Life is just chock full of surprises......
You know, I used to be intimidated when doctors yelled at me. Even though I was close to 40 when I graduated from nursing school, and learned quickly to have all my facts and figures lined up before I called an MD, I was easily cowed by their angry outbursts and could hardly wait till I got off shift so I could go cry in the bathroom. And even though I haven't had that many bad experiences with physicians overall, some of the ones I have had were pretty traumatic.
Today I managed to get not one doctor, but THREE of 'em, plus a nurse practitioner, hopping mad---in one case, enough to rip me a new hiney and hand it to me. They all practice in the same building along with a number of other physicians, NPs and PA-Cs, but I'd never known them to gang up on other healthcare professionals; in fact, I've worked with two out of the three MDs as well as the NP, and had decent relationships with all of them. Until today.
The backstory is, one of the MDs who recently retired from this clinic---a fact neither I, nor my resident, nor the pharmacy had any idea about until this morning---has a bad habit of not responding promptly to faxes and phone calls from my facility and the pharmacy about renewing this one resident's Duragesic patches. The resident's insurance, as well as state administrative rules, require that the prescription must be renewed every 30 days, so we have had to fax this doctor at least two or three times almost every time the med came up for renewal, and sometimes he hasn't responded---despite early requests for renewal---until she was as much as 48 hours overdue for a patch change. 
To say that this has been frustrating would be the understatement of the year. The last time, the poor woman went almost THREE DAYS without a new patch. The last time I had to intervene, I sent a fairly strongly-worded fax that said, in essence, that this was unacceptable and that I expected my resident's pain to be managed in a manner consistent with best practices.
That got his attention, and for a couple of months we had no problems. Then this morning I got a call from our house pharmacy saying that they'd faxed the physician three times (we requested the refill two weeks ago!) with no response. Of course, no one calls a doctor's office anymore unless they have time to spend ten or fifteen minutes on hold, listening to elevator music and falling asleep. So, Super Nurse here went into Patient Advocate Mode and sent an urgent fax to the office that left no question in anyone's mind about where I stand on pain treatment, its priority in my building, and doctors who can't be bothered to take five seconds to scribble their signature on a fax to renew the order.
I had HAD ENOUGH OF THISSS!!!!!!!!! as Bill Cosby would say, and when I fired off my fax, I really didn't care who knew it. And I didn't think a thing of it until the office manager came to my office and said "Dr. P is on the phone for you". Well, I hadn't faxed Dr. P, so it was a genuine surprise when he began to yell in my ear, "That fax was the most unprofessional and inappropriate thing I've seen in my career!" He proceeded to inform me that Dr. N had retired, and that Dr. S, who had replaced him, was FURIOUS about all this and would be speaking with my supervisor. Now, this was the first I'd heard about Dr. N---even the resident herself didn't know he was no longer her doctor---but Dr. P was so mad I couldn't get a word in edgewise. All I could do was let him finish, say "I'm sorry you feel that way" and let him hang up on me.
A few minutes later, Dr. S called wanting to talk to both my boss and me; he was out of the building at the time, so she got me. By this time I was fully prepared for another butt-chewing, but it didn't take many words of conversation to figure out that she and I both had been the victims of poor communication: she's brand new at the clinic and didn't even know she was supposed to be the resident's doctor until this very morning. And of course, we knew nothing of the change ourselves, so when she got my fax, she was totally mystified and upset; but at least she allowed me to express MY concerns, and when I was done she wasn't the least bit angry. She even chuckled when I apologized for inadvertently dumping on her but maintained that I was glad I'd gotten a response, even if it was like ripping the lid off a keg of gunpowder!
In fact, she told me that if I ever have trouble getting a response from the clinic, I am to use the private physician's line to talk to the doctor personally (rather than go through the voice message system and listen to "Don't Cry for Me Argentina" until I'm ready to commit hara-kiri). She did talk to my boss later when he came back from lunch, but of course by that time I'd already told him what I'd done and why and showed him the fax I sent, and nobody was upset any more.........except maybe the other doctor and NP who had called demanding to speak to him about the same fax, even though it didn't involve either of them.
Meanwhile, I got backup from my administrator and an apology from Dr. S, and the resident got her fentanyl patch, which was the only reason I'd stuck my neck out in the first place. As for the other members of the practice who got so hot under the collar............well, I hope they get over it, because I was right to advocate for my patient and I'll do it again if necessary.
I'm sorry these folks didn't appreciate the way I pointed out their (former) colleague's neglect of my resident, but dang, if you don't like signing endless faxes on endless patients, then don't take the big bucks.:angryfire And for Pete's sake, when you retire........LET YOUR PATIENTS KNOW!!!
Anyway, I'm making like a duck with water running off its back: it doesn't affect me personally. No, thank Heavens, I've finally gotten past the fear of offending the great god Doctorus Medicus Ad Nauseam. I guess most nurses do, eventually. I just didn't know I had until today.
