How to handle condescending doctor

I'm a 2nd career nursing student and here is a situation I witnessed in clinical last week. I was in a patient's room with my nurse who is not an inexperienced but who looks very young (I don't know if that had anything to do with this doctor's behavior).

Anyway, the patient was in kidney failure, very edematous, and had three family members at the bedside. There had been an issue with very high BP, but the most recent reading wasn't too alarming. However her heartrate was low, around 50. The doc (he's a hospitalist) walked in, was talking to the family about the patient needing to start dialysis, etc. He answered their questions, then the nurse said, "Oh, her BP was xxx, but I---" The doc said, "Got it, I'll check the computer," and glared at her. Then the nurse said, "But her heartrate is low--" and the doc cut her off again, "I SAID I'll check the computer," with another glare and a hand gesture meant to shut her up.

So we all finished up in the room and the doc said to the nurse, "I need to talk to you in the hallway." I stayed in the room, but I could overhear him telling her, "When I tell you to stop talking you need to stop talking. This family is stressed out and I don't need you adding to their stress. I can easily check the computer for her vitals." I moved further back into the room so I couldn't hear her response.

If anything, I think the doc's attitude toward the nurse and him glaring at her would escalate the family's stress, more than the nurse reporting the pertinent info.

I'm not sure how I would have handled the situation. But it made me angry and I like to think I would have stood up for myself. What would you have done?

I would have taken the hint and shut up. Actually, I would have discussed it with the doctor privately to start out with. It's up to the physician to "translate" that information and present it to the family in a way that's meaningful to that patient's care. Throwing random "bad" statistics out isn't doing anyone any favors. They need to understand what the numbers mean ...and in some cases, they don't mean much on their own.

Maybe the doctor has a better bedside manner with the patients than the nurses, but I'm not sure he was wrong. If the family really was anxious already, insinuating that there were additional problems could have been a mistake on the part of the nurse. If I'm in the room when a doctor comes in to talk, I usually wait until I'm asked a questions, because I don't know what that doctor looked up before coming into the room. I'm not one to back down when I know I'm right, but sometimes I have to remember that providing information just for the sake of information isn't always productive.

A nurse should never contradict a physician in front of a patient and their family. That's beyond unprofessional. The hospitalist was not going to start dialysis without checking labs and consulting the primary. The physician makes the medical decisions for the patient, not the nurse. She should have just shut her mouth like Sour Lemon said.

As a student, use it as an opportunity to learn. Look at it from the perspective of the family. I'm sure they know the pt is ill; however, if the family has no medical knowledge and they hear the nurse (frantically?) say "but his heart rate is low..." it IS likely to create more stress for the family. Continuing to push the abnormal VS on the doc could only make it worse for them. Sure, if the pt is hemorrhaging or she is in V fib make sure the doctor hears you and the appropriate things start to happen. In the situation you describe, however, listen to the doctor when he/she asks you to not rattle off the vitals, and catch up with the doc outside of the room.

I really don't think it is worth upsetting the doc over what is a perceived slight. Could the doc have handled it better? Yes. Is any good going to come from confronting him about it? Probably not...it's just as likely something negative could come of it if the doc decides to take it up the chain of command and embellish his side of the story. No reason for the nurse to try and push it when she might not be in the right to begin with.

Nurse-doctor collaboration takes place in private, not at the bedside.

He could have handled it better. An excellent doctor would have explained why he was not concerned about the vitals to both nurse and family.

But doctors are people too and do not always react in the perfect way.

That said, the doctor was pretty clear he didn't want interruptions. The nurse should have used her nursing judgment to tell what vs could wait until a private moment.

I have to agree with the doctor. This physician is telling both the patient and family that she now needs dialysis, and that as you can imagine is quite life changing and probably a bit of a shock to everyone. While the physician is discussing such a serious matter, that is not the time to bring up more bad news, even though it would seem minor to us, the family may not understand that.

Also it is probably frustrating for the doctor to be talking and then get interrupted which can sometimes result in missing information or confusion amongst the patient and family.

There is time and a place for certain discussions, and that wasn't the place or the time to bring up a minor issue, especially since her kidneys are obviously already beyond saving to a certain degree. The doctor at least talked to the nurse about it after.

Annie

Agree with the general statements above.

If anything, I think the doc's attitude toward the nurse and him glaring at her would escalate the family's stress, more than the nurse reporting the pertinent info.

The basic issue is that the information wasn't terribly pertinent .

Most times I see docs finesse the situation much better by saying something like, "Yes, that's a good observation. So in this case...." explaining it to the family and nurse as Cleback said. The way this doctor reacted could make family suspicious about the plan, unfortunately.

We can participate professionally in conversations as appropriate and we should be paying attention, too, so we know best how to reinforce the information to the family. An interjection when the nurse is the one with the question or concern is not appropriate, though, IMO.

She should not be giving vitals that might make an already crazy family more demanding because they have no clue as to what it means then they will google it and become even more unmanageable.The doc was telling her TMI, and she acted clueless.

I agree that this in this particular situation, the nurse was at least partly in the wrong. However, as a nurse you will almost certainly find yourself in the (hopefully occasional) situation in which a doctor is actually condescending for no reason at all.

I don't know if it will be considered the right thing to do or not, but I tend to just ignore their bad attitude and worry more about myself remaining professional and above reproach. I don't have time for their nonsense anyway when they are acting like that.

*This is when they are just being a mild pain in the butt, not overtly aggressive or seriously impeding patient safety or care.

Example: The other day, at his request, I provided a physician with the name and phone number of a particular physician at the hospital from which our newly admitted patient had transferred from. Without taking a good look at the paper, he sighed and complained that I had provided a number but no name. The name was printed above the number, along with contact details about the referring hospital as well. He was too busy being disappointed in my work to bother reading, apparently. Whatever - I have other stuff to do! I just told him it was right there on the paper. He said "Oh." Not "thank you". Just "oh". Then I walked away and got on with my day. Maybe next time, he will remember that I am competent after all. If he still prefers to behave rudely, he can do it without me there.