How to deal with overbearing doctors?

SHGR, MSN, RN, CNS · Jun 23, 2012

I believe that your thinking is right on target. Are you familiar with SBAR? Situation, Background, Assessment, Recommendation. As in, using the SBAR technique you are confident that you have your information together concisely in a way that leads to your recommendation (which is, of course, the patient-centered order you are looking for).

When I learned SBAR and got good at it, it changed everything about communicating with docs. Sometimes- and I work with all experienced nurses now- we practice it with each other before a crucial call to a physician known to be difficult. Then, on the off chance he's still snarky about it, we're like, "Good SBAR!" Having the support of other nurses and management definitely helps. Then, proceed directly to CYA charting.

I hope that helps.

kayern · Jun 23, 2012

I agree with the previous poster. SBAR is a wonderful communication tool. One other piece of advice.........do not get defensive. Give the facts, don't defend your reason for calling or the care you are rendering to the patient (for I'm sure it will be the best). Your patient is #1, so be the advocate you refer to, get what you need from the MD for the sake of the patient. Once the patient is taken care of, speak with your manager and see how the institution deals with difficult physicians. We have a zero tolerance for ill-behaved physicians but when speaking with your manager, do not embellish the interaction. Leave personal feelings out of the equation. When you get more comfortable in the role, and you will, speak with the offending physician and discuss the interaction. Sometimes, they don't even realize what they are doing and will thank you for bringing this to their attention.

ckh23, BSN, RN · Jun 28, 2012

I agree with others. I think you gave a pretty good answer for the position you are in. You will eventually find out, after some experience, to politely tell them to go pound sand.

detroitdano · Jun 29, 2012

SBAR is great. They really can't argue with you if given all the pertinent info. They can, but they won't get anywhere with it.

Just don't say you'd argue with them. A debate of sorts, sure, but belittling each other or being rude is never acceptable in healthcare. If the other party becomes harsh and unreasonable, say something to the tune of "So from my understanding, you believe that .... does not need ... and you will not be ordering anything at this time." I actually interviewed someplace a while ago and they told me that's exactly what they wanted to hear when having a disagreement with a coworker.

SHGR, MSN, RN, CNS · Jun 29, 2012

SBAR is great. They really can't argue with you if given all the pertinent info. They can, but they won't get anywhere with it.
Just don't say you'd argue with them. A debate of sorts, sure, but belittling each other or being rude is never acceptable in healthcare. If the other party becomes harsh and unreasonable, say something to the tune of "So from my understanding, you believe that .... does not need ... and you will not be ordering anything at this time." I actually interviewed someplace a while ago and they told me that's exactly what they wanted to hear when having a disagreement with a coworker.

Yes- the classic "No new orders received." :)

Ruby Vee, BSN · Jun 29, 2012

two days ago, i interviewed with two managers at one local hospitals new graduate interview fair. one of these managers was from the icu. it was a very interesting interview, more of a conversation really. he did a lot more talking than i did. but one question that was not on the formal list of questions stood out to me. he asked "how would i 'confront' a doctor who was known to be overbearing?". confront, meaning how would i advocate for my patient with a doctor who is known for eating up nurses for breakfast, lunch and dinner. from my limited experience as a student, surgeons are the most primadonna doctors out of all the types of doctors i have interacted with. even other doctors are scared of them, and they seem to have a big influence in how things are run at the hospital. i answered that i would make sure to have all pertinent information about the patient on hand so that i'm not floundering on the phone or face-to-face. that is the best answer i could give.
how else could i 'confront' an overbearing surgeon? what other tools could i use to make sure i advocate for my patients and that i don't look like an ass? as a new nurse i want to prepare for any possible scenario.
sent from my ipad using allnurses.com

i suspect that was a trick question. you don't want to be confronting anyone simply because they're "known to be overbearing." confrontation is never a goal in colleague to colleague interactions; you want to get along. in order to get along with someone known to be overbearing -- and maintain your dignity as well -- have all of the information you need before contacting him. (they're almost always "hims", aren't they?) if he happens to arrive on the unit and start firing off questions before you're ready with the information, ask him to wait one moment and you'll get the information and be right with him. then do that.

if the "overbearing doctor" shows up on the unit (or calls on the phone) and immediately starts yelling at you, that's a confrontation, but it's not one that you initiated. you don't want to be the one initiating confrontations; you want to be the one resolving them. good communication skills and having the information needed -- or being able to find it quickly -- will go a long way there. i've found that you generally teach people how to treat you, and if you don't let them treat you poorly they won't. even the overbearing surgeons. (although we do have one anesthesiologist i haven't been able to figure out yet. i'm not alone. when i went to have my own surgery, the pre-op nurse confided how happy she was that he wasn't going to be the anesthesiologist for my case.

Biffbradford · Jun 29, 2012

After 15 years working with cardiovascular surgeons, I don't think I've ever been 'confronted'. They might be overworked, tired, crabby, but I've never gone toe to toe with any of them. If they don't want to give you orders at 2am, then that's fine: " Okay Dr. Z ... I'll talk to you later." and keep calling them every 30 minutes if you have to. They'll get the picture eventually. :)

1. Know your patient. Spend 5 or 10 minutes at the beginning of your shift, before you do anything else, and find out what happened the past 2 or 3 days. What did the CT scan show? How's the CXR? Any positive cultures? What ABX are they on? Etc. It doesn't take long, and then you'll come across as knowledgable and competent to any 'surprise' questions.

2. Know your doctors. Each has their own preferences. It might take some time to learn them, but then you'll know how to react to problems. Dr. Z hates giving diuretics in the first 24 hours post op ... so why call him at 2am with low urine output? Wait until he's up at 0500 and tell him then. That's where team work comes into play ... the nurses might have some insight as to how each doc would react to particular problem.

3. Know your orders. We had a surgeon who often couldn't sleep at night, so with nothing better to do, he'd call up for a 'surprise' update. No surprise, we expected his call! "What's the patient's weight this morning?" Got it right here! "How high is the patient's bed?" Why 30 degrees Dr. Z! (cuz that's what the orders say!)

:yeah:

whichone'spink, BSN, RN · Jun 30, 2012

Thanks for the feedback. In an interview that was less than half an hour, I am still pretty sure I gave a decent answer, and all the pointers you guys gave comes with experience. I just hope that in that short period of time, I made the impression that I am teachable, and that I'm on the right track. Because while I know I've got a lot to learn, I'm not completely clueless. I was taught the SBAR format in school, so that is what I answered from. I certainly don't want confrontation. It's not my nature to start confrontations. But I have to advocate for my patients, and if a surgeon gets ***** about it, I have to keep the peace, and still get what's needed.