Dealing with grumpy physicians

when i was a new grad i was in a pacu. we had a chief of surgery who was known for being a bear. he brought in a massive abdominal mess with irrigations going in and drains going out every which way. he wrote for the antibiotic to irrigate in with but didn't specify what solution to put it in. i reasoned that d5w was a bad idea, giving bacteria glucose to feed on, so i hung it in ns with the approval of my preceptor.

when he returned to see the guy i told him what i did and why. he stared at me, harrumphed, ordered transfer to icu and stalked out. on his way he wrote for it to go in d5w but we didn't get a chance to change it before the patient went to icu... and i heard later that night that he changed it to ns immediately afterwards while the patient was en route there.

what i learned there was that sometimes ego is more important than patient care, and putting a nurse in her place for thinking is more important than patient safety...but also that the docs aren't usually stupid; they just don't want you to know they recognized you were right, so they harrumph and tantrum. forget it.

I am never over friendly with ******* docs. If they are being *******s I keeps a neutral tone of voice or stone face (depending on the setting) and only deal with facts, if he refuses one of my suggestions I ask for his, if he does nothing and I feel something should be done I pass it to my charge and let her do what she thinks is best. There is more than likely a reason for him being an ass but that doesn't excuse the behavior so unless I feel completely abused by the doc I ignore the behavior. You are an adult and have the right to be treated as such but sometimes you just have to pick your battles, if a patient is at risk because you feel the doc isn't doing enough, THAT would be the battle I would take, anything else, let it roll off your shoulders but don't be super nice and reward his poor behavior. Sometimes being super nice to someone being an ass can make you look weak and they will continue with the behavior. And I am in no way saying I agree with my last statement but I know there are people who think this way.

"What medical school did I go to" was the question I was asked by a snippy MD one night eons ago.

I had to call him for a significant change of status for one of my LTC residents. He ordered Vistaril 100 mgm IM for her restlessness/confusion. It took me by surprise and I took a moment to tell him she was 99 yrs old and barely weighed 99 lbs. That's when I got the med school comment and then he hung up.

I piddled around a few minutes as I was getting ready to phone my DON on call because I was so uncomfortable with the order. The phone rang and it was Dr. Snippy calling back with Vistaril 25 mgm and orders for UA and CXR. I just said, "thank you very much for calling back".

As GrnTea posts, some MDs are just very touchy about nurses making specific recommendations specifically, like we're practicing medicine. Now, I'm very careful about suggestions --- I'll just ask if they'd consider a steroid or a cough suppresssant WITHOUT NAMING A MED by name. They seem more accepting of my directive suggestions. This works best for telephone interactions; when it's in-person with MDs, I can be a little more direct as I've established myself with them. And then, some MDs have had really bad experiences with dingbat nurses that have tainted them.

Yeah, it's playing a game, but it seems to work for me. And I haven't had any real negative encounters in a looong time.

"I try to just let it roll of my back but in the back of my mind it still bothers me. I try to kill him with kindness and be polite and never have I once been disrespectful or rude towards him; he just makes me feel like I'm an idiot at times."

You can bet the rent Dr. Jerk is not letting this bother him. Killing him with kindness is most certainly seen as cow-towing... and he will never gain respect for you.

When an issue arises with Dr. Jerk's patients, notify him in a crisp professional tone of voice, using the SBAR format. However, I would not make any suggestions toward the treatment. Let him sweat that out. If you don't get the order you wanted or expected.. go up the chain of command.

Do NOT let him make you feel like an idiot. He is just blowing off his responsibility to his patients and ignoring your worth as a nurse.

I am a new grad and I find these threads very interesting. This is the 3rd or 4th thread where I have seen a nurse explain that the MD basically threatens, or actually moves their patient to ICU. Basically implying that the nurse on the floor is incapable of caring for their patient. Does this really happen that often? That MDs will move their patients to ICU because they don't like the response they get from the RN? This is seriously at least the 3rd time in 2 weeks that I've seen that in a post!

I'm sure every case is different but I'm willing to bet the RN wanted action taken earlier and the doc declined and later found out the patient actually needed an intervention and now required ICU care, and instead of admitting their error they blame the patients poor condition on the nurse. I work at a large teaching hospital and doctors don't get to transfer patients to the ICU and waste beds on non critical patients just because they don't like the nurse.

I am a new grad and I find these threads very interesting. This is the 3rd or 4th thread where I have seen a nurse explain that the MD basically threatens, or actually moves their patient to ICU. Basically implying that the nurse on the floor is incapable of caring for their patient. Does this really happen that often? That MDs will move their patients to ICU because they don't like the response they get from the RN? This is seriously at least the 3rd time in 2 weeks that I've seen that in a post!

You're misinterpreting the OP. What happened is what usually happens in this particular situation -- the RN wants to transfer the pt out to a higher level of care but the primary team/doc resists. (Mostly stems from a control issue in my hospital at least.)

You're misinterpreting the OP. What happened is what usually happens in this particular situation -- the RN wants to transfer the pt out to a higher level of care but the primary team/doc resists. (Mostly stems from a control issue in my hospital at least.)

I wasn't referring to the OP. I was referring to Grntea's post, and others that I have seen lately. :-)

Thanks for your replies, everyone. I was talking to some my coworkers about this at work and I guess it isn't just me, this MD gives an attitude with everyone. I just wish he would give a simple yes or no answer instead of stating matter-of-factly why I'm wrong and basically making me feel like I'm an idiot.

I am a new grad and I find these threads very interesting. This is the 3rd or 4th thread where I have seen a nurse explain that the MD basically threatens, or actually moves their patient to ICU. Basically implying that the nurse on the floor is incapable of caring for their patient. Does this really happen that often? That MDs will move their patients to ICU because they don't like the response they get from the RN? This is seriously at least the 3rd time in 2 weeks that I've seen that in a post!

The nurse isn't incapable of caring for the patient. Patients are moved to ICU because they can be monitored more closely. Last week I had a patient admitted for pneumonia but the docs couldn't figure out why the patient's ABG was getting worse. Chest CT and X-rays were pretty unremarkable. The patient was young, pretty much a walkie talkie but was very tachypneic at times and required continuous BiPAP support. The patient must have been feeling VERY crappy prior to me taking care of him because the patient reported to me that they were were feeling much better. The pulmonogist came by to see the patient in the evening and made the decision to transfer the patient to ICU for closer monitoring, not because I was incapable of taking care of the patient. ICU wasn't happy with me because they were already short-staffed but that wasn't my decision, it was the MD's decision. ANd it was better for the patient.

"... mds will move their patients to icu because they don't like the response they get from the rn?"

yeah, great, and then we get to deal with them. believe me, if they're jerks with you in ltc or on the med-surg floor, they're jerks to icu nurses too. but no, the patient isn't moved because of that. they're moved because they actually need a higher level of care.

most of the docs i work with are fine. some are great. some of the very important physicians at my hospital are some of the nicest, most professional people you could hope to find. and then, there are the others. we have one surgeon who gets red in the face and bellows his outrage on a regular basis, in situations where everyone else would be perfectly reasonable. the result is, no one cares about keeping him happy, because we all know he'll never be happy. he's been known to throw cups of coffee. of course, it's because "he cares so very much about his patients":rolleyes:.

do your job. protect your patient. protect yourself by doing what you're supposed to do. as my manager expressed it, she can defend a nurse who's, say, making a phone call in the middle of the night for something the doctor deems unnecessary. she can't defend not making the phone call for something that is.

it's a shame some people spew nastiness like that. seems to me you did exactly right, and that doc is just a jerk.

"... MDs will move their patients to ICU because they don't like the response they get from the RN?"

Yeah, great, and then WE get to deal with them. Believe me, if they're jerks with you in LTC or on the med-surg floor, they're jerks to ICU nurses too. But no, the patient isn't moved because of that. They're moved because they actually need a higher level of care.

Most of the docs I work with are fine. Some are great. Some of the Very Important Physicians at my hospital are some of the nicest, most professional people you could hope to find. And then, there are the others. We have one surgeon who gets red in the face and bellows his outrage on a regular basis, in situations where everyone else would be perfectly reasonable. The result is, no one cares about keeping him happy, because we all know he'll never be happy. He's been known to throw cups of coffee. Of course, it's because "he cares so very much about his patients":rolleyes:.

Do your job. Protect your patient. Protect yourself by doing what you're supposed to do. As my manager expressed it, she can defend a nurse who's, say, making a phone call in the middle of the night for something the doctor deems unnecessary. She can't defend NOT making the phone call for something that IS.

It's a shame some people spew nastiness like that. Seems to me you did exactly right, and that doc is just a jerk.

I guess that's with everywhere you go regarding grumpy physicians...we also have another one who can have a really nasty attitude but this MD works days and I work nights :)

And that is vey true with calling - even tho I hate getting chewed out, I would rather call for something *I* think is important vs. not reporting anything and then later it falls back on me. That happened to me...and the nurse manager went to bat with the physician the next morning. His response, "well she still shouldn't have called.". He was a high and mighty cardiologist...*eyeroll* basically his patients need to be dying or on their way for him to pay attention to you. It's sad, really, and bad for the patients, too.