How to handle condescending doctor

caliotter3 · Mar 13, 2018

I agree, I would have taken the hint and shut up. Sometimes it takes others to show us we are straying into left field.

Alex_RN, BSN · Mar 13, 2018

There are some smart replies to this post worth learning from, but don't dwell on this incident. Managing your MD relationships gets easier with even a little experience and this microscopic blip will be forgotten soon enough. When you are on your unit, you will know your doctors better. You will trust them and vice versa.

Also, I would never look agitated or overly concerned in front of family. Calm, competent, and compassionate on the outside no matter what is going on in my head.

iluvivt, BSN, RN · Mar 13, 2018

I agree that the nurse should have kept her mouth shut! The patient and the family was being given some life altering news and the doctor was being sensitive to this fact and the nurse was not.Had I done that I would have apologized to the physician

bsyrn, ASN, RN · Mar 13, 2018

I Have to agree with the Doc on this one :)

Irish_Mist, BSN, RN · Mar 13, 2018

I actually agree with this physician. She should have kept quiet and spoken with him in private.

Have Nurse, ADN, RN · Mar 13, 2018

I don't know. It sounded as though he was being cognizant of the emotional state of the family. I can't fault him for that. And frankly, in this culture we seem to have a need to talk over, or keep talking to someone who has already made it clear he has a plan. He was being more protective than "condescending."

The nurse may have had experience, but wisdom should have shut her up until she could speak with him privately.

When I was serving in the military, in Basic, if we interrupted, or talked over the Drill Sargeant, we paid for it.

In Nursing, there are times when it is appropriate to open ones' mouth, and to keep it shut.

I support the doc on this one....

Crush · Mar 13, 2018

I would have taken the hint and shut up. Actually, I would have discussed it with the doctor privately to start out with. It's up to the physician to "translate" that information and present it to the family in a way that's meaningful to that patient's care. Throwing random "bad" statistics out isn't doing anyone any favors. They need to understand what the numbers mean ...and in some cases, they don't mean much on their own.

As a student, use it as an opportunity to learn. Look at it from the perspective of the family. I'm sure they know the pt is ill; however, if the family has no medical knowledge and they hear the nurse (frantically?) say "but his heart rate is low..." it IS likely to create more stress for the family. Continuing to push the abnormal VS on the doc could only make it worse for them. Sure, if the pt is hemorrhaging or she is in V fib make sure the doctor hears you and the appropriate things start to happen. In the situation you describe, however, listen to the doctor when he/she asks you to not rattle off the vitals, and catch up with the doc outside of the room.

I agree with the above. I would not have mentioned the vitals at all in front of the family though. I would have spoken to the doctor after or before going into the room with any concerns I may have had, never in front of the family. As someone mentioned if they were an anxious family and heard that, there is a chance they may become more anxious and become more difficult to deal with and explain things to.

nursemike, ASN, RN · Mar 13, 2018

I'm not sure how I would have handled the situation. But it made me angry and I like to think I would have stood up for myself. What would you have done?

I think it's important to recognize a difference between standing up for oneself and reacting defensively to criticism. Obviously, I couldn't hear the doctor's tone of voice, but I see nothing condescending in the statements quoted.

TriciaJ, RN · Mar 13, 2018

Also, we don't know which, if any of the family members had HIPAA clearance. That means the doctor must educate and reassure without crossing that line. It can be a delicate situation. All it takes is one family member with a bit of information and an axe to grind to set off a whole ****storm.

SpankedInPittsburgh, DNP, RN · Mar 13, 2018

I agree with most of the sentiments here. I work in an ER and have excellent relationships with my docs. I have interrupted such family / doc conversations but only when I thought the information was pressing and not readily available. All our patients are on a monitor so the vitals would be right in front of his face so I've never faced this exact situation. I usually try to take the doc aside and communicate new info I was following and awaiting results for (labs, imaging, medical records from other facilities...). Interjecting in such a situation is rarely a good idea and I think may lead to confusion for the family as to who actually is the decision maker

Mavrick, BSN, RN · Mar 13, 2018

I'm a 2nd career nursing student and here is a situation I witnessed in clinical last week. I was in a patient's room with my nurse who is not an inexperienced but who looks very young (I don't know if that had anything to do with this doctor's behavior).
Anyway, the patient was in kidney failure, very edematous, and had three family members at the bedside. There had been an issue with very high BP, but the most recent reading wasn't too alarming. However her heartrate was low, around 50. The doc (he's a hospitalist) walked in, was talking to the family about the patient needing to start dialysis, etc. He answered their questions, then the nurse said, "Oh, her BP was xxx, but I---" The doc said, "Got it, I'll check the computer," and glared at her. Then the nurse said, "But her heartrate is low--" and the doc cut her off again, "I SAID I'll check the computer," with another glare and a hand gesture meant to shut her up.
So we all finished up in the room and the doc said to the nurse, "I need to talk to you in the hallway." I stayed in the room, but I could overhear him telling her, "When I tell you to stop talking you need to stop talking. This family is stressed out and I don't need you adding to their stress. I can easily check the computer for her vitals." I moved further back into the room so I couldn't hear her response.
If anything, I think the doc's attitude toward the nurse and him glaring at her would escalate the family's stress, more than the nurse reporting the pertinent info.
I'm not sure how I would have handled the situation. But it made me angry and I like to think I would have stood up for myself. What would you have done?

Excellent, professional communication by this doc. If that nurse keeps interrupting him in front of family with inappropriate facts it could get a lot messier.

You may have over reacted to a "look" that may have required a "glare" to get Chatty Cathy to SHUT UP.

chacha82, ADN, BSN · Mar 13, 2018

He was rude, file him away in your "Rude Doctor" list and move along. However, I also would have stopped talking when he told me the first time.

Many doctors are in a hurry just like we are in a hurry. A very wise nurse told me once if a doctor gives me attitude it's their issue, not mine. And it is so not our problem if he is rude or gruff. Just make sure you don't talk to anyone like that. There will be plenty of other things during the day that need your attention.

Also! You never know but maybe this MD was burned by this RN in the past or another one who stirred the pot with this family or another, whether they meant to or not. It is a major reason I refer questions about results, history, etc to the MD. Even though we can see results or info in the chart, I was taught it's not in our scope to disclose them.