"If you want to be a doctor, go to medical school"

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So I'm caring for my patient with COPD who came in with chest pain, ended up not having any cardiac compromise... pt has a history of anxiety, fibromyalgia, COPD, and ascites. Pt on 2L NC, satting anywhere from 90-96%, but says "I'm on 3L at home."

Pt has been on 2L NC whole 2-day stay, develops a spike in back pain and becomes anxious. The cardiac fellow just so happens to walk in at this time, and pt's oxygen is still fine, but mentions it to the doctor that 3L at home. Doctor says, "put them on 3L." I state, "they have COPD, and we are trying to keep their oxygen between 88-92%, and they've been on 2L their whole time here." Dr. "put on 3L anyway." "OK"

I come out of the pt's room, and the dr. says "Don't ever argue with/question a doctor in front of a patient. I'm a doctor, you're a nurse. If you want to be a doctor-go to medical school. Besides, they're on 3L at home." My response: "that doesn't mean they need to be on 3L."

I discussed this with the ICU/Pulmonary attending and he completely agreed with me, and said "she obviously doesn't know what she's doing and is rude!" However, I'm sure this lady is going to try to cause trouble for me as she intently stared at my badge and wrote down my name!

Part of being a nurse, especially in the ICU is being a patient advocate and speaking up about clinical issues for the patient. I didn't think this was out of line, but she sure did! Was she implying by her statement, that my suggestions were not characteristic of nursing?

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

If she causes trouble, or tries to, see if the ICU/Pulmonary attending will speak up for you.

She was rude.

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Specializes in CTICU.

I would think titrating oxygen levels are well within a critical care nurse's scope of practice. I would probably have said something about "collaboration" or "teamwork" when told not to "question" a doctor's order.

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Specializes in Nursing Professional Development.

I think the Doctor is over-reacting and should just let it go. However, I can understand why she was irritated. How would you feel if a physician questioned your nursing competence in front of a patient? Those conversations are best left outside of the patient's range of hearing.

It doesn't really matter who was right or wrong about the patient management. It's generally not professionally appropriate to question someone's competence in front of their patient. That may have been what caused her rude over-reaction.

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You are probably right, but I think her comment was still unwarranted.

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Specializes in CVICU, ICU, RRT, CVPACU.

I wouldnt worry about it at all. I work with a hospitalist who is of middle eastern decent and has a very profound hatred of most males she comes in contact with. Our whole hospitalist group is very intimidated by our CVI nurses and have actually tried to use that comment before. One of the hospitalist told a girl I work with the same thing.............Im the doctor and you are the nurse. We all busted out laughing and I said......."Oh no, you have to do better then that in this unit buddy". Just continue to get back up in their face about stuff and they will eventually leave you alone.

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Specializes in EMS, ER, GI, PCU/Telemetry.
I wouldnt worry about it at all. I work with a hospitalist who is of middle eastern decent and has a very profound hatred of most males she comes in contact with. Our whole hospitalist group is very intimidated by our CVI nurses and have actually tried to use that comment before. One of the hospitalist told a girl I work with the same thing.............Im the doctor and you are the nurse. We all busted out laughing and I said......."Oh no, you have to do better then that in this unit buddy". Just continue to get back up in their face about stuff and they will eventually leave you alone.

we had a cardiologist who was working one night when their patient coded on the way to the floor. we got them to the nearest room and proceeded as usual, chg nurse paged him inhouse and he strolled in after we were on our 2nd round of meds. well he just had a fit and said that you're doing this wrong, what the heck is wrong with you people, f this and f that, are you retarded... just all kind of horrible off the wall stuff. the ER doc and nursing supervisor looked at each other and said "ok guys, lets go". and we turned to leave and started walking down the hallway when dr. personality stuck his head out of the door and said "wait, i can't run this code by myself. where are you going?" and the ER doctor said "back to the short bus". we wrapped up the code and stabilized the patient... and we all got letters of apology.

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I agree with the above replies that the discussion of the order should have been kept outside of the patient's room. That's with any one members of the interdisciplinary team. Discussing such matters infront of the patient will only make the patient uncomfortable. I also do believe however that the MD's response to questioning the rationale was over the top. I can see that this MD may have felt a bit slighted because the order was questioned infront of the patient but the whole "Im a doctor, your a nurse..." soap box was inappropriate and unprofessional. Just in case this doctor tries to write you up, if I were you I would document, document, document.

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She should have been kept at 3lmp-that's how she received insurance coverage! What you were making such a big deal about was stupid, I'm sorry. The difference in oxygen levels were 4%-

Anne

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Specializes in ICU/Critical Care.

The next time I have to deal with a doc who says that to me, I am gonna bust out laughing. You are all wonderful. Never let them think that just because they have a medical degree makes them better than us. As for the OP's post, COPD patient's usually sat 88-92%, don't know how that doc was going to think one extra liter of O2 was gonna make the patient any better.

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the error in thinking was that the doctor thought that the oxygenation was making the patient anxious, when, in fact the pt just has anxiety provoked by random things like pain- the issue at the time. then, the MD didn't consider the best outcome for the patient, which was maintaining an ideal level of oxygenation which drives their respiratory effort, unlike most people who don't have COPD. learn the facts: COPD functions best on 88-92%. Increasing the oxygen would not help ANYTHING!

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Specializes in CTICU, Rapid Response Team, telemetry.

That was a good one!!! (about the short bus)

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