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.
I have as most nurses, have had to deal with difficult people. All sorts, patients, family members, other employees, doctors, etc, etc. I have tried many different tactics, they don't all work with everyone. I have learned to read people. This is something that can't be taught, it takes experience. The most important thing I have learned is not to cower, If I don't know I say so, I may say, I don't know "yet" but I'm going to find out. Or, "let me check on it", not simply I don't know, most people don't like that response. Don't stand mute like a deer in headlights, be proactive. I also kindly correct a doctor if they are wrong, like they think patient so and so is still on a certain drug, I just kindly say that it was stopped by Dr. Smith yesterday, they need to know that I am valuable and an asset. I have never had a doctor yell at me yet, but I am prepared if they do. I can see myself saying, Doctor, What in the world is wrong with you today?! What's the matter? Take a deep breath and let's put our heads together and fix it, OK? Or Good Grief Doc, did you get up on the wrong side of bed today or what? It's OK to talk to them like they are human.
I did have a doctor answer the office phone and tell me she was the secretary, I recognized her voice and knew she was lying to me.I reported the blood pressures that I took. She said she didn't believe the readings, I assured her the readings were correct, I took them carefully myself. She said she still did not believe the readings, I then asked, "Are you calling me a liar or incompetent?". We had a intense discussion where I told her I knew how to take a blood pressure better than she did, little miss secretary. LOL. Sorry but she made me mad! Never had another issue, the thing this idiot didn't obviously know is that the patient had autonomic dysreflexia and this was the reason the blood pressures would fly out of range. Still I was bound to report them. Apparently there were multiple issues with this individual as I heard a lot of not so good things about this doctor. In any event she left the area thank goodness. I wasn't going to put up with that doo doo. Don't let them run ramrod over you, don't be a victim.
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.
I concur, talk to them like they are people. I had a doctor just really grill me on why I thought a patient was acting a certain way. He'd say, well why do you think so, what are you basing that opinion on? It was an interchange of ideas, I didn't mind him asking and I hope he didn't mind me asking the same of him. Even if I wasn't sure I was correct, I answered his questions as to what I was thinking and what lead to the conclusions I had. No problem, ask away. That was just his style.
We had a doctor at our hospital who always seemed a little grumpy and short. One morning he stomped into the unit and barked "Who is the nurse for Mr. Smith?" I said "It's Robin." Then I called out "Robin! Dr. Jones is out here demanding to see the nurse for Mr. Smith!" The doc turned red and said "I wasn't DEMANDING." I just flashed him a big smile and said "Oh good, here's Robin."
He never pulled that again, and actually showed himself to be a really nice man under the gruff.
Of course, as said above, not every technique works with every person, and almost nothing works if they don't respect you professionally. So ALWAYS have all the information at hand when you call them so you never have to say "oh, I didn't check" when they ask for vitals or other reasonable information.
Specializes in Clinical Leadership, Staff Development, Education.
On 4/21/2019 at 3:24 PM, kldepp08 said:
May I ask why, in this day and age, we are researching, writing and reading articles on this topic?
I am glad you responded to this article. I was actually thought I would receive more comments like your own due to the diversity in work cultures. It is interesting to read perspective of someone working in different environment. I am a nurse in Alabama and unfortunately, the nursing profession here is a step behind professionally. Not in regards to the quality and caring of our nurses.. but in terms of outside perceptions of the nursing profession.
Forest2
625 Posts
I have as most nurses, have had to deal with difficult people. All sorts, patients, family members, other employees, doctors, etc, etc. I have tried many different tactics, they don't all work with everyone. I have learned to read people. This is something that can't be taught, it takes experience. The most important thing I have learned is not to cower, If I don't know I say so, I may say, I don't know "yet" but I'm going to find out. Or, "let me check on it", not simply I don't know, most people don't like that response. Don't stand mute like a deer in headlights, be proactive. I also kindly correct a doctor if they are wrong, like they think patient so and so is still on a certain drug, I just kindly say that it was stopped by Dr. Smith yesterday, they need to know that I am valuable and an asset. I have never had a doctor yell at me yet, but I am prepared if they do. I can see myself saying, Doctor, What in the world is wrong with you today?! What's the matter? Take a deep breath and let's put our heads together and fix it, OK? Or Good Grief Doc, did you get up on the wrong side of bed today or what? It's OK to talk to them like they are human.
I did have a doctor answer the office phone and tell me she was the secretary, I recognized her voice and knew she was lying to me.I reported the blood pressures that I took. She said she didn't believe the readings, I assured her the readings were correct, I took them carefully myself. She said she still did not believe the readings, I then asked, "Are you calling me a liar or incompetent?". We had a intense discussion where I told her I knew how to take a blood pressure better than she did, little miss secretary. LOL. Sorry but she made me mad! Never had another issue, the thing this idiot didn't obviously know is that the patient had autonomic dysreflexia and this was the reason the blood pressures would fly out of range. Still I was bound to report them. Apparently there were multiple issues with this individual as I heard a lot of not so good things about this doctor. In any event she left the area thank goodness. I wasn't going to put up with that doo doo. Don't let them run ramrod over you, don't be a victim.