Question about Doctors

locolorenzo22, BSN, RN · Apr 10, 2007

I'll never forget my first run-in this semester. 1st day of actual floor work, and my patient was scheduled for a needle biopsy. He had the doctor I've heard horror stories about at work and who is always ordering B/Ps lying and standing, nm if patient is unable to stand. I was taking care of him and this patient was a bit cantankerous to say the least.

He was NPO, and wasn't getting any oral meds until after procedure, breakfast, etc. I get told as I'm walking to find staff nurse about another patient's need that doc and nurse are on way to the room, so get in there. Doctor asks nurse 1 question, then she has to leave to do an admission. Then charge comes in, answers 1 question, pager goes off and she has to leave...so my knees are knockin now!

Dr. asks why his tongue looks yeasty...I rattle off "He's NPO til 10 due to scheduled needle biopsy then we'll get his meds, lunch and probably a tall soda for him, right? (winking at the patient)" Dr's impressed, asks a few more questions, then we go back to the station. He writes a new order, then asks me if I know what WBC differentation is. I say "not offhand, but I could probably go look it up(like the dr doesn't know what it is!!)" He tells me not to worry about it, then gives me 10 minute lecture about the immune system.....I listened to the last 2 minutes, I knew the rest before i got there!

So, it wasn't as bad as I thought it was going to be. You have bad times here and there, but doctors are realizing nurses are their equals, not people to be yelled at. When they leave the floor, we are the ones who have to care for patients. Don't worry, it comes and goes!

Daytonite, BSN, RN · Apr 10, 2007

if this is something that you are worried about, there are things you can do to prepare for it. you learn assertiveness techniques and it also wouldn't hurt to take a class in interpersonal communication if your college has one.

as a nurse you are going to be working with all kinds of people. doctors aren't the only ones who can go off on you. patients and visitors get mad too. when you perceive yourself as being low on the totem pole, a doctor seems like an awful intimidating figure. the old days when a doctor could stare at a nurse on general hospital and bark, "you're fired!" are gone. doctors don't have that kind of power anymore unless it is in a private practice that they own and run. in addition, there are too many state and federal rules that facilities have to follow when it comes to worker's rights.

you want to be scared, so here goes. we had one physician who would go up to nurses, stand toe to toe, get right in their face as close as he could and scream, "you killed my patient!" after unsuccessful code blues. when he came in to make rounds, the nursing staff would just disappear. it was amazing. it got to the point that nurses dreaded having to call him for anything because you never knew if he was going to blow up on you or not. had another doctor who took a chart and heaved it across the nurses station when a nurse stood her ground and assertively questioned an order he was giving that she thought was inappropriate. when i was a supervisor i had to inform an intoxicated surgeon that he was being denied or privileges that evening and that the chief of surgery was on his way in to talk to him. he doubled up his fists and started walking toward me. i thought he was going to punch me and i got out of his way. i was being as nice as i could and only conveying a message. had a patient who started screaming, threatening to sue the nurses and carrying on because we couldn't let him smoke in the room. he told the nurses he was going to "fix them". then he pulled back the sheet enough so they could see his hand on a gun he had under the sheets. security was informed and that was the last of the gun because he surrendered it, but it could have ended quite differently. the situation had escalated because one of the nursing staff started acting bossy and started quoting rules. no one knew about the gun, however, until this. had another patient who got upset with a nurse, who i have to say did have a rather smart mouth. he got nasty on her, but like a fool she argued back. before she knew what hit her, he reached over, pulled out the top drawer of the bedside stand and swung it at her breaking her upper arm. it could have easily been her head that got hit. but, the man was strong and very fast.

if there is anything i've learned over the years and any wisdom i can impart to you students, it's to pay attention to communication techniques and psychology, stay calm, always treat others with respect and don't show any temper. you can't learn the practical side of these techniques and skills in a few months of school. it takes years and years of working on them. but, it ultimately pays off and you will find you will be able to get along much better with people than most others who won't bother to learn this stuff. there are times when a good outcome is that both sides backed down or both walked away without winning. you can't change others behavior, but you can change and address your own. you can't always reason with an angry person, but you can remain the rational one in the situation. and it never ever pays to lose your temper. ever.

i had a very good-natured boss years ago before i ever went to nursing school who used to always say after solving some crisis that would come up, "a hundred years from now, nobody is going to care about what just happened." thirtysome years later and i still remember him getting another cup of coffee and going back to his office saying that time after time. he was absolutely right. most situations are just not of the grand scale of a world war that they require such an emotional cost.

LogCabinMom · Apr 10, 2007

Not me, but a fellow student had a run-in 2 wks ago: she was wearing a white lab coat and the doctor she was observing mistook her for a medical resident, not a nursing student. The doctor proceeded to tell our instructor that none of us should be wearing white lab coats in the hospital.

Some people.

queenjean · Apr 10, 2007

People who are bullies (they come in all professions) know who to pick on. I can honestly say I have NEVER had a doc yell at me. Get short with me, yes. Get snippy, yes. Yell at me, degrade me, humiliate me? No, not as a student, not as a nurse.

Some of it I am sure has to do with how I hold myself. I just do not accept being treated poorly. We have one doc who has a horrible reputation; he started in on me one day, and I stopped what I was doing, turned around, stepped right up to him, and looked him in the eye. I find that holding eye contact usually takes it all right out of them.

Once when a doc started to b*tch at me when I called in the middle of the night, I just interrupted with "Dr K, I am so sorry, the call schedule has you as the physician on call for this group. Could you please tell me who is on call, so that I can contact them to take care of this?" There was a moment of silence and then she said, "What?! I'm the f-ing physician on call!" and I just said, "Oh! I'm sorry, I thought by your demeanor you weren't expecting phone calls about patients. Since you are the one on call, I need to discuss this patient's critical lab values with you right now." And that was that.

That said, I also don't call about stupid stuff (who cares if there was no diet ordered for a patient who came in at 0300 and is totally zonkered? That can wait until 7 or 8, it doesn't need to be clarified at 0330, like one of our nurses did last week); I have all my stuff together when I call--the chart open on the computer, I know all the meds, the lab values, the vitals, anything that the doc might need to know. I always introduce myself clearly and professionally when I call, and I give a quick review of the patient. Something like, "Hi, Dr. K, this is J from XYZ hospital and I am calling about Mrs. Smith in room 201. She's an 89 year old patient of Dr. F's who was admitted yesterday with chest pain. Are you familiar with her?" And then go from there. I hear some nurses call and don't even say who they are, refer to the patient by their room number, and just blow into the problem. They dont' have the chart in front of them, they haven't gotten a recent set of vitals, or they can't answer a question like, "Does this patient have a history of afib? or What was her previous potassium level?" I'd be grumpy too if someone called me about a patient and wasn't actually ready to give me everything I needed to know to make a decision on how to help her.

Also, if I do something wrong or screw something up, I take responsibility for it. If I feel like I didn't handle something well, I say so and ask what I should do the next time such a situation presents itself.

I don't know, now that I've said this, I'll probably go to work tonight and get reamed. But I've been there a couple of years, and never gotten it full in the ear or face. Some people seem to get it all the time. Based on what I have seen others go through, I've developed a little script that I would say if someone started to launch into started to treat me like crap. I think that helps me not worry about getting yelled at, because I already know how I would handle it, and maybe because I don't worry about it, I don't end up getting yelled at. I don't know exactly why some people get it more than others, but having a plan of how to handle it calmly and professionally helps.

TexasER_RN · Apr 10, 2007

Interestingly enough, this situation came up just today and was discussed in post conference. This didn't happen to me but to a fellow healthcare team member in my class. We are just finishing up second semester RN training and we don't deal with IV's until next semester. Anyways, a doctor in L&D has his hands full with his patient and he's sterile with an IV med hanging out of his gown pocket....he asks the student nurse to take the med from his pocket and administer IV push for him.....the student explains that this isn't something we are checked off to do yet and that he's sorry but he won't do it....the doc then proceeds to yell obscenities at the student reminding him of what an incompetent little twerp he is and says he's (the student) worthless to the medical profession and should just quit now !!!! Well, I am so proud of my fellow student I could just kiss him.....he stood his ground and didn't reply to the doc or let him see "being upset" which is probably what the jerk of a doctor wanted in the first place !!!! I've never had a bad experience but I'm sure it's quickly approaching... our preceptor said the situation was handled appropriately and gently reminded us that we have more to lose than the doc at this juncture in our lives......sooooooooo everything turned out pretty okay in the end:lol2:

YUPPIE2009 · Apr 10, 2007

See my fear is not being able to stand up for myself. I know how to stand up for what I believe in, but I have this image in my mind where the Doctor is allowed to railroad the RN staff and we just have to accept it as "the nature of the beast". I would just think that there would come a time when enough would be enough.

I do agree that sometimes they deal with you based on the vibe that you are sending out.

Daytonite, BSN, RN · Apr 11, 2007

yuppie2009. . .much of your fear comes from being inexperienced and unsure about the unknown. believe me, after a few years of seasoning and feeling confident as a nurse you will feel differently. i really strongly urge you to take a course on assertiveness at some point and review the information periodically over the years as well as practice the techniques when opportunities arise to do so. i've taken one day seminars on "how to deal with difficult people" over the years. these seminars are about assertiveness and recognizing and dealing with aggressive, manipulative, or deliberately intimidating people. assertiveness is a skill you can learn and must practice in order to master, no different from learning how to insert an foley catheter or an iv, except it involves more to do with your thinking and what comes out of your mouth. believe me, assertive and aggressive people learn those skills and behaviors and they are reinforced by the positive or negative feedback received in encounters with others. as i said above, it's taken me a career to learn these skills. nursing, in many ways, belongs classified with the behavioral sciences and with good reason. taking that first introductory course in psychology was only the beginning of your journey in working with people. the more you learn about how people interact and respond to each other, the more savvy you become in how to deal with troublesome personalities and behaviors in others. as a charge nurse, and in all likelihood you may very well be a charge nurse someday, you will have many interpersonal communication challenges ahead with co-workers, doctors, patients, visitors and bosses. you can shrivel back like a milquetoast or passive-aggressive person and take whatever bullying might be dealt out to you, or you can put your foot down, take control and learn how to take charge when an aggressive situation occurs. it's really all up to you. the one thing about being in the career of nursing that never changes is that there is always something to learn and improve in ourselves, even after school is over.

KnitterMama · Apr 11, 2007

Daytonite, I think that is great advice. I would definitely benefit from assertiveness training of some sort. Example A : Dr S throws a hissy fit because someone accidentally handed him the wrong piece of paper along with the ones he needed. He b*tched about it and threw the paper on the floor at my feet. I said "thank you" and walked away. :uhoh21: I'm such a weenie.

queenjean · Apr 11, 2007

See, I just don't think I deserve to be treated like that; I don't think ANYONE deserves to be treated like that. I honestly would have a hard time not laughing out loud, or stepping into the doc's face eye to eye and saying something like, "Are you f-ing kidding me? Are you seriously going to throw a temper tantrum like a two year old? This I gotta see." It would depend on my mood, and if I was busy (and therefore would have to just walk away laughing) or had the time to watch a doc blow a blood vessel in his head.

Obviously if I were in the presence of patients, I would get eye to eye, raise my eyebrows, and say something like, "Please maintain your professional composure; after we are through here, let's discuss this in a professional manner at the desk, shall we?" If it didn't work, I'd just walk away (if it were safe for the patient for me to do so.).

I dont' know, I just can't see taking that crap. It is just so completely unacceptable. It is no more acceptable for a doc to scream and throw a tantrum than it is for a doc to strip off his clothes and pee in the corner.

Practice your incredulous look (as in, are you seriously acting like this and thinking it is okay?), practice the words you would say if confronted like that. Good ideas are "Please lower your voice." "I will discuss this with you when you are calm." "I'm sorry, I will not respond to this type of behavior. I expect you to be polite and professional." Make up a script for various situations that you would feel comfortable saying to a doc. Then you are prepared if something like that ever happened.

YUPPIE2009 · Apr 11, 2007

I think that this is a good thread because....it seems that there have been some concens about "Nurses eating their young", but clearly there is more to that dynamic... I hear what all of you are saying and I think that they are great suggestions. My mother works at a hospital and states that she has noticed that Doctors must "watch" the way they once treated nurses because of the shortage and the ability for nurses to switch jobs if they feel like they are not being treated fairly. I think at her hospital the nurse manager (or someone like that) does evals on med students, residents, and other DOCs. I think that is a great idea !!!!!

KnitterMama · Apr 11, 2007

See, I just don't think I deserve to be treated like that; I don't think ANYONE deserves to be treated like that. I honestly would have a hard time not laughing out loud, or stepping into the doc's face eye to eye and saying something like, "Are you f-ing kidding me? Are you seriously going to throw a temper tantrum like a two year old? This I gotta see." It would depend on my mood, and if I was busy (and therefore would have to just walk away laughing) or had the time to watch a doc blow a blood vessel in his head.
Obviously if I were in the presence of patients, I would get eye to eye, raise my eyebrows, and say something like, "Please maintain your professional composure; after we are through here, let's discuss this in a professional manner at the desk, shall we?" If it didn't work, I'd just walk away (if it were safe for the patient for me to do so.).
I dont' know, I just can't see taking that crap. It is just so completely unacceptable. It is no more acceptable for a doc to scream and throw a tantrum than it is for a doc to strip off his clothes and pee in the corner.
Practice your incredulous look (as in, are you seriously acting like this and thinking it is okay?), practice the words you would say if confronted like that. Good ideas are "Please lower your voice." "I will discuss this with you when you are calm." "I'm sorry, I will not respond to this type of behavior. I expect you to be polite and professional." Make up a script for various situations that you would feel comfortable saying to a doc. Then you are prepared if something like that ever happened.

That's some great advice. I really should practice, as you suggest. I don't think I deserve to be treated that way either, I've just never been good at standing-up for myself. That particular doc seriously did throw temper tantrums like a 2 year old all the time. Literally. I actually heard him say "GOD! Every time you need a woman she's in the BATHROOM!!!". He's a real dink.

I will have to think up ways to handle these types of situations. I like your suggestions - professional and assertive.