Difficult Doctors:  Tips for Students and New Nurses

It is a common scenario- a student or new nurse attempts to communicate to a difficult physician.  The nurse’s response- blank stare, red face or maybe a defensive response. This article will provide tips for dealing with difficult physicians to ease the transition from novice to confident and competent. Nurses General Nursing Article

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Difficult Doctors:  Tips for Students and New Nurses

I can vividly recall how stressful it was as a nursing student and new nurse graduate to communicate with physicians. I was already intimidated by doctors and it seemed my mind drew a predictable blank when I had to interact with them. As a novice, I had to learn how to organize my thoughts and provide the appropriate information to communicate the patient issue clearly. This is a learning process most students and new nurses will experience and build confidence. There are tips for communicating with doctors and an interdisciplinary team that may make this process a little easier.

A study published in the Journal of Patient Safety, by Tija et al, found several factors that can affect nurse-physician communication. These included:

  • Lack of openness and collaboration- nurse feeling hurried by the physician or feeling the physician was not interested in the information the nurse was sharing.
  • Frustration with the lack of professional respect- 16% reported being interrupted by the physician before they were finished communicating important information.
  • Logistical challenges- difficulty finding a quiet place to communicate, finding time to communicate with the physician and not being able to get in contact with a physician when needed.
  • Language barriers- difficulty understanding physicians due to language, accent or use of medical jargon.
  • Nurse preparedness- nurse not being prepared with assessment data or information the physician will need to make decisions and/or changes to patients care.

Being aware of nurse-physician communication barriers is the first step in students and new nurses building skill and confidence in communicating with the interdisciplinary team.

Scenario One:

Jane is a nursing student at clinical and is reviewing a patient’s record at the nursing desk. Jane is approached by a doctor asking for information on a patient and her instructor or another nurse are not at the desk. Jane explains to the physician she is a student at clinical and the physician, frustrated, states “can you not find someone who can tell me something about my patient?”.

Scenario Two:

Matt is a new graduate and just completed orientation for his first nursing position. Matt is approached by a cardiologist asking why patient X was ordered a cardiology consult. Matt provides background information and the physician states, “What do they think I can do for them? This is a waste of my time!”.

What do you do when you find yourself in a situation similar to the above scenarios? Your first reaction may be to go blank or become defensive. Here are some tips to help when you find yourself communicating with a difficult physician.

Stick with the facts and leave emotion and opinion out of the conversation. It may be as simple as, “I don’t know the answer to your question but let me find someone who can help you”.

  • Be aware of your body language and stand straight to convey a look of self-confidence.
  • Take a step back to avoid a defensive or aggressive response. Respond in a respectful manner and expect respect will be returned.
  • Apologize when appropriate.
  • Report the interaction with your clinical instructor, preceptor or charge nurse to ensure acknowledgment of the behavior. The physician’s behavior may be a pattern and documentation may be needed to address. Do not accept inappropriate or abusive behavior- walk away, stand silently or ask to be spoken to respectfully.
  • Practice communicating with physicians on a regular basis. The best time to practice is when you are with your instructor or preceptor. Take notes on how your preceptor approaches, answers questions and communicates with physicians.
  • Be prepared before calling or talking to a physician about a patient. Write down pertinent information to clearly communicate the patient situation. Having information available and organize may help minimize problems. For example
  • Patient’s name and room number
    • Reason for call
    • Health history
    • Lab values that relate to your reason for calling
    • Recent vital signs
    • Medications related to your reason for calling
    • Allergies

Effective nurse-physician communication is key to providing safe care for positive patient outcomes. Fortunately, there are steps nursing students and new nurses can take to improve their communication with physicians. With practice and experience, the novice nurse will become confident, even when dealing with difficult physicians.

What tips would you like to share to support students and new nurses?

Resources:

Institute for Healthcare Improvement: The SBAR Tool for Communication

Tija, J., Mazor, K., Field T., Meterko, V., Spenard, A. & Gurwitz, J. (2009). Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety, Journal of Patient Safety, 5(3):145-52.

Patient Safety and Quality Healthcare (2012).  Nurse to physician communication: Connecting for safety.

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J.Adderton

About J.Adderton, BSN, MSN

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J.Adderton RN MSN has over 20 years experience in a variety of settings. Has enjoyed bedside nursing, community health, leadership and nurse education.

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Specializes in Community health.

I’m a new nurse, and one more piece of advice from my experience is: Form your own opinion about each doctor (and each nurse for that matter!). Sometimes, all the experienced RNs will tell you “Dr Smith is awful, so watch out” and “Dr Jones is great” but you may find that you get along better with Dr Smith. If you listen to a bunch of gossip before you even meet the doctor, you may walk into a conversation defensive and expecting a battle before the other person has even opened their mouth.

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Specializes in Psych (25 years), Medical (15 years).

"What tips would you like to share to support students and new nurses?"

I've had only a few docs actually got emotional and yell at me in my career. When use the concept of there being only two emotions- love and fear- it helps to keep my head in the right place.

All other emotions stem from the two basic emotions of love and fear and anger is commonly manifested when one feels fear. So, when docs have yelled at me, I respond to that reaction with understanding and empathy and say things like, "I understand why you could be angry" and allow them to blow off steam. As long as the fire isn't fed and an approach of "What can I do to make the situation better?" takes place, the doc usually runs out of steam and logic usually comes into play. The situation can then be rectified, if not, the doc usually huffs off after throwing the tantrum.

One thing NEVER to do is to make excuses as a reason why a need was not met. One time, a nurse in med surg gave excuses for the reason why a particular situation was not done and the doc, not too much of a hot head, exploded.

I was working inpatient at a community mental health clinic when a psychiatrist became inappropriately angry after I made a suggestion on dealing with a situation with a patient. He angrily said, "Just do what I told you to do!" I responded with, "It was only a suggestion. Is there something you'd like to talk about?" The doc just looked down and shook his head.

This doc and I never really liked each other but we got along well enough that he didn't yell at me again.

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Specializes in Psych (25 years), Medical (15 years).
On 4/18/2019 at 12:22 PM, CommunityRNBSN said:

I’m a new nurse, and one more piece of advice from my experience is: Form your own opinion about each doctor (and each nurse for that matter!). Sometimes, all the experienced RNs will tell you “Dr Smith is awful, so watch out” and “Dr Jones is great” but you may find that you get along better with Dr Smith. If you listen to a bunch of gossip before you even meet the doctor, you may walk into a conversation defensive and expecting a battle before the other person has even opened their mouth.

Amen, CommunityRNBSN!

I was breaking into a new job in OR at St. Anomaly's Health Center back in '91 when I was scheduled to do my first TAH with Dr. S- "The Nazi Surgeon".

The other nurses told me how terrible he was; mean and strict. I studied his procedure and memorized it to a T. During the surgery, when I found an opportunity to to talk about him, I took it. All through the surgery, Dr. S told me stories, mainly having to to with triumphs.

The procedure went well and at the end of the surgery, the Nazi Surgeon said to me, "Good job!"

He just needed a little love and attention.

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I'm not a new RN, but new every 13 weeks, and dealing with EXTREMELY condescending and rude docs and a PA on this contract. I just CANNOT believe what these nurses put up with! Multiple times in only 7 shifts, I have been the recipient of eye rolls, horrid condescension, outright dismissal when presenting legit concerns (NO, this patient cannot go home, he can't walk, or even crawl, he's still in active withdrawal!) And (I've asked 4 times now for a DNR order for this pt who has a clear advanced directive...Nope.)

Admin is aware of the problem, and apparently this team has been "spoken to" by HR multiple times about their (collective and individual) behavior.

It's unreal how quickly, with the doc I've worked with most, (again, only 7 shifts) the attitude has shifted. I've looked him straight in the eye on multiple occasions, and said something to the effect of, "I'm not sure what you meant by that comment, but I'm telling you from my experience that X is what's going to happen if we do Y without Q. I don't really care, since neither one of us will be here when he (pulls out the NG, has a seizure, has to be exposed to more radiation d/t another CT...) but in the interest of his (health/comfort, whatever) can you just hear me and do what I'm asking?"

He has started to actually come to me and (not ask for advice, that would be too much...) hint subtly that suggestions would be considered. He actually commented the other day that I was to be commended for "using my own judgement" and not feeling the need to "bother him" by "getting confirmation" on a patient concern.

Um, thanks, jackass, but I don't need your approval to educate my patient. That said, it really was validating, and the charge and two other nurses heard him, and were like, "How the hell did you do that??!! Actually get him to talk to you like a person, instead of a peon??"

Honestly, I know my ***. And I'm not afraid to tell you what I know, and what I DON'T know.

Now, if I could only get the PA to stop thinking she is God's gift to Neurosurgery...

ETA: Maybe mine's not the most helpful post for a new nurse...more of a rant, but I will say, confirm your feelings/suspicions with a more experienced nurse, Unit Director, even House Supervisor. If warranted, stand your ground! Docs, NPs and PAs will dismiss your concerns if you are emotional or seem unsure of yourself. Once you have confirmed that your concerns and recommendations are legit, be calm, firm and direct. Don't let anyone dismiss you.

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You do not have the power to transform a reasonable, sensible person into a jackass. If the person you are dealing with is acting like a jackass, it is not because of something you did. It is because he or she is a jackass.

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Specializes in Nephrology, Cardiology, ER, ICU.

As a nurse and provider, the staff nurses are much more open to calling me then the physician. It does help that for the most part we serve as the gatekeepers in that, we can usually take care of the issue.

I have never yelled at anyone but I do ask that when I'm on call that the nurses have the vitals/meds/allergies/weights pulled up on the computer. I almost always ask what they think should be done too.

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Specializes in Medsurg.

1. Know your patient in and out.

2. Know the disease process in and out.

3. Know nursing interventions and considerations in and out.

With all that said when you consult with a dr. Do it in a place of confidence. They are more inclined to answer professionally than not. No matter how they answer, stand your ground with shoulders up and use direct eye contact....kinda with anything in life. Confidence!

However there are situations that would need to happen. I have two known Drs here that are so rude to nurses that whenever you mention their names its like a Lord Voldermort situation out of harry potter. Both drs i made in a point to put them in their place publicly in front of the nursing station. ? funny how i think i'm one of the few nurses they say good morning(or whatever the time is) to now.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
On 4/18/2019 at 8:45 PM, hherrn said:

You do not have the power to transform a reasonable, sensible person into a jackass. If the person you are dealing with is acting like a jackass, it is not because of something you did. It is because he or she is a jackass.

The only problem I have with this post is that I cannot like it a few hundred times.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

I was probably 20 years into my career when computerized charting came out. I had already developed the habit of writing pertinent information down on my "brain sheet" and calling the doctor without entering into the electronic chart. Entering the information was, at first, an ordeal, and sometimes the patient need was too urgent for me to waste time figuring out how to chart it before calling the doctor. Besides -- I already had all of the information right in front of me before I picked up the phone.

I learned quickly (and the hard way) to chart the information before calling the doctor. The second day we had our electronic medical records up and running, I had to call a surgeon about a bleeding issue. I called his cell and started to fill him in on the situation when he interrupted me with, "None of this is in the chart. I can't SEE it." Turns out he was in San Francisco at a medical conference, and when I called he was sitting in front of his laptop, perusing the patient chart on the firewire connection at the hotel. (Yes, before WiFi, too.) That's when I learned first, how useful the electronic charts could be, and second, that I needed to keep it updated at all times.

When you're new, it can be really intimidating to call a provider; especially one with a reputation for being a bit of a jerk. Years ago, I worked in a CCU where the medical director was more than a bit of a jerk. I was used to seeing nurses go back and forth about calling him. "You call him, you're the charge nurse." "No, you call him; it's your patient." "Maybe we don't need to call him. Is there someone else we can call?" "Nope. Nobody else. Let's wait an hour and see what happens." That kind of thing isn't in anyone's best interest.

I learned quite by accident that even the most sarcastic and intimidating provider is still just a human being like you and me. I discovered a scuba diving journal with Dr. Imaflamindonkeybutt's name on the address level just lying in the nurse's station and, being a diver, picked it up and flipped through it. The next time I saw him, I walked over to him, screwing up all of my courage, and said "I hear you're a scuba diver. Have you ever been to the underwater state park?" He had, it turns out, and he'd love to tell me about it. In the future, for as long as I worked on that unit, he'd come looking for me when he first walked on the unit. We'd chat briefly about scuba diving, and then he'd make his rounds. He was never rude to me again, and he was a lot nicer to my colleagues as well.

It takes only 1 or 2 minutes to greet someone, acknowledging them as a person and asking about themselves or their interests and it makes all the difference in the world when you have to call them at 3am because their patient self-extubated.

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Pro tip? Give them back exactly what they give you. Nobody in the hospital is more important than anyone else. If the doctor doesn’t show up tomorrow, we’ll get by, but what if environmental services or food services don’t show up? It isn’t a hierarchy, it’s a level field. I always approach everyone with kindness and respect. I get attitude? You’re getting it right back. Too many people, from bully nurses to arrogant doctors, have gotten away with their BS for far too long. Not around me. Stand up for yourselves. It makes everything better.

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Specializes in Nephrology, Cardiology, ER, ICU.
22 minutes ago, ICU/EMTP said:

Pro tip? Give them back exactly what they give you. Nobody in the hospital is more important than anyone else. If the doctor doesn’t show up tomorrow, we’ll get by, but what if environmental services or food services don’t show up? It isn’t a hierarchy, it’s a level field. I always approach everyone with kindness and respect. I get attitude? You’re getting it right back. Too many people, from bully nurses to arrogant doctors, have gotten away with their BS for far too long. Not around me. Stand up for yourselves. It makes everything better.

Hmmm...doubt this will work for you in the long term. It might be better to try to defuse the situation and try to get along. Just because someone gives you attitude doesn't necessarily mean you need to react in kind. Someone in the situation should remain calm so that you can both move forward with pt care.

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