Dealing with MD vs MD; and being stuck in the middle

Published

Specializes in Critical Care.

I recently had a very uncomfortable situation with two MD's in my unit yesterday that has left me feeling hurt, angry and simply stuck in the middle of something that I have no control over and I cant get it off my mind. I have been an RN for almost 4 years now and I have dealt with some uncomfortable situations with co-workers and MD's but not at the level that I experienced yesterday and I really don't know how to deal with this both externally at work and internally within myself.

Here is what happened, Please give me some feedback on what you think and how you would handle it.

I work in a high acuity Neuro Surgical ICU, and we have very complex patients, we have neuro critical care intensivists who like to manage all aspects of the patient. They rarely ask for consultations for other specialties but some patients who become very complex, they ask for the consult. There are some known conflicts between our neuro MD's and the pulmonary MD's and I feel that I have been put in the middle of two of them, which is very unsettling for me. The Neuro MD (MD P.) told me that he knows MD B. from pulmonology was looking for things to bring up to discredit his work, I could tell by his tone of voice and his attitude he was very irritated at the situation. I tried to be a non-partisan to the issue and simply told him that I was sorry that it was happening. But yesterday MD P. accused me of going behind his back and asking MD B for orders on a complex patient that they happened to be consulted on. MD P told me that he would report this to my manager; that I was trying to practice out of my scope and that I was going behind his back for orders on his patient. He told me that I was a really great RN and that he really likes my work and care I provide and thinks I am very smart but that if there are things that need to be addressed with the Pt, that I talk with him about it.

My conversation with MD B previously had been questions about what he thought about a specific situation regarding a Pt's DVT and he asked me for my thought on things that the Pt may need, I mentioned swelling in the Pt's extremities and that the right was more than the left (which I also told MD P. about but he was not convinced it was important to the current treatment at the time). MD B ordered Ultrasounds on all extremities for the Pt and told me that he would address it.

I told MD P. that MD B. had ordered the US and he was irritated about it but told me he would talk to him about the situation and told me that his current treatment of the Pt would not change currently even if more were found. At that time he accused me of nothing until a day later when he spoke to me about it. I told him that I did not ask for any orders but that I simply told MD B what I saw and asked him a few questions about probability of additional DVT's.

After MD P confronted me, I was very upset. I tried to act like it didn't bother me, but I do not hide some things well, I was very tearful the next few hours and his words kept swarming my mind and I couldn't believe that he was accusing me of this, His words were so hurtful to me. MD B ended up coming in to see the Pt later in the afternoon and he immediately told me that MD P spoke to him about the situation and was very upset about the order and his participation in the case. I was already upset and almost on the verge of tears and he saw it in my face, he asked me what happened and what was said to me. I tried my best to hold it in and I told him that I was told what was said to me and that I did not want any part in whatever the two of them had for each other. MD B was sorry that his actions caused this for me and he would talk to my manager. I told him that at this time I would like to say nothing to my manager about it and that I would approach the issue as I felt best, he then accepted that decision. For the remainder of the shift I was very not myself, MD P approached me and asked me if there was anything I needed to say and said that I was acting very snobbish. I told him that I had nothing to say, I just did not feel that I had the right words to explain the way I felt about this and I needed time to think about how to understand this situation.

MD P asked to speak to me at the end of the shift on his way out, I agreed and he told me again that he really likes me and that I a great RN, but that if there is something that his patient needs, address it with him and not another MD. It took a lot of nerve to come up with any words that would make sense coming out of my mouth at the time but I managed to say that before he starts accusing people of things he needed to understand the RN role, that if a MD; any MD asks us what we see and what things we think, we will always tell them and report the information. He said to not take his previous words in the wrong way and not to get upset about them and that he did really like me and how I provide care to our Pt's.

But even after the conversation I still feel so hurt by the words he spoke, they sting and that I am not able to get rid of. I feel that I am getting in between two MD's, one of which has been known to start drama and I want no part of if.

I want to tell my manager about it but I am unsure if I should. I am only sure that I want absolutely no part in this squabble and drama because I am the one that got hurt and I am not ok with this feeling. This whole situation sounds like an episode of grey's anatomy or something and I want out!!

Up Vote Up Vote ×

I would tell. He called you "snobbish?" That has NOTHING to do with patient care at all and wildly inappropriate.

Up Vote Up Vote ×

Document EVERYTHING. All of your interactions with these docs need to go as verbatim as possible into the notes that you write up in the patient's chart. DO NOT play that game. Get your managers involved. What these docs are doing isn't safe.

Work is no place for a ******* match. These gents need to zip up their pants and act like adults, and it may take a manager to bring that about.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I have a really good answer and suggestions but I need to mkae dinner...I'll be back. You did nothing wrong and if they can't get along and communicate it's not your problem.

Up Vote Up Vote ×
Specializes in Critical Care, Education.

I am hearing more and more about the conflict between hospitalists/intensivists & other physicians. This type of situation is becoming more and more common.

OP needs to involve her manager. This situation was not personal it was not about her ... it was a physician issue that boiled over on her. The manager needs to intervene; work with medical staff to establish ground rules & enforce the rules. The nurse does not work for the physician.... we work for the patient. Disruptive physician behavior (like this) poses a very real danger to the quality and patient safety.

Hospitals in my part of the country are implementing rules that require physician-to-physician communication, particularly when multiple consultants/specialists are involved. For example, if a physician wants a specialty consult s/he must contact the other doc personally rather than just write an order. The specialist is responsible for checking with the attending/admitting physician before writing orders. Failure to follow the rules will result in disciplinary actions.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I recently had a very uncomfortable situation with two MD’s in my unit yesterday that has left me feeling hurt, angry and simply stuck in the middle of something that I have no control over and I cant get it off my mind. I have been an RN for almost 4 years now and I have dealt with some uncomfortable situations with co-workers and MD’s but not at the level that I experienced yesterday and I really don’t know how to deal with this both externally at work and internally within myself.

Here is what happened, Please give me some feedback on what you think and how you would handle it.

I work in a high acuity Neuro Surgical ICU, and we have very complex patients, we have neuro critical care intensivists who like to manage all aspects of the patient. They rarely ask for consultations for other specialties but some patients who become very complex, they ask for the consult. There are some known conflicts between our neuro MD’s and the pulmonary MD’s and I feel that I have been put in the middle of two of them, which is very unsettling for me. The Neuro MD (MD P.) told me that he knows MD B. from pulmonology was looking for things to bring up to discredit his work, I could tell by his tone of voice and his attitude he was very irritated at the situation. I tried to be a non-partisan to the issue and simply told him that I was sorry that it was happening. But yesterday MD P. accused me of going behind his back and asking MD B for orders on a complex patient that they happened to be consulted on. MD P told me that he would report this to my manager; that I was trying to practice out of my scope and that I was going behind his back for orders on his patient. He told me that I was a really great RN and that he really likes my work and care I provide and thinks I am very smart but that if there are things that need to be addressed with the Pt, that I talk with him about it.

My conversation with MD B previously had been questions about what he thought about a specific situation regarding a Pt’s DVT and he asked me for my thought on things that the Pt may need, I mentioned swelling in the Pt’s extremities and that the right was more than the left (which I also told MD P. about but he was not convinced it was important to the current treatment at the time). MD B ordered Ultrasounds on all extremities for the Pt and told me that he would address it.

I told MD P. that MD B. had ordered the US and he was irritated about it but told me he would talk to him about the situation and told me that his current treatment of the Pt would not change currently even if more were found. At that time he accused me of nothing until a day later when he spoke to me about it. I told him that I did not ask for any orders but that I simply told MD B what I saw and asked him a few questions about probability of additional DVT’s.

After MD P confronted me, I was very upset. I tried to act like it didn’t bother me, but I do not hide some things well, I was very tearful the next few hours and his words kept swarming my mind and I couldn’t believe that he was accusing me of this, His words were so hurtful to me. MD B ended up coming in to see the Pt later in the afternoon and he immediately told me that MD P spoke to him about the situation and was very upset about the order and his participation in the case.

I was already upset and almost on the verge of tears and he saw it in my face, he asked me what happened and what was said to me. I tried my best to hold it in and I told him that I was told what was said to me and that I did not want any part in whatever the two of them had for each other. MD B was sorry that his actions caused this for me and he would talk to my manager. I told him that at this time I would like to say nothing to my manager about it and that I would approach the issue as I felt best, he then accepted that decision.

For the remainder of the shift I was very not myself, MD P approached me and asked me if there was anything I needed to say and said that I was acting very snobbish. I told him that I had nothing to say, I just did not feel that I had the right words to explain the way I felt about this and I needed time to think about how to understand this situation.

MD P asked to speak to me at the end of the shift on his way out, I agreed and he told me again that he really likes me and that I a great RN, but that if there is something that his patient needs, address it with him and not another MD. It took a lot of nerve to come up with any words that would make sense coming out of my mouth at the time but I managed to say that before he starts accusing people of things he needed to understand the RN role, that if a MD; any MD asks us what we see and what things we think, we will always tell them and report the information. He said to not take his previous words in the wrong way and not to get upset about them and that he did really like me and how I provide care to our Pt’s.

But even after the conversation I still feel so hurt by the words he spoke, they sting and that I am not able to get rid of. I feel that I am getting in between two MD’s, one of which has been known to start drama and I want no part of if.

I want to tell my manager about it but I am unsure if I should. I am only sure that I want absolutely no part in this squabble and drama because I am the one that got hurt and I am not ok with this feeling. This whole situation sounds like an episode of grey’s anatomy or something and I want out!!

You can't take what they say personally and you can't let them see they got to you. Don't apologize just state clearly that you will answer any questions to any MD about the patient. If they have issues with another physician and what they order they need to discuss it with the physician. Tell them they can report you to whomever they wish and you will be happy to call the manager/supervisor right now to discuss the situation AND their behavior in speaking to you in a derogatory manner....so this can be solved immediately.

The Neuro MD sounds very insecure and paranoid (or young) to me if he thinks other MD's are running around "discrediting his work". When they come to passively and aggressively address the situation and say you are acting "snobbish" he is clearly stating that he is aware his behavior was out of line and childish. At this point...it is Ok to say that they were offensive and hurtful....that you need time to digest the conversation and their behavior for you did nothing wrong except discuss the patient with a consulting physician and only answered the specific questions concerning the patient.......and that you feel you need to discuss the situation with your manager on how best to go forward.

Then I would discuss this with your manager on how she/he best wants you to handle this as you go forward and that you are not comfortable with their petty feuds.

Sounds to me that Neuro MD overlooked the potential for more clots and id smarting from the observation.....again not your problem.

Insecure people make themselves feel superior by hurting other people....they minimize another persons worth to make them feel powerful and superior....no better than any other bully.

Remember......"No one can make you feel inferior without your consent"........ Eleanor Roosevelt

Up Vote Up Vote ×
Specializes in Public Health, L&D, NICU.

Oh my, what a situation. Unfortunately, when docs get in a peeing contest, it's the nurses that get wet. I concur with those that suggest going to your manager. The doctor was terribly unprofessional to put you in the middle and make the snobbish comment. Really, now. He'd just hurt you and made you question yourself, and also sort of threatened you, but you're supposed to be all sunshine and smiles when he comes around? :no:

Up Vote Up Vote ×
Specializes in Critical Care.

Thank you all for your input, I decided to talk with my manager and got it off my chest. Apparently this is not a new issue with the Neuro MD, it has been happening for a few months now. My manager did say that she would like a description in writing so that she can have more data to support the follow up with the correct management regarding this behavior. We will see what happens, but at least I know that I am not alone in this.

Thank you all!!

Up Vote Up Vote ×
+ Join the Discussion