Surgeons, ugh.

[Eirene, ASN, RN]

Hey guys,

I'm going into my 4th month of nursing. I feel that I have a good rapport with the physicians, cardiologists, etc. on my unit. The nursing staff is tight and very supportive. I love my job.

Over the weekend I had a surgical patient who went down the tubes in surgery. We do not typically have surgical patients. In fact, I can count on one hand how many surgical patients I've ever had-- including nursing school!

The surgeon called. I told him of my assessment; absent BS despite ambulation, etc. I told him that I have to medicate him with 1mg of dilaudid before ambulation. HE FLIPPED OUT. He called me a freak and that he didn't give a **** about bowel sounds and asked what the hell was wrong with me for giving him dilaudid, that the patient should be on oral pain meds PRN. He chewed my butt for about 10 minutes over the phone.

Then, he came in. I avoided him like the plague. He told the charge nurse that he was never going to send a surgery patient to my floor (cardiac/ICU) ever again.

I really felt like I gave his patient very good care. I medicated for pain, ambulated, C & DB. I really don't know what else I could have done.

I STILL feel like a turd for letting this surgeon intimidate me like he did. I am not easily intimidated-- but this guy did it! How do you get over the intimidation factor? I was very respectful, but I kept looking at the ground when he was talking AT me. I felt like I would cry if I looked up at him.

I hate this.

[R*Star*RN, BSN, RN]

Danibanani, I'm sure you are a great nurse and you did the best that was humanly possible! Some people are just down right mean.

I could also use some help in getting over the intimidation factor. In fact, I've been wanting to ask this very question!

Every time I have to talk to a physician, I babble like a 2 year old and feel like I'm going to have a nervous breakdown.n

I get the "long pause" and "the look" from physicians.

If anyone has any suggestions for getting over this, please suggest away!

[UM Review RN, ASN, RN]

I've had a lot of experience with docs who flip out over the stupidest things despite my doing the very best for their patients. It's part of why I now avoid them all (the ones who yell, I mean) like the plague.

It's also why I called a surgeon at midnight the other night for a post-op colectomy patient who vomited 25 cc's of bile for the third time that day. Pt had improving bowel sounds, belly seemed softer, but there was an order to reinsert NG tube if Pt continued to have emesis.

So I called. This is the situation, there was an order to reinsert, do you still want to go with that or not? He was annoyed at being woken up.

I comforted myself with the Murphy's Law of Post-0ps: If your patient is making you nervous, call the doc. The patient will then be just fine and you will be able to sleep knowing you covered your butt. If, OTOH, you do not call the surgeon, the patient will have a crisis of some sort and you--and only you-- will get the blame for it.

So when in doubt, call. If the doc explodes, hang up on him and call him back in 5 minutes till he calms down. Practice the "icy glare of death" for those docs who dare yell at you in person, especially in public.

Every time a doc does that, you might take comfort in the fact that while a cardiologist wouldn't think of doing a lap chole, none of these docs appear to grasp the concept that nurses also specialize. I am not a terrific med-surg nurse; I'm only OK at it, because my speciality is telemetry.

Throw me a geriatric patient in A-fib with RVR and I'm on it like white on rice. But I honestly can't tell the difference between hypo bowel sounds and a partial ileus, and I have a feeling I'm not alone.

We can't order the tests that rule out a problem; we're dependent on the doc to do that. So we have to call. Take comfort in the fact that some of those patients will be alive because you called.

So be a duck. Let it roll off.

[MIKE411]

some docs just suck period. I would tell them you don't have to raise your voice and you would appreciate a little respect. Once you tell them kindly, they usually remember that.

[Indy, LPN, LVN]

It has been my experience that those who yell, scream, and have hissy fits worthy of a grade-A drama queen are covering for something, and it ain't something that has anything to do with any nurse.

Maybe this surgeon likes to go poking the wrong end of a q tip around in people's belly wounds just to play in pus. Maybe he likes to visit several MRSA positive patients in a row and stick his index finger in their wounds without washing hands in between. Maybe he can't be bothered to close his layers and prefers to staple people's bellies, leaving them looking like Curious George got ahold of a staple gun and some crayons. Hm. Or maybe he dresses up like space aliens or furry bunnyrabbits (insert ridiculous image here). Maybe he prefers to have the local law enforcement do a wellness check on him in order to get him to answer pages when he has postops recovering in the hospital.

Basically what I'm saying is there are surgeons who are actually interested in the welfare of the patient after they finish up in the OR and sign the standing orders. But if they act like you just shot 'em in the butt with a half pound of rock salt when you have reason to call, there's probably something wrong with them.

So continue doing good assessments, give good care, call when you need to, document, and if the surgeon gets disruptive, that's what incident reports are for. When they ask "are you crazy?" say YES and immediately (while they pause) launch into your reason for calling. When they get in your face you look them in the eyes and glare back. Be polite but do not use "whipped dog" body language. Allow for the possibility that you might have jumped to a wrong conclusion and do follow-up reading to see what other things may have been going on, etc, but do NOT apologize for bringing appropriate problems to the doctor's attention. Trust me, the one who gets his panties in a wad and is silly enough to call YOU a freak will NOT apologize, so don't you act like you deserve abuse.

/rant off... oh and about half of this is taken from one of my favorite LPN's rants- she rocks like none other.

[suanna]

I'm not endorsing abusive docs but learning what is a vital piece of information that needs to be called to be attending-especially at night- and what can wait till they round in the morning is part of the learning curve. People who cut open other people for a living often have a diminished capacity show much compassion or empathy- it's just the nature of the beast. I have always found it goes a long way to 1) always check with another nurse before calling a attending. There may be something I missed or didn't think of that could resolve the problem with the orders I have now. By the way NEVER say "so-and-so said to call you". You are the nurse and it's your decision to call or not. I doubt you will ever get another opinion if you try to deflect some of a cranky surgeons tantrum to a peer. 2) If I'm right I ALWAYS say so. It's OK to say " I disagree with your not wanting to be notified of this problem but I have an obligation to call in the best intrest of OUR patient and in my PROFESSIONAL opinion this warrented a call to a doctor. He can't argue with your opinion, he can just disagree with it.

[Eirene, ASN, RN]

Thank you all for all of the advise.

I really feel so much better after a few days have passed. I need to add that I did not page this surgeon-- he called me to check on the status, which never happens. I think he had a bad feeling about this patient as well.

I'm going to begin saying what I believe, even if my voice shakes.

I think it's amazing that the cardiology guys are so down to earth and the surgeons are such buttholes. You'd think it would be the opposite!

[DreamingTree]

This may be a stupid question, but if he didn't want the pt to have dilaudid, then why didn't write the necessary orders? Are you supposed to be a mindreader?

[UM Review RN, ASN, RN]

This may be a stupid question, but if he didn't want the pt to have dilaudid, then why didn't write the necessary orders? Are you supposed to be a mindreader?

Yes, you are supposed to be a mindreader! You are also supposed to have known as much as the surgeon knows even though you only went to school for 4 years in an associated field. You are supposed to be kneeling at his feet for allowing you to care for his patient!

*sarcasm intended*

[Annisme]

Hey guys,

The surgeon called. I told him of my assessment; absent BS despite ambulation, etc. I told him that I have to medicate him with 1mg of dilaudid before ambulation. HE FLIPPED OUT. He called me a freak and that he didn't give a **** about bowel sounds and asked what the hell was wrong with me for giving him dilaudid, that the patient should be on oral pain meds PRN.

I work on a Surgical floor and it is not unusual for docs to order Dilaudid for surgical patients. He wasn't worried about absent bowel sounds? I know I am just a student, but...please correct me if I am wrong on this but, HELLO! If the patient has no bowel sounds, you probably shouldn't be putting anything else down there until either you have bs or know why you don't!

Was there a written order for the Dilaudid or was it from a protocol form? Just wondering as we sometimes see the form with the areas checked off for orders.

I have issues with the name calling...it is inappropriate, unacceptable and unprofessional. Intimidation creates a hostile work environment, not only inappropriate, unacceptable and unprofessional, but illegal!

You did give this patient great care. Too bad the doc can't see what an asset you are.

[Scrubby]

Your first mistake was not hanging up on him when he as you said that he yelled at you on the phone for ten minutes. If that was me i'd just tell him to call back and discuss this when you can behave in a calm and rational manner. As a nurse you can't afford to waste your precious time being yelled at about something.

Your second mistake was showing fear and submission. That tells him that your a soft target. He gets away with this because most nurses do not have the courage to tell him to back off.

I know what surgeons can be like, I work quite closely with them everyday. I used to be scared and cringe but now I don't. I look them in the eye and tell them how it is. They never yell or scream at me because I don't show fear.

If you want to get over the fear of them next time is happens just remember this. The person may be a surgeon but he eats, sleeps, puts his pants on one leg at a time and goes to the toilet just like everyone else. He is not some sort of demi-god that can smite you with a wave of his hand.

I'm not saying you should yell back because once you do you loose the moral high ground and you'll probably get into trouble. If someone yells at me I tell them that I won't tolerate their verbal abuse and then I just turn my back on them. I speak with them anymore no matter how much they yell at me. I just pretend that they don't exist and I'll even start talking to other members of my team while they are yelling. It makes them look even more stupid than they already are. :wink2:

Hope this is helpful.

[UM Review RN, ASN, RN]

I work on a Surgical floor and it is not unusual for docs to order Dilaudid for surgical patients. He wasn't worried about absent bowel sounds? I know I am just a student, but...please correct me if I am wrong on this but, HELLO! If the patient has no bowel sounds, you probably shouldn't be putting anything else down there until either you have bs or know why you don't!

Was there a written order for the Dilaudid or was it from a protocol form? Just wondering as we sometimes see the form with the areas checked off for orders.

I have issues with the name calling...it is inappropriate, unacceptable and unprofessional. Intimidation creates a hostile work environment, not only inappropriate, unacceptable and unprofessional, but illegal!

You did give this patient great care. Too bad the doc can't see what an asset you are.

It is often a protocol for a postop abdominal patient to have a Dilaudid PCA on our floor, too, and I wouldn't have been giving anything po, even if the doc ordered it, if I thought the patient had absent bowel sounds.

Still not sure what was up with the doc, but really, his response was totally over the top.