Patience with the New Doctor

[SaoirseRN]

I was thinking the other day, as I was reading some older threads, how often we hear concerns about doctors being rude or impatient with nurses. This certainly does happen. There are doctors out there who are just difficult to work with no matter how one approaches them. Thankfully, aside from a few exceptions, I have a good rapport with the majority of the doctors at my hospital. That isn't to say that they are all saints and have never been short or rude to nurses (myself included), but that isn't really what this post is about.

Being a "doctor" doesn't give an individual license to be rude. Similarly, one could argue that neither does being a human being with the ability to communicate. Respect amongst colleagues is something we should strive for, and that is a two way street!

What I rarely hear about is nurses being rude or impatient doctors, but it does happen. My thoughts on this matter have some basis in reality, which is why I am posting about this.

There is a GP with privileges at my hospital who is very new. New to us, and also just brand-spanking new with the good fortune to take over a full practice after completing her residency. The GP she worked with retired, and she is now the family physician for his former practice. Where I work, GPs care for their own patients in hospital.

This doctor is lovely, really, but it takes her a very long time to complete her rounds and often she runs out of time, must go to the clinic, and come back after clinic hours to see the rest of her patients. On her weekends on-call, she is literally on-site the entire day. She asks many questions, often consulting on-call specialists with advice on where to go with a patient's care, or calling the pharmacy to double-check information about medications. She asks many questions of the nurses, and often calls back to add or change orders.

All of the above is because she is new, and when one truly thinks about it, it's perfectly reasonable. We always say to new nurses, if you are unsure, ask. That is exactly what she does, and wouldn't you rather she was thorough and not just guessing?

I often see the nurses complaining about her. I've overheard the pharmacy techs and pharmacists complaining about her. She's always bugging us about something or she called again to change her orders! I wish she'd just figure it out the first time!! I've heard nurses snap at her when she's trying to ask them something about her patients. I imagine she may get snapped at by people on the other end of her telephone calls, too. Heck, I even overheard her own husband being inconsiderate to her on the phone - You've been there all day, what's taking you so long? Have I ever felt irritated with her? Of course I have!

You know what? She doesn't deserve it. She hasn't even been practicing for a year on her own and she's doing the best she can for her patients. Could she alter her approach in some instances? Sure she could. Could she manage her time better? Likely. But learning those things takes time, just as it did for us nurses. She's like the physician equivalent of a new grad nurse and I feel badly for the way she is treated sometimes. It is a ton of responsibility, and a lot of knowledge that isn't always going to be right at her fingertips.

My hospital uses a call group system for weekends, each group comprised of either one clinic or several smaller ones. One GP from each group is on-call for all the admitted patients in that group.

Last weekend she was on-call for her group. I had four of her patients in the little 10-bed department where I was working, all of whom had some minor issues that should be addressed that day, but were not urgent. I knew she would show up at some point, but like most of the weekend doctors, she started her rounds up on the larger med/surg unit and would work her way down to us eventually. Therefore, I didn't call her, because there was no need to interrupt her.

She finally came downstairs at 1600 that afternoon. I said "Oh, hello!" and she sighed and asked, "Were you waiting for me?"

I explained as above, that we knew she would be along eventually so we didn't need to phone her. She looked so surprised and grateful, and it was that moment that started me thinking about this topic. I wonder how many times she was needlessly telephoned that day simply because she hadn't gotten to that patient yet, without anyone taking into consideration that she's slower than our seasoned GPs, and whether or not their concern could wait for her arrival.

The following day, I intervened on her behalf when I strongly suspected her patient was about to either punch her, or shove her over when he was trying to leave against medical advice. She looked a little like a deer in the headlights, obviously trying to convince the patient to stay for his own benefit and having a very difficult time with his resolve to refuse care and leave. She wasn't reading the body language, and I happened to walk into the room to bring a dose of antibiotic and found her hovering far too close to an agitated man (face flushed, fists clenched) for my comfort.

I tried my own, slightly different approach with the patient at first, but it was immediately clear that we would not get anywhere and he was going to leave no matter what. So I gently suggested that she go make her phone call and that I would take care of the patient until she returned. I removed his IV before he could just yank it out, got him to sign the release from responsibility form, and because I wasn't "forcing him to stay", he calmed down and agreed to at least pick up a prescription if she called it into his pharmacy.

She thanked me afterward, and we discussed the situation and I felt a little like the teacher in that moment. If we forced him to stay, he would likely never come back even if he needed medical care. By letting him go, even though we didn't want to, I felt that at the very least, he would still get medical help if he needed it.

I'm not discounting this doctor's intelligence or level of education, but in that type of situation, I have more experience, and she recognized and appreciated my help. That day we had a highschool work experience student observing, and she ended up seeing quite a bit of the "other" part of nursing, and the doctor said that she was lucky to have had me to follow for the day.

Anyway, there aren't any great sweeping words of wisdom in this post. It's more about me expressing my thoughts. I'm going to work hard on not becoming irritated with her, going to speak on her behalf when others do. It may not be much, but if it helps even a little, then I'm happy to do it.

Thoughts? Anyone else had a similar experience?

[SaoirseRN]

I apologize for the missing apostrophes. Copy and pasted from my word processor and they seem to have not transferred over.

[Ruby Vee, BSN]

I work in a large, inner city teaching hospital. I've worked in teaching hospitals and community hospitals (which sounds like where the OP is located) and I prefer the teaching hospitals. It's part of my job -- and an amazing privilege, really, to be part of the education of newly minted doctors. So much of what we do has an impact on how they view and interact with nurses for the rest of their careers, and I work very hard to make sure it's as positive as possible. I applaud your efforts to cut the new primary care physician some slack and contribute to her education. We were all new once, even the doctors!

[SaoirseRN]

I applaud your efforts to cut the new primary care physician some slack and contribute to her education. We were all new once, even the doctors!

It sounds as though you and I are of like mind on this topic. Yes, I work in a smaller hospital (150 beds) but have worked in smaller (10 bed rural hospital my first year of nursing). Another GP of ours is bringing in a family practice residency program soon, which is not something we've had here before. I'm happy he is leading it because he will be a wonderful example for them. I'm a big supporter of good working relationships/teamwork between doctors and nurses and he is too.

[gonzo1, ASN, RN]

I agree with you completely. I have worked with a few new docs and I always help them as much as I can. It's a win/win for everyone. And it doesn't hurt to have a grateful doc in your pocket.

I have been lucky that most of the docs I run into are easy to get along with too.

[NutmeggeRN, BSN]

Great post, we all need to remember that OJT takes time and experience molds our practice!

[KitkatPRN]

Thanks for sharing ! I'm a new nurse and I feel slow a lot of the time, wondering what others are whispering behind my back as I try hard to do my best for the patients I'm caring for. I work LTC so the amount of paperwork can be overwhelming as can the politics. There is an NP at our facility who always takes the time to point out something for me to learn by and offers kind words of encouragement and compliments. She has made a difference for me as I'm sure you have to the GP you wrote about. She is truly blessed to work with you !!

[echoRNC711, BSN]

I know you are not looking for it but please take a bow. Nice to hear the very best of nursing. Like many things it is not the huge things, it is more kindness ,thoughtfulness and a willingness to be there for each other that count the most. I appreciate your post as they say in Ireland "Good on ya girl!"

[monkeybug]

I prefer not to work with interns and residents because I want the best possible care for my patients, and that's just usually not it. The last hospital I worked in was not affilitated with a university, but did have a residency program. So, most of our patients belonged to a wonderful group of private OB/Gyns and the rest belonged to, gulp, the medical school. The nurses would fight over who would have to deal with them. If you ever wanted to see a case mismanaged, all you had to do was look at what they were doing any given day. As far as patience with them, I was very patient with the residents themselves if they treated me with respect. I would do anything I could to help them learn and to help them look competent in front of their patients and their attendings if they treated me with respect and kindness. If they treated me like "just a nures" or snapped at me or demanded things of me, or in any way acted condescending, I'd let them drown and spotlight their stupdity if at all possible. The other nurses were exactly the same. Woe be unto you if you crossed one of us, your next 3 years would be very difficult and unhappy. Come to the unit with a respectful attitude, and you'd leave there loving every one of us. Unfortunately, very few of them seemed to think that we had anything to teach them or that there was any reason to treat us as anything more than a servant.

I understand why there are new regulations about the hours residents work, but as a result, they are getting far fewer hours of hands-on training than their counterparts of 20 years ago. It's frightening, really. And I really wonder, sometimes, what exactly they do learn in medical school. I have seen medical students without ANY knowledge of sterile/not sterile. Even if you haven't been taught "sterlie technique" one would think that basic microbiology would teach you not to pick up something from the OR floor when you are scrubbed and gloved. I have seen medical students drop babies. Heck, that's just basic physics.

I have just chosen a former resident as my new GP. She was one of the good ones.

[Alibaba]

Thank you for your post and for reminding us that every professional has to start somewhere just like we all once did. It is always so strange to me when nurses are rude or mean to doctors who are asking questions regarding their patients' day and care.

Reminds me of a related problem I have run into at my job.

Most (95%) of our patients have the same doctor who also happens to be our medical director. He will come in at 4am, do his rounds and then write his progress notes. I promise the guy will walk into a dark room, barely place a stethoscope on the patient and do this for all his patients before sitting down to write very detailed notes about the patient's assessment. There is a running joke that he doesn't even put his 'ears' in his ears when he auscultates. We are always complaining that he doesn't really perform assessments, never washes his hands between patients, never gowns up for isolation rooms, and never wipes down his scope between patients. All the nurses complain about him.

Then, there is this other MD. He is neuro and he is the most thorough person I have ever met. He will spend 30 minutes in a room doing a full body assessment including DTRs and everything. He talks to his patients and family, explains everything. Spend tons of time looking over the patients' charts, labs, consults, nursing notes, vitals, I&Os. Everything! He knows his patients in and out. He spends time locating the nurses and asking about progress, concerns, reactions...everything. He always always suits up fully depending on isolation status, down to booties and hair nets. He is always responsive to the nurses' suggestions and if not, he takes the time to explain fully while something may be contraindicated.

You know what, nurses on the unit talk more smack about this MD than anyone else. They complain he spends too much time with their patient, he asks too many questions etc. They hide from him so they don't have to report on their patient, they snap at him if he asks them something. And some are just down right mean to him.

It seems there is no pleasing us. We always find something to complain about.

[Pets to People]

I agree with the above poster...seems that most people will always find something to complain about. This world could use a little more patience and empathy and a little less whining and finger pointing. But for the OP, I imagine that you are a breath of sunshine to this doc on the days that she works for you.

[VICEDRN, BSN, RN]

Concur. I try very hard to be a good ambassador to the attendings, residents and medical students that come through my facility. My hope is that if I go out of my way to be patient and helpful, they will have a positive opinion of my profession in turn. Makes the work day go by easier too!