Doctor Behaving Badly - What would you do?

**allnurses**

This poster wished to remain anonymous to remove any chance of backlash. However, AN feels this is a story that many of us have experienced and it deserves to be told.

Double checking the equipment we had laid out, I felt satisfied that anything the doctor asked for, we would have close at hand. Knowing that the patient had some kind of outlet obstruction or pyloric stricture, we are preparing to intubate to prevent aspiration. As I look at the patient's chart, and asked her a few questions, I couldn't help but notice her emaciated condition. Fragile, bony fingers gripped an emesis bag with the earnestness of someone clinging to life. Pale blue eyes followed my movements. Bending down, I looked her in the eyes and asked her what I could do for her.

In this moment, we are her world. Her life is in our hands. Nothing else matters, except the next hour in this woman's life. Sometimes in our hustle, we forget how afraid the person in the bed is. As the doctor walks in, he tells us what he may need to do. We confirm that we are ready.

Once we begin the EGD, we see several issues, among them an almost circumferential duodenal/pyloric ulcer. It is deep and ugly.

"I want to balloon dilate her pylorus," the doctor says to me.

My jaw dropped. I looked at my co-worker who appeared to be just as perplexed as me. I made no move to get the equipment, looking at the doctor I asked him if he was sure he wanted to dilate.

The doctor mumbled something that I did not hear then the next thing I knew he pulled the scope out. Relieved, I called the end of procedure time and began cleaning up.

The next thing I know, I hear the doctor right outside the door yelling. Looking up from the computer, I see him raising his hands and yelling. One of my co-workers came in with a clean gastroscope and began hooking it up.

"What's going on?" I asked.

Shrugging his shoulders, he said, 'I'm not sure".

Soon after, the doctor comes in the procedure room and starts to rant about being the doctor and I as the nurse, am not allowed to question him. He looks me in the eye and states, "I am going to balloon dilate."

My direct supervisor was not in the department at the time, so I wasn't sure how to proceed. I had voiced my concern. We did the procedure. As soon as he was finished, he continued to stomp his feet, raise his arms and yell at me about "questioning his judgement". "See," he said, " I didn't perforate."

When I am in a situation such as this, I realize that saying anything is futile. So, I remained silent. My priority is the patient, the last thing I wanted was for her to hear an argument. He could be the lone ranter, but is was not over.

This was not the first incident I was involved in with this particular doctor. There had been several other situations that had led me to question his skill level, decision making and safety concerning his patients. I had been witness to several of his temper tantrums that usually involved stomping of the feet, raising the hands, yelling, and irrational accusations. This latest situation was not just personal, it was professional. Usually it takes me a day to process, separate, and gather the thoughts in my head to figure out the best way to handle a situation. Of course there are usually many things that one can do in the moment, but often we forget and are so distracted that we don't act on some of the things we know can help us in these uncomfortable scenarios. In my current work place, my fellow workers are not used to confronting these doctors, and therefore the bad behavior has been allowed to manifest itself into a dangerous and unprofessional festering ball of bad that has to be halted.

As soon as the patient was taken care of, I sat down at the computer and wrote an incident report. I felt like I was in a bad marriage, trapped with an abusive spouse. I could stand it no longer. I know my job, I know what is safe and not safe. I don't claim to know everything, but my long term experience allows me the luxury of having worked with many good doctors and seeing many different scenarios that are handled in many different ways. I am not used to working with inept doctors who are blind to themselves neither am I used to an atmosphere of apathy.

Over the course of about a year and a half, I have written this doctor up for bad behavior, and dangerous actions. He has had fights with other doctors in the hallway, and in front of patients waiting to have a procedure, he has refused to abort the procedure on many occasions when food or liquid is present in the stomach, even with anesthesia asking several times. He has thrown the scope on the bed during a colonoscopy, taken his gown off all the while a snare is around a polyp and the obese patient teeters on breathing and not breathing. All because a nurse asked him to talk clearly so he could be understood. We know as nurses, that doctors are not good at regulating each other, and unless there is a paper trail, then our complaints are mute. I was not the only nurse to write this doctor up, but finally our voice was heard.

He was brought up under peer review and the concerns were addressed to him by his peers. If anything else, there is a paper trail and the review on record in case future events happen. I will not be party to a doctor's inadequacy putting a patient at risk, we are by law to be the patient's advocate.

This doctor has created with his bullying attitude and actions a place of uncomfortable violence. What are the laws about this? What can I do? This situation led me to investigate my facilities' policies as well as workplace laws regarding bullying. In the next article, I will address the latter

Doctor Behaving Badly - What would you do?

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