Difficult Doctors...Vent

[joanna73, BSN, RN]

Hi Everyone

Early this morning, I called the MD to inform him that a resident had very low urine output (60 ml in about 6 hrs). The resident was very lethargic, distended abdomen, constipated. The Dr as usual was annoyed, did not want any info, and kept cutting me off as I was attempting to give report. His demeanor is nothing new, and he treats the nurses like we're morons. However, I feel I have a duty to report when I know that something is off. If the Dr chooses not to follow up, at least I know I did my job. Another time, a resident fell. The resident was fine, but I called the Dr before I went off shift to let him know. Again, Dr was annoyed. This Dr does not make rounds either, so if we didn't inform him of certain instances, he would never know. I just cannot believe how disrespectful and unprofessional this man is! It is very hard to work with him, and we all dread when we have to call...

[Isitpossible, LPN, LVN]

Hi Joanna, i have no advice as im still a student. But I do have a question. In situations like this, when the nurse is not feeling that MD is listening can the nurse call another MD? Like, what is the protocol. We are suppose to advocate for our patients, so whats a nurse to do when their not being heard?

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

If he doesn't want to participate in the human race (pun intended), just blow him off. Do, however, always chart Dr Notified, no orders received, or something similar. It's docs like this that will be the first to blame a nurse if somebody gets a knot in their knickers over something. Keep in mind also that the outward face we show the world reflects our inward atmosphere, and he surely must be a miserable person. Pity him, and take the high road. Good luck.

[joanna73, BSN, RN]

Yes we are supposed to advocate for our patients, which is why I will call when I feel I need to, regardless of their attitude. It depends where you work. We have one on call Doc at night, and he was it. I groaned when I saw who it was. The other Docs are fine. It's just him who is a problem. So there isn't much we can do in that situation. And no, he did not give any orders. He hung up and came maybe 3 or 4 hrs later. So, I guess I shouldn't bother this man unless the resident is dead...NOT!

[joanna73, BSN, RN]

Yes I am always very nice and professional regardless. I know I need to cover my butt, which is why he will be called regardless, and I chart it. It is Docs like this who will screw you either way. Can't win. I don't let him get to me that much, lol. I really think he is a pathetic man.

[Isitpossible, LPN, LVN]

wow, thanks for answering me, i really appreciate it..it seems i read comments like these alot here on allnurses...in the first situation you described, sounded serious, (i dont know why i kept thinking kidney failure!), and to get a lack response from a doc would make me very very angry..of course you will document your actions to cya, BUT documentation wont save the patient? do you understand what i mean...AND if he habitually has a bad attitude, who can the nurses address this issue with......just doenst sound like a very healthy professional environment with that doc..

[joanna73, BSN, RN]

I have had to call him back in other instances because he hung up. Or say..."Wait a min, I'm not finished. However, since the vitals were ok, I let it go. An hour later, the pt had voided a bit more, and was responsive. So it was probably ok...this time. He did not even ask for the vitals, though. Just cut me off. Click. Grrrr, But I charted, "Dr notified and aware of pt condition."

[carolmaccas66, BSN, RN]

Can you call another doctor re the patient? A specialist maybe?

I'd be making a quick, anonymous call to the medical director about this - or get a few nurses together to complain - and get something done.

You know, it always AMAZES me when doctors don't like being bothered re patients (even when something is urgent), they don't like being called during the night, they don't like having pagers, they don't like nurses annoying them (or anyone else who isn't a senior doctor), they dislike being on call - you know what I've said to their face? You're a DOCTOR! You chose to go into this profession! These are YOUR patients!

I'd be documenting everything - even the phone call and verbatim what he said, then I'd be reporting it to your NUM, if they care to do something about him. One of those patients is in acute renal failure and needs to be assessed.

Call a nephrology doctor for a consult instead.

One of my gf's told me years ago when her Dad was in hospital with exacerbation of PD, she found the nurses too aggresssive and didn't take things seriously. I tried to explain sometimes we HAVE to be, cos we're advocates (it fell on deaf ears, my gf is not exactly intellectual), but are we TOO aggressive I wonder? Many interns told me the nurses scared the s**t out of them.

ADD: Joanna, I've actually had to say to a doctor like yours: 'Listen mate, get your butt over here NOW, or I'm reporting you to the medical director for breach of contract!' (or something like that). He came to see the patient almost immediately. Would that work?

[glencovediva]

I would report him.

[joanna73, BSN, RN]

I would love to report him. He should be reported and everyone knows it. I don't know if anyone has. Even my NM thinks he's a jerk. But I am a new nurse, so you can see how this presents a bit of a problem. I think we should all start a running list, sign it, and send it to the appropriate people. He has been practicing this way for years, from what I understand. And my residents are old. So it matters.

[DavidFR, BSN, MSN, RN]

Do you have an administrator on call who you can call to inform that you have a colleague refusing to do his/her job? I would always go as far as informing the most senior person on call if you get no joy in getting a doctor to see a patient you're concerned about, whether that be administrator, senior medical cover or nursing supervisor.

This is a common night duty/weekend/public holiday problem in all settings. If you're genuinely concerned about a patient's condition you ring every person possible until your patient is reviewed by a doctor. You ignore any personal insults - I was once screamed at and called incompetent by an irate intern for "calling her for nothing" - she soon shut up when she actually saw the patient who ended up being transferred to ICU where she died three hours later. I have often asked on-call docs why they bothered accepting an on-call if they don't want to do the work required. They'll readily accept the money.

I fully agree with the poster who said write down who you've called and when. Document everything, and if you suspect trouble, take a photocopy for yourself.

[Isabelle49]

All should view the Joint Commission website. At one time there was a big to do about docs that were rude to nurses and that this action can and does cause errors that in turn causes patient injury. Was a good article.