"You're the Best Doctor."

  1. I don’t know what causes patients to fall back to the doctor title when expressing their appreciation at the end. Maybe it’s because they are subconsciously elevating us to what they perceive to be the highest level of care and expertise.

    "You're the Best Doctor."

    Doreen came from church. Before anyone says anything, I already know. It's 11:18 on a Sunday morning. Her dress is a striking blend of rich primary colors. Deep blue, bright yellow, candy apple red and dark leaf green jump off the stark black background of the thin chiffon knee-length dress. It will be hard to get this one off her without tearing it as she reclines with the head of the ER stretcher raised about thirty degrees. Her friend helps me get her into a gown before I hook her up to the monitor.

    Doreen seems accurate, but she speaks slowly and searches for words as the story evolves. She had coffee but no breakfast. While standing at the door to the church as a greeter, she started feeling lightheaded and walked toward her friend at a nearby table. The friend takes over, telling the story from her point of view. "She wasn't walking right and seemed confused. We helped her sit down, and I gave her some orange juice. She didn't pass out or fall, but something wasn't right. She's better now, but she's still not normal. Are you the doctor?"

    "No. I'm just a nurse. Someone higher on the food chain will be here soon, but I'll get things started." Most people laugh at my "higher on the food chain" notion. The truth is, it's getting complicated trying to list all the possibilities. She may see a doctor or a PA or a NP. I won't know which until one of them walks in the room.

    Doreen is in a sinus rhythm, has normal vital signs, and moves all extremities without guarding. I page for an EKG and do a complete NIH stroke evaluation. Aside from the friend's observation that "she's still not one-hundred percent," she has no obvious neuro deficits.

    An IV catheter slides smoothly into a large vein in her upper forearm, and I'm drawing labs to cover a possible stroke alert when Jason walks in. I introduce him as the Physician's Assistant and give him a short synopsis of Doreen's history. He asks the same questions we've already covered, and Doreen is sharp enough to tell him so. He shrugs, "Well, sometimes we double check to make sure you stick to your story. I'll go get your workup started. Again, my name's Jason. I'll be the provider taking care of you today. Let me know if you need anything."

    Doreen looks at the blood tubes in my gloved hand: "Did you just take that from me? I didn't even notice you were drawing blood. You're a really good doctor."

    I correct her one more time. "Honey, I'm just a nurse. Jason, the young man who just left, is a Physician's Assistant. He's essentially the doctor taking care of you. He reviews your case with the ER doctor who may or may not see you while you're here."

    Doreen's observation is matter-of fact. "I don't know why he says he'll be taking care of me when you're the one doing everything." Her brain seems to be working just fine.

    Despite the normal NIH scale and resolving symptoms, Jason and the attending designate the patient a stroke alert. A few minutes later we're back from CT. Even the friend who has been with her since the onset agrees that her recovery is complete. Doreen laughs and waves when a large posse of beautifully dressed women from church show up. If you want a massive group of visitors, make sure you're at church, preferably Jamaican, a Hispanic party, or a kid's sporting event when you go down.

    I coax the visitors back to the lobby for a few more minutes and drag in the neuro-tele unit with a monitor and video camera facing the patient and a monitor and keyboard on the opposite side for the nurse. It looks like it could get us to the international space station if we could figure out how to fly it.

    Our neuro-tele-doc halfway across the country "examines" Doreen, walking her through the same questions we asked previously. Once or twice she looks at me shaking her head when he has her do a few of the function tests from the NIH scale. Doreen finally tells the neuro-tele doc that she'd already passed this test before she went to CT scan. Mercifully, he cuts her test short, declaring that he doesn't see any evidence of an acute stroke and doesn't believe she's a candidate for TPA.

    The beautiful ladies from church pour into the room, fawning over the patient and laughing together for about half an hour before Jason comes back to discuss her results. He tells Doreen that everything has come back okay, and it's up to her whether she'd like to stay in the hospital for observation or go home and follow up with her doctor sometime in the next few days. She chooses to be discharged, have lunch with the church group, and head home from there.

    The friends help her back into her colorful dress. She walks well and feels like she's completely back to normal. She asks me if she's making a mistake by going home and wonders what I think might have caused her symptoms.

    "I think you're good for another lap. I would choose to go home if I were in your situation. There are a lot of sick people here; you might catch something. My best guess is that you should have eaten some breakfast this morning. Your blood sugar may have been a little low, and you were probably a little dehydrated since the orange juice seemed to turn things around. Standing in the heat for too long might have made everything worse. It's not impossible that there's more to it though, so listen to your body and come back right away if anything else happens."

    She gives me a hug and a beautiful smile. Her closing words are no surprise. In spite of several corrections, some people just don't get it. But there's no point in correcting Doreen's designation again as she says goodbye. "Thank so much. You were the best doctor I've ever had."

    I don't know what causes so many patients to fall back to the doctor title when expressing their appreciation at the end. Maybe it's because they are forgetful. Maybe it's because they are subconsciously elevating us to what they perceive to be the highest level of care and expertise. It really doesn't matter. After correcting them two or three times, I just let it go. The title doesn't matter. Their sincere gratitude is everything.

    Sometimes, I gaze into the not too distant future, imagining myself on the stretcher as the frail and possibly forgetful patient. I'm hopeful that we won't completely deteriorate into cold dark environment of apps and bots by then. I'm hoping that there will be someone there who is competent and dedicated to help me when my time comes. I'm hoping that nurse will not scorn my weakness, that he or she will take enough time to hear my real complaints and make sure legitimate symptoms are addressed and unnecessary testing is avoided. Mostly, I hope that nurse will value me and treat me with dignity and respect. When that day comes, and it's my turn to say goodbye, I sometimes imagine myself saying, "Thank you so much, you were the best doctor ever."
    Do you like this Article? Click Like?

  2. Visit RobbiRN profile page

    About RobbiRN, RN

    I'm an ER RN, dancer, traveler, lover of the beach, and published author as Robbi Hartford.

    Joined: Dec '16; Posts: 149; Likes: 780
    ER RN; from FL , US
    Specialty: 24 year(s) of experience in ER

    Read My Articles

    12 Comments

  3. by   traumaRUs
    Thanks for this.

    As a vet, I'm used to my fellow-veteran patients calling me "doc" - its a term that has a lot of respect due to the medics in the field. I usually correct them once and then let it go. They know my role and thats all that matters.

    I hope a warm smile, kind touch never go out of style.
  4. by   hherrn
    55 year old guy here, often confused for the doc.
    I am curious about your use of the term "just a nurse".
  5. by   RobbiRN
    Quote from hherrn
    55 year old guy here, often confused for the doc.
    I am curious about your use of the term "just a nurse".
    "Just a nurse." Thank you for noticing.

    I'm old now too. When I was young, I sometimes felt defensive when people called me "just a nurse" derisively. When I became secure and assertive, I started taking the term out from under them before they got a chance to use it, redefining it as a term of endearment instead of an insult. Patients quickly learn who is caring, competent, and responsible, and they choose to put their trust and confidence in those caregivers, regardless of titles. So, if your are often confused with the doc for those reasons, beyond or in addition to being old and male, then you are seen as honorable.
    Last edit by RobbiRN on Aug 16 : Reason: spelling
  6. by   Have Nurse
    Quote from hherrn
    55 year old guy here, often confused for the doc.
    I am curious about your use of the term "just a nurse".

    Stop that right now. You know exactly what she meant. (smile)
  7. by   TuxnadoDO
    As a young female physician often mistaken for a nurse, I can't say it doesn't bother me to see other people called "Dr." While wearing my white coat and after speaking to a patient and her daughter for 15 min explaining my assessment and plan, the patient pointed to my male scribe and asked "is he the doctor?"
  8. by   Medic_to_BSN
    This was beautifully written and touching. Like a previous poster, I was called "doc" by the mortar platoon I went to war with (I was a medic, of course). I knew it was just the easiest way for them to relate to me. Patients are rarely going to use words like, "You're the best provider I've ever had" and my personal (limited) experience is that the older the patients are, the more apt they are to refer to all caregivers as doctor.

    Thanks for this article. It touched on just how important the nurses are - the ones who are there at the bedside, spend the most time with the patients, usually perform the most tasks and know their patients better than anyone else.

    They call Sergeants the "backbone of the Army." Nurses are truly the "backbone of the hospital".
  9. by   Nurse Beth
    Saying "I'm just a nurse" and that you are low on the "food chain" reinforces to the public the subservient role of the nurse.

    Instead, manage yourself up "My name is Beth and I'll be your nurse today. I've been a nurse in the ED for 9 years. I promise to let you know everything that's going to happen. You are in the best of hands with Dr. Valdez. What questions do you have for me?"
  10. by   Libby1987
    What I enjoyed most about this story, the author most definitely has joy in her work.
  11. by   RobbiRN
    Quote from Nurse Beth
    Saying "I'm just a nurse" and that you are low on the "food chain" reinforces to the public the subservient role of the nurse.

    Instead, manage yourself up "My name is Beth and I'll be your nurse today. I've been a nurse in the ED for 9 years. I promise to let you know everything that's going to happen. You are in the best of hands with Dr. Valdez. What questions do you have for me?"
    Your suggested introduction is textbook perfect, safe, appropriate, and defensible. Mine is, well, clearly risky. Sometimes, I start your way (except it's 25 years), but sometimes I start just like I did in the story.

    I would have been disappointed if no one called me out on the "higher on the food chain" designation. "Just a nurse" was no accident. My purpose for using both in this somewhat artsy article was to highlight the ability of patients to see past traditional hierarchy, choosing to honor and respect caregivers who treat them well instead of arbitrarily ascribing honor to titles alone. As the use of artificial intelligence escalates and the practice of medicine becomes increasingly remote and robotic, nursing remains the warm point of human contact patients crave.

    Some doctors are great with patients. I wish they all were, all the time, so we wouldn't need to clean up after them. Some are terrible at taking time to explain and answer questions. When a doc fails to take time communicate well (so he can get back to the internet), I will not waste one word trying to build him up in the patient's eyes. When I do what the doctor should have done, the patient knows which one of us met his/her need for a "doctor."
  12. by   RobbiRN
    Quote from Libby1987
    What I enjoyed most about this story, the author most definitely has joy in her work.
    Thank you your for finding the joy Libby. (Did you ever live in Walla Walla?)
  13. by   Nurse Beth
    Quote from RobbiRN
    Your suggested introduction is textbook perfect, safe, appropriate, and defensible. Mine is, well, clearly risky. Sometimes, I start your way (except it's 25 years), but sometimes I start just like I did in the story.

    I would have been disappointed if no one called me out on the "higher on the food chain" designation. "Just a nurse" was no accident. My purpose for using both in this somewhat artsy article was to highlight the ability of patients to see past traditional hierarchy, choosing to honor and respect caregivers who treat them well instead of arbitrarily ascribing honor to titles alone. As the use of artificial intelligence escalates and the practice of medicine becomes increasingly remote and robotic, nursing remains the warm point of human contact patients crave.

    Some doctors are great with patients. I wish they all were, all the time, so we wouldn't need to clean up after them. Some are terrible at taking time to explain and answer questions. When a doc fails to take time communicate well (so he can get back to the internet), I will not waste one word trying to build him up in the patient's eyes. When I do what the doctor should have done, the patient knows which one of us met his/her need for a "doctor."
    Good point
  14. by   BostonFNP
    The clinical use of "doctor" is a hurdle that nursing is going to have to cross (or otherwise navigate) in the next 5-10 years. The increasing amount of care being provided by non-physician providers (NPPs) coupled with the push towards doctorate degrees, and in truth, the shift towards the majority of care/face-to-face time in the tertiary setting being provided by bedside RNs is leading to a showdown over the use of the "doctor" title.

    The AMA has studied this extensively but only from one side of the equation; their sole focus is patient confusion between physician doctors and NPPs. They have some evidence that patients are confused about "who the doctor is". I'm not sure that is the right question to be asking. On the opposite side I sometimes have issues with confusion in NOT introducing myself as "doctor", the best example of this is when I'm on call coverage and trying to explain to a patient that doesn't know me who I am and my role.

    From my conversations with patients, as a male working in a PCP role, is that most patients use the term "doctor" not as an academic title but rather to describe the individuals that they have entrusted their care in. After all we have other non-physicians that use the term doctor in the clinical setting: psychologists, podiatrists, dentists, optometrists, natropaths, clinical researchers, etc.

    There remains an obvious gender gap with the use of the term which is unfortunate.

close