Do doctors really yell at you, and get away with it?

[copyandpaste]

I was asked in my interview for nursing school to rank the level of importance of the following things from 1-10. And they asked things like "your patient isnt eating", "your classmate takes money from a patient during clinicals", and one of them said "the doctor yells at you". I ranked it the lowest because I figured he'd get over it.

But the thing is: I began to wonder how often that happens, why did they ask me if it isnt something Im certain to run into more than once?

Cant you just report the doc? I mean, do they get away with that sort of thing??

I can see if you work in their family practice clinic maybe, but what about a hospital setting?

Thanks for your responses.

[eriksoln, BSN, RN]

I'm a nurse and there are a lot of nurses in my family, all over the country. It seems to me to be a regional thing. That is, there is a different level of tolerance for this sort of thing in different areas of the country, almost like a regional personality. I went to nursing school in Austin and now work in St. Louis. At least at the facilities where I've been in there 2 cities, it's not an issue. I've never heard of it happening. When I was looking into moving to Colorado, it seemed like more nurses there had stories about getting yelled at. My sister-in-law works there and before I started nursing school, I asked her what surprised her the most about the profession, what she had encountered that she hadn't expected. She paused for a moment and said, "I didn't expect to get yelled at so much." She said it was by the doctors, by the families, and by the administrators. I was shocked! Maybe Colorado (and other) posters can shed some light.

Thats exactly what my experience as a travel nurse has led me to believe. I know for a fact, MANY travel nurses who came out of FLA were in the travel business to get away from poor work conditions in their home state. Many would not accept assignments in their own state. In WA, doctors never "yelled" or "screamed", because that was reportable and the administration would take it seriously. What they did instead was a sort of passive aggressive thing.........talking down to people, quick to run to the managers office over triffle details etc. Now, where I am at, in PA....its kinda middle of the road. Some will raise their voices, others will not.

Its a tough situation to deal with. There is a fine line to be walked when considering if a physicians behavior is reportable or not. They are the money makers of the facility, so any report made against them will be taken with a grain of salt by the powers that be. On the other hand, there is the "schoolyard bully" syndrome to consider. Most doctors who raise their voices only do so because they see no consequence to it. They do it to one person, nothing happens.........do it to the next person and it gets forgotten......on and on until it becomes habit. Then they run into the person who won't put up with it and.............they don't know what to do with themselves. I've been that person on more than one occasion. Had an instance where I had to give a doctor who was getting VERY PERSONAL with me a warning. I let him know under no circumstances would I hesitate to put him on the floor if he continued to get personal with me. I actually made a thread here about it. I felt bad the next day but..........this guy was known for embarassing people and yelling for nonsense reasons. He reported me to my manager, I'm unsure if my "warning" came up or not. I'm still here, wasn't fired or even written up. Only thing my manager told me was to work on ignoring people of his sort. Now, this doctor is kind to me and has become one of my favorites. So.........who knows what the right answer is.

[AcousticFoodie]

That said, he still treats the rest of the staff the way he used to treat me, because he knows they won't stand up to him, that they have mortgages and bills, so they can't just up and quit. They put up with it because it is good money and they like the patients, eachother, the job, etc...

But if he can change for me, he can change for them, yet he chooses not to. And it's sad, because he has the greatest team of hardworking, self-motivated staff in his employ, and he completely takes it for granted.

Anyway, a bit of a tangent, but that's my .

So with all these stories in this thread about nurses taking crap from docs...do these nurses just not stand up to the doctor? And by standing up I don't mean yell back of course, but just letting the doc know that their behavior is inexcusable and not acceptable in an appropriate way. Does standing up for yourself as a nurse mean getting fired or something? Where is the fear coming from?

[cokeforbreakfast]

So with all these stories in this thread about nurses taking crap from docs...do these nurses just not stand up to the doctor? And by standing up I don't mean yell back of course, but just letting the doc know that their behavior is inexcusable and not acceptable in an appropriate way. Does standing up for yourself as a nurse mean getting fired or something? Where is the fear coming from?

He is the king of his practice, and jobs that you love (aside from the yelling) don't grow on trees...especially in a small labor market. Addressing the issue in the "heat of the moment" would be pointless...the situation would just escalate and the patient would ultimately suffer from the inattention.

And I'm not sure simply talking to him would effect any lasting change...it took my leaving for a period of months before he reconsidered and really made an effort. Not everyone has that luxury.

[sistasoul]

On my very first day on my own after my orientation I got screamed at by a heart doc. I wok on an ortho/neuro floor and we rarely have cardiac docs involved with our patients. I will never forget that day. It was 0800 and I was just starting to get my meds ready and see my patients. I was paged to the desk to talk to a Dr. I was already nervous to begin with not knowing what to expect. I had a patient who had a foley in the day before. A hospitalist had wrote an order to D/C the foley the day before. I had never had this patient before and had no idea that the patient had even had a foley in. Did not get that in report. Doc was concerned about the patients I and O. This MD started raising his voice and it got higher and higher and louder and louder right at the nurses station. I am surprised all of the patients did not hear him. Very unprofessional. He wanted to know why the foley had been taken out and why there wasn't any charted amount of urine output. Happened to be that the patient was incontinent and the aide had charted incontnent one time. The Doc thought this meant 1 ml. I could not believe my ears. The Dr was so dramatic that I stood their stunned. This MD had the reputation of being nasty. To this day I shudder if I have to call a cardiac doc for anything. What a first day as a nurse.

I have had a few others get sarcastic and codescending. I had another ask me what I wanted him to do about the patient's rising troponin level. I know our hospitalists are overworked so I am forgiving of them if they get a little short at times. Most of the time our hospitalists are rather nice.

[Argo]

Short answer is YES it can and does happen. It should not be allowed by the nurse or their management but most management is spineless and that makes the nurses less likely to say anything for fear they will loose their jobs. When I took over my depth a couple years back it stopped for me an my staff. I took the offenders to the internal medical board and they were dealt with.

On the other hand I can sympathize with MD's sometime because it would **** me off to get some of te calls they get that don't require orders, just some common sense. I would get ****** and do get ****** off When our floor staff don't do what they are supposed to as nurses.

I should preface this all with the fact that I too am male at 6' 290 and large built.

[diane227, LPN, RN]

Not much any more because I stand up for myself. If they continue to do it, I report them to the chief of staff.

[RNperdiem, RN]

"yelled" "screamed"

This is pretty theatrical behavior.

I have never seen anything like that in 16 years.

What I have seen is impatience, getting a little snappish, and some dressing down(often when a nurse really screws up).

I guess yelling and screaming are in the eye of the beholder and some people will label every roll of the eyeball as abuse.

[cokeforbreakfast]

"I guess yelling and screaming are in the eye of the beholder and some people will label every roll of the eyeball as abuse."

You are so lucky that you have worked in settings where this has not been the case. I was just sharing my experience, which I thought was the point of this forum. I know the difference between "snappish" and "yelling/screaming". I'm pretty sure the former doesn't involve wild gesturing, throwing instruments on the floor, and using a tone of voice that I have seen make the PATIENTS cry because they thought THEY did something wrong. Just my opinion.

[traumaRUs, MSN, APRN]

I used to be meek and shy but not so much anymore.

I work in a large practice with 15 docs of varying personalities and temperaments. I get along with all of them. However, I try to have my ducks in a row when I call them too and not waste their time. Respect works both ways - all of them talk/email me too with their concerns/questions.

[canigraduate]

Hmm... haven't run into this problem yet. But then, I'm female, 5' 5", so I must be VERY intimidating. LOL! Sorry guys, but who cares what size you are? My husband is 6' 4" and is the biggest teddy bear. People are more respectful to me than him.

Anyway, I have worked around a lot of A-holes, and the only reason they are A-holes is because no one stops them. I must give off a "don't mess with me or I'll cut you" kind of attitude. The most I have to do is raise an eyebrow and look at them funny when they start their foolishness, and the behavior usually stops before it gets started well. I have only had one repeat performer, and that's my brother, who knows when and how fast to run.

I think that a lot of the problem is that people believe it's a BIG DEAL to be yelled at. It isn't!!!! It's usually not even about you. It's about whether or not the wife will find out about the girlfriend, a patient isn't responding well, the Knicks lost, etc. You just happen to be there when the volcano erupts. Don't react with fear or defensiveness. Just turn around and walk away if you don't know how to deal with it. That's better than standing there and taking it. Otherwise, find someone you know who doesn't get yelled at and imitate their behavior.

It's not even about male vs. female. I know many women who don't take crap from anyone, and men who are spineless. It's all about what is tolerated. If you don't tolerate crappy behavior, usually the people around you will follow your example and all of the crap will stop.

[PMFB-RN, RN]

Usually docs never yell at me and I do not tolerate it for a second. Not do I tolerate them yelling at any of the other non physician staff I work with. On the very few occasions when a physician did yell at me I simply turned my back on them and walked away, ignoring anything they where saying (assuming we where in a patient care area). Then later when I can catch them outside a patient care area (parking lot is best) I will confront them in a very aggressive manner and demand an apology and insist they never do that again. I am a large guy and usually get my apology. The SICU where I work is full of male nurses, most of who came to nursing as second or third careers. Nearly all of us are military vets. We have lots of former truck drivers, farmers, loggers, and factory workers who now work as RNs in the SICU and are simply not going to put up with any BS. Our docs are usually very polite. Every now and then we will get a new physician who doesn't know any better.

Word gets around and it's just not a problem for me. None of you should ever tolerate being yelled at by physicians.

I am not talking about the newer physician who gets excited and raises his/her voice in a code or emergency situation. That is a different situation and is usually a result of the physician being insecure in that situation.

[shiccy]

All but two MD's and a few residents every MD is at least cordial on the phone (I work nights) when you call them for patient issues.

It's actually really funny this topic came up because I just had an experience last week. I'll share my story and tell you what I ended up doing in the end.

I had a patient with a stable hematoma of the groin. At 0500 she told me, "My groin site feels a lot harder and tighter than it was before." After inspection, she was spot on. Her PT on that side had also had a change from moderate to weak. I called the Vascular resident to notify him of the abnormal findings. I knew from experience that if it wasn't occluding her lower extremity circulation he'd just say watch it and I'll be there in the AM, but instead he decided to be a jerk about the situation.

The conversation ended up going like this:

Him: "This is vascular somebody paged."

(Please note that he doesn't announce WHO he is, even though he's been talked to about this more than once. Luckily his name is ingrained in my head because he's such a jerk every time you call it is ridiculous.)

Me: "Hi Dr. (name). I'm calling about (pt name), are you familiar with the patient?

(I ask because he never is familiar. He never takes the time to actually learn his patients names, so I always ask b/c I hate wasting time repeating information. He will never admit that he doesn't know the patient so he hopes something you say will trigger his memory)."

His response: "What's your question."

Me: "The reason I'm calling is I've noticed a change in the R gr hematoma size and thought you should be made aware."

His response: "So? Why are you calling me?"

Me: "Her hematoma size has increased. She was suppose to go home last night but ended up having to stay. I wanted you to be aware of the change."

His response: "So what. Why would you call me with that?!"

This went on for a few more back and forths. Each time he responded, his voice became more and more caustic and by the end he was seething with attitude and contempt. I've had problems with this resident in particular. Eventually I had had enough. I was on hour 10 of a 12 hour shift, and was sick of the flack I was receiving. This was my response (I was just as caustic as he by this point).

Me: "Look. I'm calling to inform you of a change in one of your vascular patients. If you want to order something, great - I'd be happy to fulfill those orders. If you don't want to order anything at this time, great - I'll chart that you were notified and that I received no orders. (Aka: Order something or I'll chart that you don't care and I'll be free and clear when your rear gets hauled to court.)"

His response: "Stuttering and attempts to make me feel like an idiot."

Me: "LIKE I SAID. If you want to order something, order it. If not, great I will chart it as such."

His response was to say in a tort manner, "So I'm being called in the middle of the night for a charting issue?!"

My response was, "You know what yeah it is. If you don't want to order something great."

He finally decided to get some more information from me. The hematoma was 1 foot by 8 inches and hard. He ended up giving me orders after mulling it over for a bit. At the end of the conversation he said, "Oh by the way, health care is about the patients, it's NEVER about charting. That's just bad nursing."

Guess who didn't show up in the morning and instead sent one of the other (and much more nice) residents up to see the patient?

We have what is called "Incident report forms". When a physician is inappropriate or demeaning, rude, cursing, yelling, belittling, etc. you write the incident up. When we submit these forms they are sent to the director of the physician portion of our hospital (the head of the head of the head). Physicians have actually had their privileges at our hospital totally revoked for a specific period of time. The more evidence you have, the more likely something will happen. Also, since these are residents (I'm sorry NY state b/c he's going there soon!), the information also gets sent to the attending physicians so they can write that information on the evals for when they get placed.

The sad thing is it does indeed break down communication. Who the heck would want to call a jerk like that at ANY time to tell them anything? Patients end up suffering, loss of limb may be imminent, etc. It's just poor PHYSICIAN care, and should be reported ASAP and in as much detail as you possibly can because it helps your case in the long run.

Make sure you chart specifics on the patients flowsheets as well!

PS- I'm a guy. I *do* see I get more respect most of the time, HOWEVER, I fall into a *I* have a different mentality than some of my female counterparts. It almost seems some of my counterparts become airhead-y on the phone when they talk to the MD. I don't know if it's their 'phone' voice, (my voice changes a lot and I get a lot more stoic and serious and my voice is much deeper) but it's just my impression.

When some are talking on the phone to the MDs, MANY are not prepared for the questions they ask (Vitals, labs, etc). To this I can say that if *I* were the one being called and woke up for something and they weren't ready, I'd probably be short and cranky too.

I don't work with tons of other guys, so I only have women to go off of.

I now need to go e-mail my director about a POSITIVE experience I have with the above's cohorts.