How to handle condescending doctor

[MyAimIsTrue]

I'm a 2nd career nursing student and here is a situation I witnessed in clinical last week. I was in a patient's room with my nurse who is not an inexperienced but who looks very young (I don't know if that had anything to do with this doctor's behavior).

Anyway, the patient was in kidney failure, very edematous, and had three family members at the bedside. There had been an issue with very high BP, but the most recent reading wasn't too alarming. However her heartrate was low, around 50. The doc (he's a hospitalist) walked in, was talking to the family about the patient needing to start dialysis, etc. He answered their questions, then the nurse said, "Oh, her BP was xxx, but I---" The doc said, "Got it, I'll check the computer," and glared at her. Then the nurse said, "But her heartrate is low--" and the doc cut her off again, "I SAID I'll check the computer," with another glare and a hand gesture meant to shut her up.

So we all finished up in the room and the doc said to the nurse, "I need to talk to you in the hallway." I stayed in the room, but I could overhear him telling her, "When I tell you to stop talking you need to stop talking. This family is stressed out and I don't need you adding to their stress. I can easily check the computer for her vitals." I moved further back into the room so I couldn't hear her response.

If anything, I think the doc's attitude toward the nurse and him glaring at her would escalate the family's stress, more than the nurse reporting the pertinent info.

I'm not sure how I would have handled the situation. But it made me angry and I like to think I would have stood up for myself. What would you have done?

[AceOfHearts<3]

As everyone else has said the nurse should have left it alone at that moment. Once the doctor was out of the room away from the family, most likely at a computer, I would have shared my concerns/observations with the doctor then.

[Wuzzie]

He was rude, file him away in your "Rude Doctor" list and move along. However, I also would have stopped talking when he told me the first.

I don't agree. He wasn't rude. He actually acknowledged her concern by saying "got it" and then gave her the "shut up, shut up, shut up" look. If you have kids you know exactly what that is. Unfortunately she didn't shut up so he had to shut her down before she did any more damage. And he spoke to her after instead of running to her manager.

[guest940422]

Always remember you only get a piece of the picture in school.

You don't know how long this nurse and doctor have worked together or how closely.

You don't know the unit culture politics or policies.

You don't know how long the patient has been receiving care intermittently on this unit (they may have known this patient for years)

You don't know how much the patient wants his family to know about his condition or if the doctor already knows the vitals and they are expected given the lab work and clinical picture.

The biggest mistake students can make is to assume they know what they would do in a situation. I did that a lot and realized quick after school there is a lot more to it when it's your turn. Worse yet, if you offer the nurse advice, you risk offending them and not wanting to teach you anything.

What I can tell you in the times I have legitametely been in these situations is there is a proffessional way to handle it. Remind yourself you and the other individual are on the same side and have a common goal to help the patient. Empathise with their point of view. They did not react appropriately, but they most likely did not do it with malace. Address the issue with the person directly as soon as possible while still respecting thier time and priorities. I suggest letting them know you would like to have a quick chat in private before the end of the day and asking them to grab you when they have a free minute. This starts the exchange on common ground and keeps anyone from getting defensive or feeling ambushed. For the love of God do not do any of this in front of co-workers, patients, or family members.

I usually keep it quick and simple, I tell them I understand they were frustrated but the way they handled it made me feel disrespected. Request that next time they simply excuse us to speak privately or offer up some other acceptable way they could have handled the situation. Request feedback on how you could have handled the situation differently as well (for instance that nurse could have waited until after the md was done to update them on the vitals so they didn't make them look like they weren't informed in front of the family).

I know it sounds like a lot but the whole exchange would take less than 5 min. Assure your co-worker the conversation will stay between the two of you (and make damn sure it does). Different people work differently and you need to take time out to learn about each other's styles/expectations/quirks/pet peeves/ triggers to work together more efficiently.

It can be awkward, but by opening up this kind of dialogue, you will gain a lot of respect and be able to work with some of the most difficult personalities.

Never forget: you don't work for the doctor any more than the housekeeper works for you! You are all co-workers and equals. But they won't see that if you act like a pissed off teenager demanding respect instead of initiating a professional dialogue.

Good luck

[Apple-Core, ASN, BSN, RN]

Nurse-doctor collaboration takes place in private, not at the bedside.

This. If I had been that nurse, I would have approached the doc outside the room. If he was condescending to me at that moment (ie. outside the room), then we would be having words....but, in all honesty, the nurse blurting out vitals in front of the family wasn't a wise choice.

[EaglesWings21, ASN, RN]

I would probably not report a heart rate of 50 unless the patient was on a new medicine or symptomatic. I especially wouldn't interrupt the doctor when they were communicating with family and wouldn't be giving information out in front of an already anxious family. I think the doctor did well to inform the nurse why he stopped her.

[RNperdiem, RN]

I have been the family member and that 5 or so minutes you get with the doctor a day is very important. Families have lots to talk about regarding the plan of care. As a nurse, I make every effort to protect that time from interruptions. Nurses are not the only ones who strive to actively listen to patients and their family and deal with their concerns.

[hppygr8ful, ASN, RN, EMT-I]

Huh,

OP never returned guess the answers were unexpected!

Hppy

[JKL33]

MyAimIsTrue -

How do you feel about our answers?

It's not really an everday occurrence that the replies to any given topic on AN are quite as like-minded as we seem to be on this thread.

I hope you will share more of your own thoughts after processing things from a different perspective. I find our collective responses on this particular matter uplifting.

[audreysmagic, RN]

Not to repeat everyone's great answers, but...yes, I can see where your concern comes from, OP, but sometimes shutting up in front of family is necessary. Catching the doc away from the patient/family if you have a concern is best. I see where the nurse had concerns, but he told her he was going to look at the vitals, and providing more less-than-great news in front of a family with little to no medical knowledge, potentially, is a situation ripe for dramatics.

I work with one doctor who is known to many of our staff to be "a jerk." He's really NOT, though - his issue is that he has zero tolerance for BS from professionals. If you call him without vitals, freaking out over minor things (and questioning him when he isn't alarmed), or write consults for things he has already addressed - YES, he's going to be cranky. However, the nurses and staff who are competent and have their stuff together, he's perfectly polite and even kind to. "The patient keeps complaining about it" after an issue has been properly addressed doesn't make something an emergency, though, and some nurses don't seem to understand that.

[psu_213, BSN, RN]

Huh,

OP never returned guess the answers were unexpected!

Hppy

However, I am glad the OP did not come back, argue about it, and each time add more "facts" to the story (as some do).

Hopefully the OP read the largely thoughtful responses, and is able to apply it to her career as a nurse.

[MyAimIsTrue, BSN]

Huh,

OP never returned guess the answers were unexpected!

Hppy

Guess what? I'm back! I happen to be a full-time student in finals week, a part-time worker, and a mom of 3, so can't check in here every day.

Anyway, this thread was enlightening for me. I don't think I told the story very well, however; when I verbally told my friend about it (and she's a physician herself) she said she would not speak to a nurse like that and that it did sound condescending. She also said this doc sounds old school and that younger doctors are generally more respectful of nurses.

I also know that the nurses don't like this doctor at all. At the beginning of shift, one nurse was overheard saying, "Oh we got Dr. XX today. I can't stand him and he knows it." I later put 2 and 2 together and understood this was the doc the nurse had been referring to.

As I said, I am a 2nd career nursing student. I work in a professional environment and have for 20 years. I cannot imagine anyone in my office talking to a colleague the way he talked to that nurse.

I am still thinking about everyone's comments...thanks for sharing them. Every clinical rotation is a learning experience for sure.

[Naturally Brilliant, BSN, RN]

I used to work in a MICU until recently as an RN, so let me throw in my two cents here. If you feel that you have clinically significant data that the physician HAS to know about, you can ask him/her before they talk to the patient, "By the way, sorry to bother you, could you take a look at these values real quick?" and discreetly direct them to the computer screen. They may say they'll take a look at it later, or they may put eyes on it there. It really depends how you bring it up.

Also, think of it this way. Imagine you're in the room doing a sterile procedure (e.g., central line dressing change), focused on doing what needs to be done, and then someone else barges in to start chatting with the patient (can be a tech, a physician, a family member, whoever!). You're going to be annoyed at the interruption and most likely you'll say something like, "Hey give me just a few minutes, I'm in the middle of a sterile procedure". And if they're even remotely competent, they'll excuse themselves while you're doing your high-priority task. Most people operate on a time crunch and aren't keen on being interrupted, regardless of their role.

Lastly, context matters. If a physician starts talking to a patient, and you suddenly notice sudden active hemorrhaging from a wound site or a femoral sheath area, you obviously aren't going to stand there idly until the MD is done talking. Everyone knows you have a critical role at the bedside, physicians included, and people will defer to you when you have to perform a necessary interruption.

With all of that said, everyone in a professional work environment has an obligation to keep their emotions in check. If someone starts using profanities or verbal abuse at you (doesn't matter what title or job description they have), that's not tolerated in any environment. So in that case it's incumbent on you to write up emails to your manager, to the ethics line, and wherever else on the chain of command these situations arise. Needless to say, most nursing jobs are high-stress ones, but there wouldn't be a 'culture of abuse' anywhere if all nurses were proactive in setting and enforcing clear boundaries of workplace conduct.