Dealing with an oppressive doctor at work.

[tserofw]

Hello fellow nurses,

So a little background...

I recently moved to California and worked as a traveler at this particular facility. I extended and eventually applied for a permanent position and was hired (mostly because I enjoyed most everyone that worked there and the facility in general is a good place to work as a nurse). The only friction I have had is one doctor.

This doctor is generally known and accepted as being sassy. Sassy, in my opinion, is a nice way of putting it. If I were to use the words I wanted, it would not be appropriate for this forum. It was jarring the first time I experienced his attitude and I just let it slide. I quickly learned that the attitude was a permanent fixture and after each event I have resolved myself to think it had something to do with me specifically. Some highlights of this behavior range from him rolling his eyes when talking to me, to making rude comments, to avoiding me when trying to talk to him about my patient that he is covering.

Without unnecessarily making this post longer, one major unprofessional event was when dealing a patient. I had a patient that was recently trached who at home was used to taking 80mg of oxycodone and was not receiving any while in the hospital (he was on IV fentanyl which was DC'd when extubated and trached). All he was receiving was 1mg of Ativan Q6. So not surprisingly the patient was anxious at the beginning of the shift. When the doctor was making rounds I asked if so many words if the Ativan could be supplemented with something else, I mentioned the home dose of oxycodone and he immediately said no with no rationale. I asked for precedex, he screamed "WHY DO ICU NURSES ALWAYS WANT PRECEDEX". I just ignored his tone and asked if he could at least get more Ativan. He said "How about 2mg Q6?" and then walked away. 2 hours later my patient ended up needed propofol and fentanyl because he was acidodic. When in the room he literally said the words, "I don't know what happended." This story is the only possible source I can think of his attitude and unprofessional behavior with me.

I have not directly brought up with and have instead attempted at trying to make a connection with him with the hopes of getting past his prickly nature. All my attempts have been met with disdain and eye rolls. What I am asking is this:

Have you dealt with a doctor like this and how did you do it?

Should I tell management (for fear of affecting my newly obtained job or suck it up because I'm the newcomer)?

I'm afraid of dealing with this issue directly because everyone at the unit seems to just accept his behavior which undoubtedly has contributed to him being this way.

HELP

[JKL33]

I would inform management (in a professional manner, choosing your words carefully) that you plan to speak with him and find out if this working relationship can be improved because he is very unprofessional in his interactions with you. This is what they say they want us to do when experiencing difficulties with a colleague/coworker. It likely won't come as as surprise that your concern is with him in particular, since you imply they know about it and yet do nothing. Then you have that conversation with him. "We need to figure out how we can get along better for the sake of our patients. Do you have particular concerns about my work? [blah, blah....] "the way you communicate with me and your body language is not appropriate and not conducive to good patient care, and I am asking you to stop."

This is one of those occasions for excellent eye contact, good posture, and straight-talking.

Good luck.

[cleback]

Have any of your coworkers talked about it to him and has the behavior improved? If so, you would probably want to follow their lead. If not, all I can say is good luck.

In psych, I've worked with a doctor who would hang up on the nurses or avoid our calls altogether. We would be trying to call the doctor to get admission orders or with changes in condition. I brought it up to our manager as well as the medical director for our service... nadda. Likewise, your managers probably don't care about his (lack of) professionalism. If his behavior leads to unsafe clinical situations, I would document it and continue to let your manager know. Even if they do nothing, you have evidence that they were aware of the situation.

I'm afraid to say, if this doc creates unsafe clinical situations for you, or if his rudeness is not tolerable, you are probably better off finding different employment. If you continually bring situations up to your manager, you are going to get a negative reputation, even if you are completely justified in alerting them. Sorry.

[Munch]

I cant believe he was letting a poor patiently suffer like that. 80mgs of oxycodone is a lot an not just for an occasional headache. Unless by some miracle the condition he was taking it for went away by guess is your patient is still having pain.

Ive gone over doctors heads before to get what a patient needed. Ive also waited for shift change to ask the covering doctor to order what my patient needed. You can try and go to management and complain. Just be careful the doctor might resent it and then you can wind up going from the frying pan into the fire.

[malenurse69, MSN, NP]

Sounds like you need to get management involved. Let your ANM know, especially now since his hard-headed behavior (Assuming your end of the story is true,) lead to a patient "event". The bare MINIMUM a physician can offer is yes or no WITH rationale. Never let a doctor just say "no" and walk off, be assertive and ask for answers. "No" can sometimes be a "I don't want to deal with it" vs an actual rationale that is specific to the patient. Always ask for clarification and elaboration, I don't care how rude or eye-rolly the doctor is. It is your job to advocate for your patient and it requires you to stand up to these kind of physicians.

[malenurse69, MSN, NP]

Just be careful the doctor might resent it and then you can wind up going from the frying pan into the fire.

My experience with these types of personalities is that they thrive on passive behavior. This physician needs to be called out every time he starts acting out. Patient care can only be achieved with cohesive teamwork.

[OrganizedChaos, LVN]

I would write him up & talk to him. I don't take any horse manure from anyone. We are in charge of taking care of patient's lives. If he wants to act like an ass, he can do that outside of the hospital & on his own time.

[AutumnApple]

Take a deep breath and count to ten. Fill your head with Gandhi's voice.

Fact #1: I've dealt with physicians like this before, I'll deal with another handful of them before I'm done.

Fact #2: Same goes for you.

Hate to say it, but they're not going anywhere. Just keep them in the proper perspective, with patient outcomes being the priority.

They're viewed as the money makers, we're the money takers. We're disadvantaged. Play your hand as best you can and keep yourself and the patient safe. *If* you're unable to prevent there being a poor outcome and this doctor has a hand in it, you'll be better suited to defend yourself *if* everyone else knows you've managed to remain professional through the whole process.

Beyond that, truth is, sometimes we just have to eat crow.