Surgeons - ugh!

JKL33 · Aug 30, 2019

9 hours ago, Melanin said:
I have been told that the RNs should not venture so far as to recommend conservative pain relief strategies such as icing or warm compresses because we are practicing "out of our scope."

Told by whom, in what context?

9 hours ago, Melanin said:
I have approached a surgeon to ask his opinion about a new formulation for a very specialized & frequently prescribed medication that the surgeons needed

What kind of opinion? Do they find it efficacious? Do they feel it is better than the old formulation?

9 hours ago, Melanin said:
I've had a surgeon literally turn his back to me and begin speaking to another provider as soon as I started contributing to a discussion about the experiences of a certain population of patients who I triage all day and who provide their own perspective of what they experience in terms of a very specific and subjective condition

I haven't ever really noticed surgeons being the best of experts in the subjective or having much interest in long-term coaching of people regarding their subjective disease experiences (very generally-speaking).

Either you need surgery or you don't, or sometimes it is more a matter of either you want surgery or you don't. At the very end of the day the bottom line is that there are other specialists who work with patients who are struggling with something and either don't need or don't want surgery.

Your patient population sounds at like it could be at least a little bit complicated?

9 hours ago, Melanin said:
No matter what I do or say, they think I am a complete imbecile. They want me to shut up and fax stuff.

It sounds like they are not interested in what you are interested in, or not in the way you are interested in it. And before anyone thinks, "right, they are not interested in the patient" - that isn't (necessarily) true. They are interested if they believe they can help the patient. If they think that what they have to offer is not likely to help or isn't helping or that something someone else can offer would be of more help to a patient, then they do not seem to prefer continued intimate involvement, in my experience/observations.

9 hours ago, Melanin said:
Why should I kill myself for a surgeon?

You shouldn't.

10 hours ago, Melanin said:
I tell myself that it doesn't matter what they think, since I am not doing anything terrible or dangerous.

That is kind of a low bar for measuring your performance.

9 hours ago, Melanin said:
Even if I love what I am learning with all my heart and brain [...]

From their perspective you are not there primarily to learn, although we would all expect knowledge and wisdom to grow while working in a particular area (and hope that it would). But you have to get the job done. Your office's specialty is more surgery, and less medical-psych-social long-term management.

Or, if you are expected to field and pacify and/or turf the day-to-day long-term complicated and partially subjective problems of a large population of patients who are in this middle ground of deciding whether or not surgery is warranted or desired, and if the practice does not involve other disciplines and services that can support this, then yes your job is just frustrating and you should find a different one.

LovingLife123 · Aug 30, 2019

I guess I could see where they might get upset over you simply recommending heat or ice over the phone and not letting the provider know. It could be something that needs attention.

What I often do if a patient finds that whatever pain meds we gave them are not managing their pain, is I will offer an alternative therapy but then let the provider know. I will tell the physician as soon as I see them, hey, the norcos are not working. I gave them some heat packs and it seems to be working well. We go from there. I’m guessing they are worried they are not being adequately informed on pain management and that you are simply brushing the patient off. Which I’m sure you are not, but that’s how it comes across.

Also, how do approach the surgeon when asking a question? I usually ask, hey do you have a moment that I can pick your brain? They may be super busy or have things on their mind, or they may have a second. I know which ones are approachable and which are not.

I will say, it can take years to develop these kinds of relationships. I’ve been on my floor for over 5 years. It took me a couple of years to get to point where I was friendly enough with all the surgeons to ask those types of questions. You have only been there 10 months.

brownbook · Aug 30, 2019

I worked for 17 years in out patient surgery. I've never had a surgeon get upset if I asked if they wanted icing. It is usually routinely prescribed or they say, "Oh did I forget to write that as an order, thanks." I haven't had situations where heat seemed useful, but I'm certain if it was it would be accepted in the same manner.

I am so curious to know what the "new formulation for a very specialized & frequently prescribed medication" is?????

Anyway I enjoy working with surgeons and find most of them to be very appreciative of suggestions by nurses. It is not out of the scope of nursing practice to advocate for your patient.

**CommunityRNBSN, BSN, RN** · Aug 31, 2019

Surgeons (much like pilots) have a reputation for being like this. In my experience, that reputation is well-earned. I do think that the prior commentor, who mentioned age, is also onto something. Surgeons approaching retirement age sometimes seem to view nurses as basically their secretaries who should be seen and not heard.

I know I’m painting with a broad brush, and I’m sure there are some lovely surgeons. Now that I think about it, I did meet one who did Mohs surgery who was lovely and had a great relationship with his nurses. But overall, I think you just have to let it roll off your back. Advocate for the patient when it is really truly needed, and otherwise, keep your mouth shut and then roll your eyes when you’re out of their line of sight.

FolksBtrippin, BSN, RN · Aug 31, 2019

God bless you OP. I find these surgeons' behavior unacceptable.

I would complain to HR using the term "hostile working environment".

If I did not see any improvement, I would find another job.

We don't have to put up with this stuff.

JKL33 · Aug 31, 2019

48 minutes ago, FolksBtrippin said:
God bless you OP. I find these surgeons' behavior unacceptable.
I would complain to HR using the term "hostile working environment".
If I did not see any improvement, I would find another job.
We don't have to put up with this stuff.

And (although I am not arguing this is the case with the OP, since I have no idea), what should happen when nurses interrupt patient care with numerous basic misundertandings to ask questions to which they should know the answer, or to assert their professional or personal interest about something that has nothing to do with their job/role?

It has been very interesting to watch the one-sided and goal-directed manner in which the threat of the "disruptive physician" label has been thrown around IRL.

Nurses often/sometimes don't seem very objective about this. In my direct observations, physicians are interrupted with the ridiculous way more than rarely; with "updates" that are insignificant and inconsequential, with inane questions, and even with general personal/social commentary that could test the patience of a saint and cause any sane person to say "IDGAFlip!! ?"

Elaken · Aug 31, 2019

2 hours ago, JKL33 said:
Nurses often/sometimes don't seem very objective about this. In my direct observations, physicians are interrupted with the ridiculous way more than rarely; with "updates" that are insignificant and inconsequential, with inane questions, and even with general personal/social commentary that could test the patience of a saint and cause any sane person to say "IDGAFlip!! ?"

The problem I have with this is it is really hard to say something should be known or is inconsequential. We have a doctor who will think you are the dumbest nurse alive if you have high BP and don’t stop IV fluids. This doc also takes over an hour to respond to being paged. Yet we get told that we can’t stop IV fluids without a doctor’s orders because it is out of our scope of practice. So yes she thinks we are idiots if asking to stop fluid but technically we have to.

Or the cardiologist who gets annoyed when calling to inform about some burst of rhythm that I *know* isn’t a big deal but I am not allowed to make that call. The patient didn’t have it before so I can’t just say doctors aware. Yes we all know it is about CYA but that is the game we play.

Or this doctor is dramatic about everything so I have to know that he needs to know about X but that doctor doesn’t care. And if I forget the second doctor thinks I am bothering him with inane issues.

Or normally I mention the slightly elevated but not at all critical creatinine to a doctor when I see them because they do not want to be called about something that simple but oops this doctor doesn’t round until 6 pm because he tries and avoids families so now he is upset I didn’t call him with that label value.

Or the fact that nurses learn *so* much on the job and it is unfair to expect a 2 year nurse to know X and Z are pointless updates but by year 5 she will know it.

I don’t think doctors realize how much we have to just pick up as we go and thus every nurse is at a different level of knowledge and ultimately when we don’t know it is the provider who has to be notified. Or how much doctor’s have their idiosyncrasies and we are suppose to memorize them and adjust accordingly. The fact that I am even suppose to know this doctor likes a text, this likes a message through this system, this one likes a page. Or this one you need to give X time to call back before trying again. But this one you need to probably page 3 times so don’t wait too long between each or you won’t get a response for over an hour.

Yes. Doctors get lots of calls. And sometimes they seem unnecessary. But ultimately RNs are doing the best and most try and mitigate the calls but doctors don’t really help with that.

Orion81RN · Aug 31, 2019

3 hours ago, JKL33 said:
And (although I am not arguing this is the case with the OP, since I have no idea), what should happen when nurses interrupt patient care with numerous basic misundertandings to ask questions to which they should know the answer, or to assert their professional or personal interest about something that has nothing to do with their job/role?

What should happen? The physician can use those exact words. Remain professional. If they've already addressed an issue such as this with a nurse guilty of the above behavior, then I could maybe understand an "IDGAF." Maybe.

3 hours ago, JKL33 said:

Melanin · Aug 31, 2019

Ok, I should probably explain myself better in regards to the "I don't care" thing, since I don't want people to assume that I fit neatly into the (apparent) stereotype of the RN who asks a million irrelevant & stupid questions - at least, not in this case.

In THIS case, the pharmacy that compounded a medication - the precise formulation of which was created and approved by a venerated surgeon who retired from our department - informed us that in two weeks they would no longer make it for us. The doctors who regularly prescribe this treatment were quite upset to hear this and even called the pharmacy to try to talk them out of discontinuing, to no avail.

So I took on the task of finding a new source for that medication. I found 2 new compounding pharmacies willing to make the exact formulation for us, but at a much higher price (not covered by insurance, so out-of-pocket for patient).

I did, however, find a third pharmacy who had their own version of this medication at a very reasonable price. It was a similar formulation but with one different ingredient and with a somewhat different ratio of ingredients.

Since I am an RN, I didn't feel comfortable making the call on whether it would be okay to substitute a different formulation. That is why I approached an MD to ask for an opinion on the affordable option - I was preparing a written proposal for the MDs to review and discuss so that I could have the medication available prior to the two-week deadline I had been given. The MD I approached is an expert in the subspecialty that uses the medication.

I did not ask him to explain how the medication works, or chat about my interest in the medication, or propose my own ideas for how to use it; I simply asked - or tried to - if the MD could weigh in on whether the affordable version was a viable substitute.

Thanks!

subee, MSN, CRNA · Sep 1, 2019

There's only 1 chief surgical residency while there are multiple medical chief residencies. Hence, they have to fight and brown nose into that 1 position. They often don't know much medicine because they just want to do surgery. They are often short on social skills and it's really up to the hospitals to keep then in line when they are insulting the nurses. Just give their rap right back to them and they'll back off. I've worked with many lovely surgeons but they are more rare and everyone wants to work in their rooms because it's going to be a good day. Not enough if those rooms:(. But think about the boundaries they need to set for themselves since so much of what they do would be barbaric outside of an OR. It's a very stressful job and while all of the other interns and residents were growing up , they were busy brown nosing, so they dont handle personal stressors well at all:)))

Melanin · Sep 1, 2019

Ha ha, that explains a lot.

It looks like you have some experience. I'm pretty new (5 years now, second career). Thank you!

FolksBtrippin, BSN, RN · Sep 1, 2019

21 hours ago, JKL33 said:
And (although I am not arguing this is the case with the OP, since I have no idea), what should happen when nurses interrupt patient care with numerous basic misundertandings to ask questions to which they should know the answer, or to assert their professional or personal interest about something that has nothing to do with their job/role?
It has been very interesting to watch the one-sided and goal-directed manner in which the threat of the "disruptive physician" label has been thrown around IRL.
Nurses often/sometimes don't seem very objective about this. In my direct observations, physicians are interrupted with the ridiculous way more than rarely; with "updates" that are insignificant and inconsequential, with inane questions, and even with general personal/social commentary that could test the patience of a saint and cause any sane person to say "IDGAFlip!! ?"

I don't see the problem you are describing. I literally have never seen it anywhere from a nurse. From nursing students, yes. But never from a nurse.

If you are not accusing the OP of stupidity or inappropriateness then why bring this up here?

I guess your questions are rhetorical. Did you want an answer for what you should do when a nurse doesn't know something you think she should know? You teach her.

Do you want an answer for what you should do when you think a nurse is expressing an opinion or asking a question about something that isn't her role? Realize that she is responsible for patient education, for catching errors, for coordinating care, so it is her role to understand the big picture and have a working knowledge of everything that is happening with her patient.