How to handle condescending doctor

As I said, I am a 2nd career nursing student. I work in a professional environment and have for 20 years. I cannot imagine anyone in my office talking to a colleague the way he talked to that nurse.

You have to keep in mind the hierarchy in healthcare is still very much alive, even if current schools are encouraging a more shared leadership-type approach. Shared leadership in healthcare is just not true, and probably won't change in the near future. Part of the reasons is that organizations go to great lengths to recruit (and keep) physicians because they are viewed as the money makers. Nurses are more expendable. This can and does color how much crap/poor attitudes the nurse is conditioned and expected to take, and you can clearly see it from some of the comments. For example, the comment on here that physician-nurse collaboration doesn't happen in front of the patient. I don't personally agree with that statement, but it's just the way it is for some.

I say this just to forewarn you. It may be a culture shock to you if you come from a more egalitarian first career.

Edit: In this situation, as I mentioned in my original reply, the nurse still could have improved her communication. Both parties could have. But likely, if people had to choose sides, they would side with the physician, not the nurse.

I think that nurse didn't recognize that she should have kept quiet about the statistics of blood pressure, heart rate. She isn't wrong about her concern, but should have told the doctor out of the view of those family members. They are under a tremendous amount of stress, and any little thing can make it so much worse. They don't know what will happen to their loved one, so it wouldn't take much to crack under the pressure. The doctor did recognize that and I think he was trying to tell the nurse that. He gave a harsh response to shut her up and then talked to her after. So it might not look like it, but he was on her side too. He really was trying to give her the hint the first time, but she didn't pick it up.

Healthcare is different from other fields in that you are dealing with the lives of people. Interrupting the doctor and reporting numbers was not appropriate. I communicate with doctors in SBAR format. Many times they appreciate it and give me what I ask for. Sometimes they don't and explain why. Sometimes they don't and it seems like it's because they didn't think of it so it must not be necessary. However randomly rambling off numbers in front of anxious family is not ok or professional. If it was something that concerning like others have stated speak with the doctor outside of the room. If the doctor still doesn't want to hear it chart that you told them and call it a day. If it is a true safety issue go up the chain of command.

Unfortunately in healthcare a lot of times we can't pause what we are doing and keep everyone's feelings from being hurt. That's part of what makes the job so hard. I try to be conscious of how I say things as to encourage and not put down but now everyone does.

I also know that the nurses don't like this doctor at all. At the beginning of shift, one nurse was overheard saying, "Oh we got Dr. XX today. I can't stand him and he knows it." I later put 2 and 2 together and understood this was the doc the nurse had been referring to.

Now I can see why the MD was brisk. If staff made it known they didn't like working with me, I would probably be frosty in return. I treat every shift with a clean slate, even if I have had an issue with an MD in the past. 12 hours is a long time and we all have to be in the sandbox.

There have been a lot of really good responses. I just have a quick thought to add. Many hospitals are pushing RN-MD rounding at the bedside. Most of the teams on our floor do this, and it helps tidy up things like whether we should continue IVFs, or the patient asked at 2 am for a sleeping aid (would it be something that could be added prn for the future?), or any other countless little issues that come up but weren't necessarily worth paging for. I'll add that almost all of this discussion happens *outside the patient's room* before we go in. I'll also try to be in the room when the NPs talk to the patient so I have an idea of the plan. I usually chart on the computer while they talk. I won't speak up unless the NP says something like "You'll be having an MRI later today." If I just got a call from radiology, I might speak up and say "Oh yeah, they just told me it will be at 3 pm". That's helpful info for both the patient and the provider. Almost all providers will ask me, after they finish talking to the patient, if I need anything. If it's something simple I'll bring it up in the room, otherwise I'll ask my question outside.

The situation you describe is a lot different though. Your situation is a *goals of care* or treatment planning discussion. It's not always readily apparent when I enter a room if the physician is doing routine rounding or talking about care goals. Sometimes it is easily apparent from the looks on my patient's/family's faces, and I back out and close the door. Other times I have to listen a minute or two to know. As another poster said, this time is precious, and we advocate for our patients by protecting that time from interruptions.