"The Disruptive Behavior of Doctors"

[dharmanurse]

I am currently reading a book on nursing careers that talks about "the disruptive behavior of doctors." I'm sure we all have stories! Can you tell me of ways in which doctors' behaviors have made your job harder? The pundits talk about ways to improve health care. Well, one thing that would really make a huge difference: changing doctors' behaviors.

[morte, LPN, LVN]

I was working with a Dr. who was performing a bronchoscopy at the bedside. The pt coded after the Dr. began the procedure. The pt recovered and was transfered to the ICU unit. Months after this incident the Dr reported me to the nursing board that I "caused the code" by giving too much Versed. The documentation clearly shows that the code happened well after the Versed was given and that it was the Dr's fault the the pt coded. However the board still had to investigate and I had to hire an attorney, etc, etc. Talk about disruptive behavior! The Dr was a jerk to work with and a big jerk, afterwards, with his false accusation to the board.

Did you sue the orifice?

[AOx1]

I don't tolerate those types of behaviors, and have had to deal with very little of it. I also will hang up or walk away if I am being treated disrespectfully. This is the only thing that will change this behavior. Reporting, although I always do so, hasn't changed much. But refusing to allow this sort of treatment from anyone- docs, patients, etc is effective. It took one doc twice to learn this, but I told him that I was calling him on a professional matter regarding his patient, and would document that I had done my part, but would not be yelled at, and subsequently hung up as he yelled. He called back, apologized, and gave appropriate orders. My job is to assess and report my observations. When I have fulfilled that, I no longer have a responsibility to that physician, only to the patient. If the physician is unable to handle his/her responsibilities professionally, I will take it higher up to the house physician to ensure that I care for the patient. I am a professional and expect to be treated as such. My job duties do not include being a verbal punching bag. It is also not my responsibility to teach someone else proper professional etiquette. I will however teach them how I will and won't be treated.

[BoomerRN]

Talk about disruptive? When I first started working as a nurse in the late 70's, I worked at a very small hospital in my hometown. Except for two or three docs, the rest were, jerks and demanded I turn all my attention to them whenever they came on the floor. I had trouble with three of them trying to get me to go out with them (I was married with three children), and making sexual advancements towards me almost every day. One of the surgeons actually came into a pts. room, while I was helping the aide with a dying pt., and wrapped his arms around me from the back. I told him to get out, which he did, laughing. Whenever I called him about a pt. he would ask me personal questions and make remarks about my appearance such as: are you wearing a dress to show off your pretty legs? I reported all these behaviors to the Director and all she would say was: "Oh, just ignore them." I stayed there about 8 months. I was so angry and almost left nursing, but I decided to find another job and leave. It was the best decision I ever made. I have never found another work place as bad as that one was. My favorite place to work was the Cleveland Clinic Hospital.

[MichelleB34]

It is policy at our hospital that when we take a telephone order we are to read it back and to write under our order that we read it back. The policy is in place to avoid those kind of issues. I had a problem with an order I took on a 5 month old for chloral hydrate for a procedure. The director of medical records called me one day saying that the pediatrician said that she did not give that order. I informed the director that she did give the order and I repeated it back. I also told her that I am not in the habit of making up orders. I have not heard another thing about it.

[MichelleB34]

I think the new JCAHO rule on disruptive behavior will force more hospitals to create and enforce policies that address any and all disruptive behavior.

Could you eleborate on this rule. I don't think I have heard about this.

[MichelleB34]

I think from my experience that if labs, etc. were on the chart in a more timely manner when possible, by the designated staff member, it might eliminate some of the requests. I know that nurses have many demands on their time. I worked on med-surg for 11 1/2 years. But I feel it is part of the nurses' job to work with the doctor to help facilitate the patient's care. Whether that be the floor nurse or the charge nurse as appropriate. After all who knows the patient better than you the bedside nurse. However interacting with the doctor should not be detrimental to your patient care. You are the gate keeper. We should be advocates for our patients.

[snootwiggie1]

I think that overall, docs have improved since the '70s when if they walked into a nurses station, the nurse automatically stood to give up her chair. I've worked with docs who threw trays of surgical instruments (including sharps) at you, tore up charts and cussed you out for trying to confirm an order. Now I work in home health and was doing diabetic management. The pt was under the care of an endocrinologist. The order read if BS > than 400, call physician. I phoned him and was thoroughly cussed out and told told to call her PCP and the phone was slammed down. His receptionist reminded me of a nazi and was just as disagreeable as he was. I "assumed" that since he wrote the orders, he was the doc who needed to be called. Never assume! My supervisors had no better luck with these pathetic excuses for health care "professionals" and I use the term loosely. On the other hand, I've dealt with Wound Care specialists who were always more than happy to speak to me and revise orders to expedite patient healing. The endocrinologist was the worst doc I've dealt with in many, many years. It sure blows the mood of the whole day when you get one like him.

[sequin121]

We do not tolerate disruptive behaviors from anyone, in our facility. We have defined service standards to which everyone is trained and held accountable. We also add these behaviors to our evaluation process. 50% of the evaluation is based on the essential functions of the job and 50 % is based on essential behaviors. It's not enough to be a "good nurse", if you are a "bad person". We take these very seriously. We also have addressed the medical staff and their behavioral expectations. We have very good medical directors of our specialties so if there is a disruptive physician, they are dealt with through the medical staff services department and ongoing issues could result in loss of privileges. Also, if we have patients and families who have ongoing abuse issues towards the staff (many times these are repeat patients with repeated behaviors), our CEO will send them a letter after discharge "Inviting" them to seek treatment elsewhere, in the future. Not at our hospital. The key is having the support of your CEO, physician group and DON in developing and maintaining a culture of respect.

The Joint Commission has addressed this. In July of 2008, TJC issued a sentinel event alert (#40) entitled "Behaviors that Undermine a Culture of Safety". Part of that alert indicates:

There is skills-based training and coaching for all leaders and managers in relationship-building and collaborative practice, including skills for giving feedback on unprofessional behavior, and conflict resolution.

This is pretty clear in it's intent. Also, hospital management should encourage a culture of support to hospital staff which allows them to set boundaries with what they will accept from physicians and other personnel. Of course, this boundary setting would have to be done firmly and politely and in a way that de-escalates the situation....not escalates it.

Good luck!

[annabanana1219]

Did you sue the orifice?

Am seriously considering it.

[Spidey's mom, ADN, BSN, RN]

Talk about disruptive? When I first started working as a nurse in the late 70's, I worked at a very small hospital in my hometown. Except for two or three docs, the rest were, jerks and demanded I turn all my attention to them whenever they came on the floor. I had trouble with three of them trying to get me to go out with them (I was married with three children), and making sexual advancements towards me almost every day. One of the surgeons actually came into a pts. room, while I was helping the aide with a dying pt., and wrapped his arms around me from the back. I told him to get out, which he did, laughing. Whenever I called him about a pt. he would ask me personal questions and make remarks about my appearance such as: are you wearing a dress to show off your pretty legs? I reported all these behaviors to the Director and all she would say was: "Oh, just ignore them." I stayed there about 8 months. I was so angry and almost left nursing, but I decided to find another job and leave. It was the best decision I ever made. .

This behavior isn't limited to doctors . . . . . . your description fits a manager I worked for at a computer company in the 1980's . . . he came up behind me while I was typing and put his arms around me and his hands on my breasts. I sat there frozen - scared - I was young. :icon_roll I think he sensed I was afraid because he walked away. But when I complained about his behavior to his boss, the guy chuckled and said "What do you expect, you are an attractive woman". Well, I guess I should come to work with a bag over my head and wearing a burlap sack. I quit - but it took me a week.

steph

[chickie]

Although most of the doctors are finally starting to look up their labs, etc. on the computer, there

are always a few who ask. Once we became computerized and the doc persisted to ask us for

previously documented information, we complained to our Nurse Mgr who took our complaints to

the Medical Staff director who directed to docs and also provided them with training to look up this

information. We still have a doc who writes an order to call with lab values, however, our Nurse mgr.

states "do not call with normal labs" as they have the ability to look up this information. We are very busy

nurses looking after several patient's needs at the same time, however, the Docs see one patient at a time.

One Doc pulled a phone out of the wall because the dictation was not working correctly, scaring many people

who were in the vacinity at the time. He was sent a bill for the phone and I hope disciplined, but why do

these doctors keep getting away with this type of behavior?

[Wade21, ADN, RN]

I have worked with polite and disruptive doctors. If I need to call a doctor in the middle of the night because of a change in a pt.'s condition, the last thing I'm going to be concerned about is if the doctor is going to "chew" me out for bothering him! To me, that's the worst thing that could happen!

I look at the bright side and think "at least I have not, as of yet, worked with a Dr. House!