just stood there redfaced and confounded and my co-workers were running for cover to let their snickers loose.
Whenever you respond to their infantile tirades, be sure you say and act in a way that would make them sound totally ridiculous if they complained about you. "She said bless my heart and said I was upset!!" At the very most, he could say I was being condescending....~sigh~ isn't that a nice reversal of fortune?

LOL, Leah...I used to work with a nurse from the South, and she could do just what you're describing. It was great! :lol2: