How to deal with physicians effectively

Aeterna, BSN, RN · Jul 13, 2012

I agree with the person who said to ask your charge nurse if you are unsure! Or, ask any nurse who has been on the floor and working with these doctors for a while because they will know when the doctor would like to be called for what reasons. Or even if I know the doctor's habits and preferences, if I'm still unsure about making the call or not, I still ask the more experienced nurses for advice.

That being said, sometimes, you have to just let things slide. You're there to help your patients, not make doctors happy. We have one doctor who works on our floor who is always quite blunt and often rude, no matter what, so we all know to let it roll off our backs. We know it's nothing we did wrong because you could have all your ducks lined up and sorted, and he'd still be PO'd about being called.

And sometimes, doctors freak out on your for things that are not your fault but more because the circumstances are frustrating. For example, I had a resident yell at me because I needed admitting orders on a patient, but she was never informed about the transfer of care (or even who the patient was and what they were in with), although she did apologize to me after she was finished ranting and collected herself. It's similar with patients who are frustrated with their situations - they will often take out their feelings on the nearest target, which is often the nurse.

But, never be afraid. It might take time to build up your confidence if you're new. For example, we have another doctor on our floor who is usually very nice and has a good sense of humour, but if things aren't going well, he can get grumpy and take it out on the nurses. The nurses who have worked on our floor for a while have the confidence and the professional relationship with him to ask light-heartedly, "Why are you so grumpy today?" and it sort of forces him to realize how he's acted and when he's ready, he will be genuinely apologetic. When I was new, I never would have thought to do that, but now that we know each other, I don't fear him at all and know how to deal with him if he has a "grumpy" kind of day.

Lastly, if a doctor truly is being very rude and downright acting horribly, report him/her! We've had doctors abruptly hang up on us, we've had doctors needlessly threaten our licenses, we've had doctors absolutely refuse to address a very real concern. We have reported them and their unprofessional behaviour.

Maremma · Jul 13, 2012

What about on call Dr's? I am confused on what to do about them? Do we report them to the DON or what? And if so what good does it do anyway? What can they do to make a Dr be more reasonable in how they speak to us and what they will and won't do anyway?

We have one regular Dr that left specific instructions that if Dr so and so is on call we are to bypass that Dr and call the regular Dr's cell phone instead. even other Dr's don't like one of the on call Dr's and doesn't want them to have any input on their patients. (can't say I blame him after actually dealing with this one) She is vicious beyond measure. She will grill you like the spanish inquisition and ask you if you are stupid or lazy or some other nasty thing if you can't answer her fast enough and if you can't answer her at all she gets even worse screaming at you how incompetent you are and did we get our license out of a gumball dispenser! Then you take all this abuse from her and she doesn't help you anyway! She tells you "Well I can't make the decision on that, you have to call their regular Dr in the AM"

I would guess the regular Dr's speak to the on call Dr's to get report from them on anything we called them for right? I am guessing this lady Dr is just as nasty to the regular Dr's as she is to us if the regular Dr would prefer we call his personal cell phone on his "off time" rather than have her involved with his patients at all?

One nurse I work with actually started crying when she saw who was on call and she had a patient that was declining. I had to make the call for her because she began to hyperventilate when we were forced to call her. Yep sure enough she seemed set on trying to humiliate me and make me crack. I personally was not intimidated by her bullying but I can see why my coworker was such a nervous wreck at just the idea of having to deal with her. She is an outright lunatic. This Dr seems to need to go see a psych Dr.

Ruby Vee, BSN · Jul 13, 2012

apologize. you know you called the doctor more than you needed to, and it doesn't sound as if he was "rude and brutal" as much as exasperated with your pestering. then figure out how you could have handled things differently next time. when in doubt, run it by your charge nurse. you're in the wrong here, not the doctor. so do the grown up thing and admit it to the doctor. if he seems open to it, ask him about his preferences for being called.

dirtyhippiegirl, BSN, RN · Jul 14, 2012

I agree with the person who said to ask your charge nurse if you are unsure! Or, ask any nurse who has been on the floor and working with these doctors for a while because they will know when the doctor would like to be called for what reasons.

Yeah...right...until you're working with nurses that value their license over anything else. (Not necessarily a wrong thing to do.) One of these days, you'll ask "Should I call about this?" and get that carefully studied, blank look from your charge.

Born_2BRN · Jul 16, 2012

A tip for the future:
Please have all issues regarding a patient ready when you call us instead of making multiple calls. It really does make things so much easier and, for residents who're on call and maybe trying to catch an hour nap when things quiet down, it really is a blessing when a nurse pages you only once instead of interrupting your sleep by paging you multiple times regarding the same patient. This is especially true when we're on night float or on-call since the intern or resident is easily cross-covering 70+ patients. Depending on specialty, interns can easily be covering more than 100 patients on any given night. So that's a lot of people we're trying to keep alive till the day team shows up and any help/cooperation from the nurses goes a loooooong way in helping things out.

I understand what you meant and I do try my best to have issues together before calling. However, that is not always the case, especially when 2 to 3 of your patients have the same attending. In this case usually their needs are different and I do not want to wait until evening to call when all these patients' needed are jotted down in my note. Believe it or not I rather all of my patients have different attending physicians. Make my life as a nurse easier.

Born_2BRN · Jul 16, 2012

apologize. you know you called the doctor more than you needed to, and it doesn't sound as if he was "rude and brutal" as much as exasperated with your pestering. then figure out how you could have handled things differently next time. when in doubt, run it by your charge nurse. you're in the wrong here, not the doctor. so do the grown up thing and admit it to the doctor. if he seems open to it, ask him about his preferences for being called.

r

ruby, i thank you for your input. i did apologize for calling him with this very same issue. the problem he didn't like me calling was he had 3 of my patients. their needs were different and arise at different time. i did what i knew best call if it needed to be address during my shift and when i had time. not another 2 hrs with a new admission on the way or pass it on to the next shift. that is a no no. i can get a written up easily. i never said he is in the wrong. i am a grown up and yes i did my job.

i also would like to mention. although your charge nurse can be a valuable source of information, often they are not really helpful. i had asked one of them about a certain issue at one time and they suggested i call. i got yelled. now i have learned listening more to myself. i look up stuff i do not know or familiar with.

turnforthenurse, MSN, NP · Jul 16, 2012

I don't think I would have called with a Cr of 1.8 unless there was a big jump based on their previous Cr level. If you are ever unsure of when to call a doctor, ask either your charge nurse or one of your coworkers.

As for dealing with rude doctors, you eventually just get used to it. There is one physician in particular where I work whom I HATE calling. If it's early in the evening, or if he is on the unit I can approach him with questions, but if I have to call him later on in the evening or at like 0200, I dread it. I called him once at 0300 because his patient's BP was in the 170's/100's, had no PRN orders. Was afraid the patient would stroke out. That MD proceeded to ask me, "why are you monitoring my patient's BP at 0300? I would be ****** if you were doing that to me, so STOP monitoring the BP! *click*" I was upset and livid. I called my supervisor and told her what happened, and she said to just document and also put the incident in our reporting system. The next morning that same MD was in the ICU complaining about me and that I called him at 0300...and the ICU manager went to bat with him, telling him, "what else was she supposed to do? She was doing her job" and he replied, "well but she still shouldn't have called, blah blah blah."

turnforthenurse, MSN, NP · Jul 16, 2012

R
Ruby, I thank you for your input. I did apologize for calling him with this very same issue. The problem he didn't like me calling was he had 3 of my patients. Their needs were different and arise at different time. I did what I knew best call if it needed to be address during my shift and when I had time. Not another 2 hrs with a new admission on the way or pass it on to the next shift. That is a no no. I can get a written up easily. I never said he is in the wrong. I am a grown up and yes I did my job.

This is true. A majority of our patients are hospitalist patients, and on nights we only have one hospitalist on call. There is our floor and then of course our MS units and ICU with hospitalist patients. I have never really had a problem with them and I think it's because they are used to being called a lot on nights, but I notice they do get a little irritated when you call for one patient and then a few minutes later you call for another one. But sometimes that just can't be helped. Do you have a text paging system? We recently implemented that and our hospitalists LOVE it. Unfortunately it only works for our hospitalists and not for the other docs. My coworkers and I also pool together and will ask each other if anyone needs to call the hospitalist (or another physician if they have more than one patient on the unit) that way they get less calls from us.