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.
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?
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.
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.
It's worked for 27 years, so I think it's ok. You never let a conflict interfere with patient care. I'm talking more about personality conflicts with difficult people. They continue to be difficult because other people allow it. Anyone can have a bad day, and everyone gets a second chance. Getting along is the first option, and is why I always approach with positivity. Other than that, stand up or enjoy being run down. It's everyone's own personal choice.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
38 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.
Pro tip? Probably not. I doubt this will make for smooth workplace relationships in the long run and might actually get you fired. Approaching everyone with kindness and respect is a better idea. Even if you get attitude.
The hallmark of a bully is someone who is proud of "giving it right back." Bullies -- and there are some, but not as many as one might think from reading this forum -- always feel justified in treating someone badly because "I'm just giving them back exactly what they gave me."
Pro tip? Probably not. I doubt this will make for smooth workplace relationships in the long run and might actually get you fired. Approaching everyone with kindness and respect is a better idea. Even if you get attitude.
The hallmark of a bully is someone who is proud of "giving it right back." Bullies -- and there are some, but not as many as one might think from reading this forum -- always feel justified in treating someone badly because "I'm just giving them back exactly what they gave me."
If you think standing up for yourself is being a bully, you're obviously part of the problem. Encouraging the culture of just taking it.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
On 4/20/2019 at 3:15 PM, ICU/EMTP said:
If you think standing up for yourself is being a bully, you're obviously part of the problem. Encouraging the culture of just taking it.
There's a difference between standing up for yourself and being proud of "giving it right back." You can stand up for yourself without sinking to the level of being a bully.
There's a difference between standing up for yourself and being proud of "giving it right back." You can stand up for yourself without sinking to the level of being a bully.
Call it what you like. There is a reason that this behavior is institutionalized in healthcare. And again, I think you need to check up on the definition of "bully."
I am glad this is being discussed but I can't help but laugh. As I was reading the tips for dealing with doctors it reminded me of wildlife safety tips to help you survive a bear or puma encounter.
It's worked for 27 years, so I think it's ok. You never let a conflict interfere with patient care. I'm talking more about personality conflicts with difficult people. They continue to be difficult because other people allow it. Anyone can have a bad day, and everyone gets a second chance. Getting along is the first option, and is why I always approach with positivity. Other than that, stand up or enjoy being run down. It's everyone's own personal choice.
Thanks for clarifying. I too have been at this 27 years as a nurse and 20 as a PHRN - I personally find far more conflict pre-hospital than in-house.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
On 4/18/2019 at 5:55 PM, Apples&Oranges said:
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??"
Probably because you spoke to him like a person, and not the Grand Supreme Ruler of the Universe. I think the staff have gotten themselves into a vicious cycle with this doctor. They approach him timidly and defensively, and are probably afraid to get their patient a cup of tea without his written approval. Then he gets frustrated with their lack of assertiveness and initiative and continues treating them like morons.
Hopefully, now that you've started to change the dynamic, they can keep it going after you're gone.
Call it what you like. There is a reason that this behavior is institutionalized in healthcare. And again, I think you need to check up on the definition of "bully."
You may be right - we don't know what standing up looks like in your daily life.
I have known some people who came off very strong in their declarations of not taking anything from anyone, and unfortunately they were absolutely part of the problems they encountered - their general mistake was in living out that belief "front and center" so-to-speak, which resulted in thinking that practically every person who spoke to them had done something that needed to be put in its place.
However, I would never presume this is true in your case, since I have no idea. ?
There are a lot of ways to not tolerate poor interactions, including not reacting in kind - sometimes even simple refusal to react. A decent rule of thumb is to not use words, mannerisms, or actions that look bad out of context (even if they are marginally defensible in-context). I refuse to compete with ridiculousness, since that's always a losing game.
As far as some of the reasons this is institutionalized or ingrained (to whatever extent it may be), it's time to start acknowledging that part of it is that we keep perpetuating the idea of it despite the fact that physician-nurse relationships have improved greatly over the last decade or so. Especially now, this is not as difficult as (some) nurses make it out to be: Know what you're talking about/use your own brain, get your information organized, don't waste people's time, talk to others the way you wish to be spoken to/consider their perspective, and you're golden 99% of the time. Deal with the 1% like a grown-up.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
1 hour ago, traumaRUs said:
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.
I agree with this. It works better in the long run if at least one person is willing to be the grown-up.
Specializes in ICU/ER/Med-Surg/Case Management/Manageme.
1 hour ago, traumaRUs said:
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.
I agree with you only about 90%, traumaRUs. We get no where with attitude, but at the same time, after many years in this profession, I don't think we (nurses) need to take attitude, either. After many years in this profession, I've dealt with all sorts of personalities. I'll cut someone a bit of slack simply because I don't know what happened to them 5 minutes ago or that morning, etc., but most often, I'll call them on their attitude - "Hey! What's going on with you? I just walked in so I know you aren't upset with me." - or something to that effect. Same thing at the grocery store check-out line.
There is no excuse for treating anyone less than respectfully. And a smile is cheap.
I have just retired after 44 years as an RN, i have a BHSc, Grad Certificate in Cardiac Nursing and a MNurs (Adv Practice). Some advice for new graduates! “Learn your Stuff!” And start doing it quickly!
Don’t do a “Nurse in A Specialty” be a “Specialist Nurse”
Medical Practice is based on knowledge acquired from clinical trials via Journals and Conferences but they can’t know them all! Most Physicians will concentrate on the “hallmark” articles and studies.
Be part of it, read it, learn it, visit it and then you get the respect of the Medical Fraternity and other health professionals when you can suggest alternative treatments for patients that are evidence based or respond in ways the Physicians would expect from a professional colleague.
Nursing is not just about washing bums, cleaning up “***” beds, sitting around the nurse’s station and being handmaidens to Doctors, it is about being a professional team member whose nursing colleagues are in the patient’s attendance for 24 hours aper day, a team who has earnt respect, not demands it.
ICU/EMTP, BSN, EMT-P
128 Posts
It's worked for 27 years, so I think it's ok. You never let a conflict interfere with patient care. I'm talking more about personality conflicts with difficult people. They continue to be difficult because other people allow it. Anyone can have a bad day, and everyone gets a second chance. Getting along is the first option, and is why I always approach with positivity. Other than that, stand up or enjoy being run down. It's everyone's own personal choice.