Doctor Behaving Badly - What would you do?

Maybe one day there will be no bullying in the workplace, but from my experience and talking with other nurses, far too many incidents are happening. This is my story of one experience that had been preceded by many, creating an environment of violence. Is the fact that the perpetrator is another ethnicity? A man? Sure, but I really don’t care. I won’t be party to such behavior Nurses General Nursing Article

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Doctor Behaving Badly - What would you do?

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

3 Votes
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A culture of safety is essential and widely recognized.

Here is a primer sheet from the IHI :

http://www.ihi.org/education/ihiopenschool/Courses/Documents/SummaryDocuments/PS%20106%20SummaryFINAL.pdf

When you notice something is wrong, could go wrong, or even if you are concerned in a procedure you should use critical language. Basically this means to word your concerns in a way that it is easy for you to speak up and easy for the other person to "save face" which can be a factor for some providers. A typical piece of critical language in your context would be to say:

" Dr. xyz -- can we stop for a second? I need some clarity". This usually is known to be some code speak for "you are about to mess up big time - please lets re-evaluate". Wording it that way appears to be accepted and this also comes from the IHI - they have a video about it in one of their open school courses.

If you have already complained and the person was under review it seems that there is some ongoing struggle.

You can continue to report to your manager - it does not seem that it is doing anything.

Here is a medicare link about reporting safety concerns, which is geared towards the patient. But it gives you a good idea what is deemed acceptable and what should be reported:

"To file a complaint about your doctor (like unprofessional conduct, incompetent practice, or licensing questions), contact your State medical board."

https://www.medicare.gov/claims-and-appeals/file-a-complaint/doctor-hospital-or-provider/complaints-about-providers.html#collapse-2372

Since most hospitals are also seeing Medicare patients they have to play by the rules. Again - this is for patients but I know of providers who were investigated based on complaints made to the Board of Medicine from people other than the patient.

Also this link is good and go to number 6 culture of safety

Top 1

1 Votes

This is when having the luxury of not being held financially hostage is a blessing, as well as knowing your stuff, being post menopausal and having a stony **** attitude and no fear of beligerent jackasses.

It's ridiculous that these people get away with this substandard practice as long as they do.

2 Votes
Specializes in Nephrology, Cardiology, ER, ICU.

Great article. Very shameful IMHO that we as nurses must be concerned with telling these types of stories. This behavior should NEVER be tolerated

2 Votes

They are still turning out MDs who do these types of things? WOW. He, my supervisor and me would have a heart to heart about how it is MY JOB to question him. And I will continue to do it especially when he behaves in such a childish manner. After all our job is to protect the patient and that means from everything, even the doctor when they are throwing a hissy fit. Very unbecoming behavior from an MD. Stand up to him anytime you need to.

2 Votes
Specializes in Hospital medicine; NP precepting; staff education.

In the most toxic environment I ever had the misfortune to work the provider put his finger in my face between the patient rooms and nurses station. His seething and clipped words to me were, "don't you ever do that again!!" The action for which he complained was filling the schedule as I was supposed to do. I went up to him further down the corridor, away from patients but in front of two coworkers and I calmly told him he is not my father nor husband and under no circumstances is he ever to put his finger in my face nor talk to me that way. (Neither my father nor husband would dare, either).

My position at the time was in management and I also had responsibilities to work the floor and direct the staff. My subordinates had a habit of not respecting authority which is why I elected to not exclude them in the interaction.

I wrote him up for creating a hostile work environment and I subsequently was written up by him for insubordination. To add insult to injury, he was to perform a procedure for me in the following weeks and on the day of that appt, he informed me that it was a conflict of interest after previously agreeing to take me as a patient.

The same organization but a different office also denied treating me after he convinced them to withhold necessary treatment. His line about conflict of interest didn't truck with me because he's treated my boss' boss.

I had to wait 6 weeks in increasing pain to get treatment outside of my own network for relief. Somehow I didn't have to pay the expected copay. I suspect it had to do with my conversation with my boss' boss, who also was an integral piece in retaining this problem physician.

Being disrespected was one thing but the lack of ethics and moral couth this provider showed was one of the Last straws that sent me to the DON asking for a transfer in the organization.

He no longer is with the company and future treatment resumed with my office after a new provider was in place and I was in a better department.

2 Votes
Specializes in Nephrology, Cardiology, ER, ICU.
In the most toxic environment I ever had the misfortune to work the provider put his finger in my face between the patient rooms and nurses station. His seething and clipped words to me were, "don't you ever do that again!!" The action for which he complained was filling the schedule as I was supposed to do. I went up to him further down the corridor, away from patients but in front of two coworkers and I calmly told him he is not my father nor husband and under no circumstances is he ever to put his finger in my face nor talk to me that way. (Neither my father nor husband would dare, either).

My position at the time was in management and I also had responsibilities to work the floor and direct the staff. My subordinates had a habit of not respecting authority which is why I elected to not exclude them in the interaction.

I wrote him up for creating a hostile work environment and I subsequently was written up by him for insubordination. To add insult to injury, he was to perform a procedure for me in the following weeks and on the day of that appt, he informed me that it was a conflict of interest after previously agreeing to take me as a patient.

The same organization but a different office also denied treating me after he convinced them to withhold necessary treatment. His line about conflict of interest didn't truck with me because he's treated my boss' boss.

I had to wait 6 weeks in increasing pain to get treatment outside of my own network for relief. Somehow I didn't have to pay the expected copay. I suspect it had to do with my conversation with my boss' boss, who also was an integral piece in retaining this problem physician.

Being disrespected was one thing but the lack of ethics and moral couth this provider showed was one of the Last straws that sent me to the DON asking for a transfer in the organization.

He no longer is with the company and future treatment resumed with my office after a new provider was in place and I was in a better department.

Totally shameful! I'm so sorry you had to endure this...

2 Votes

We all know there are bad doctors. If this was another field, the bad ones would be fired. One of the keys to this is working for a good administrative team that knows how to deal with personalities. You will find some hospital staff work together really well and give excellent care. Other hospitals have some bad doctors that continue to cause harm. A lot of it is the management. If this doctor does that to you, he is doing it to other people. Management knows and does nothing about it. Why?

1 Votes

I only saw one response here that said anything about reporting the doctor to his board. If you believe a physician is incompetent you are obligated to do so. Anything less and you are remiss.

1 Votes

No more Captain of the Ship approach, it seems.

Thank God for brave nurses.

I would be hardpressed to let this doctor argue, shout, and demean where patients could hear him.

I once took the arm of a tantrum-ing doctor and said, "C'mon, Sir, let's go have a break", and pulled him into the locker room. He was stunned but complied.

These days, I know more is required - reporting to Admin, Board of licensing, CMS, etc., but it felt good to abort that particular incident.

Keep on keepin' on, y'all.

2 Votes

Good job on that one. I bet he avoids the locker room now.

2 Votes
Specializes in Critical Care, Education.

Wow - great article. Every hospital is supposed to have a policy & procedure for handling disruptive physicians, so that should be our first stop. In addition, filling out an incident report will usually create a redundant paper trail that is harder to cover up. If all else fails, I advise our staff to go ahead and use the Compliance Line... these issues go directly to a 3rd party organization that only answers to our Organizational Compliance Officer; our CEO also receives a copy.

FYI, my state is the only one with a legally (since 1983) defined "nurse-patient duty" that cannot be subsumed by the physician-patient duty. This means we are legally obligated to intervene if we believe that the physician's actions are clinically, legally, or ethically improper. But - it still takes a great deal of courage to do so..... as illustrated by the Winkler County case.

1 Votes
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