Told a doctor about how I thought he felt I had no common sense

[ratherbe]

I had a patients family member who was a doctor come up to me during my shift and stated that they just came to visit her dad and he is not recognizing anyone. The patient did not have dementia, and about thirty minutes earlier I went in and was having a joking conversation with this alert and oriented man. I was concerned so I came in asked him the usual questions, took vitals on him, and all he could tell me was his name, could not keep a conversation. His o2 sat was 81% on 2.5L which it was 95% earlier, and I cannot remember his exact pressure now but it was in the 90's. I work on a rehab unit so we don't have any monitors or anything like that but the pt had been transferred the day before just an hour after newly diagnosed afib. So I knew the 81% might just be are pulse ox reading incorrectly because of his afib. I called the doctor telling him that I was concerned about him not really able to talk to me or recognize his family. The only change in his assessment I could find was his confusion and vitals. The first thing my rehab doctor said to me was well, is the oxygen turned on? After trying to explain the changes in the pt, the doctor cut me off and said ok I get it. The doctor ordered some tests, I called our statcare docs to let them know and our rehab doctor came up in a few minutes. He spoke with the family and assessed the patient. He didn't cancel any of the tests after his assessment. He called the statcare doctors and he sounded concerned on the phone as well when speaking to them. About ten minutes later those doctors came up and sometime between when the rehab doctor came in and assessed them and when they did, the patient became a little more with it and he was speaking clearly. His ABG's came back and were fine and the statcare doctors basically said he was ok. After those doctors left my rehab doctor came to me and said, did you actually see any change in his assessment or did you just call me because of his oxygen sat (he said this in a stern manner). I simply responded yes. But at this point I was confused because obviously he saw a change in him otherwise he would have cancelled the tests after he saw him, and I had been slightly ticked that he asked me earlier if the oxygen was actually turned on because I felt like it was sort of an insult d/t past experiences with this doctor. So about 30 seconds of pondering why would he be so stern and ask me that like I just base things on numbers and not actually my mind I decided to tell the doctor how I felt. I said you know dr. _________ I was not going to say anything but I think you should know that I feel a bit disrespected that you would ask me that in the manner you did and for that matter I feel like you are implying things about my intelligence by asking questions like well was the oxygen turned on. I said it and felt good that I said it because I didn't want to feel walked all over like I had on repeated instances with this man. He said in response no I am insulted that your insulted by asking you that. Your problem is that you take things way to personally. I bit my lip because I felt like maybe he was right. My question to you all is if you had a doctor that repeatedly said things that you felt made you feel like he thought you were not even stupid but lacking any common sense, would you have told them? If so, how should I have said it. I am just very sad because I feel so belittled all the time by the rehab doctors that I work with that I really felt I needed to stick up for myself. Maybe it was a bad example for the doctor that day of how I feel belittled but there seems like there are so many instances that I had to say something. I don't get questions like that from the other statcare doctors I work with, just the rehab doctors. I know he said that I take things personally, and I know I do at times which I don't know how to fix but I know it wasn't just me that felt disresspected by these doctors. I've had many nurses that I work with meintion that when they worked other med-surg floors their opinion was more valued and on our floor it is like we are treated as just pill pushers with no mind of our own. I guess I just want some advice or maybe someone to say feel better cuz right now I feel like crap. It's days like this I start thinking I am just stupid and I am that nurse has no common sense. It gets to the point where I feel like maybe I should rethink my career...like I should go be a bagger at the local supermarket. It really effects my self esteem and I wish it didn't. Any advice? Also, I know this is probably gonna be asked at some point but I've only been a nurse for two and a half years. Thanks for the vent.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

Change in mentation in a patient with A-Fib can be serious. You did right, medically. The rehab doctor has a bad attitude and sounds sarcastic to me. IMHO you let the doc get one up on you, letting him get questioning yourself at length. I suggest that you document the difficlties with this/these docs and bring it to your supervisors attention. If you let the docs bad attitude get to you, you'll get to the point that you won't report significant information to them, and if there's a bad outcome, you're pretty much $crewed.

[netglow, ASN, RN]

You could try this next time... (I did this with a Doc I used to work for)

Doc: "Your problem is that you take things way too personally."

You: "WRONG ANSWER Doc. You were supposed to say, I had no intention of leaving you with that impression, sometimes I am abrubt when I work, and I don't mean to be"

[ebear, BSN, RN]

You did the right thing. I would have said "Dr. So N So, don't insult my intelligence, sir, I know what I'm doing and will call you again in the future if I see a change in a patient's status." Respectfully but firmly state your point and walk off. Then report to supervisor in writing and save a copy for yourself. Good for you for sticking up for yourself and looking out for the welfare of the patient. Don't let some arrogant orifice sour you to the profession. Hang in there like an old, rusty nail, Baby!

ebear (37yrs RN experience)

[tyloo]

Kudos for you being assertive and directly telling him how you feel. Maybe he will think about what you said to him just like you are taking in consideration of what he said to you.

You have been a nurse for two and a half years. I think you know when a patient isn't quite right and your nursing judgment kicks in to notify the MD. Even if he felt it was incorrect to call, it is still his job as a Doctor to assess a patient and/or prescribe a treatment when a nurse identifies acute problems.

I think your feelings are valid. No one wants a Doctor, supervisor, coworker to think that one is incompetent. You said other nurses on the floor feel that way which leads me to believe that he is the problem. I would not take it personal, especially if he has been communicating with others in the same manner. I respect the opinions of those that respect me. If you feel like he doesn't respect your nursing judgment than you don't have to respect his opinion.

I think all nurses have had their moments of wanting to be a bagger in a grocery store. I wish I could go back to the days when I was a waitress. I would definately respond in a different manner to customers, knowing what I know now...LOL. I used to think it was the end of the world if people got their food late. I also thought that when I was a nurse I would get a lot more respect than when I was a waitress. I think I may get a little more respect as a nurse but not much more! Atleast we have those rewarding times to make up for the times that are less rewarding.

[ktliz]

Sometimes it's hard not to take things personally. It is possible that the doc meant no disrespect, and was just covering all his bases. Hopefully sharing your thoughts will cause him to reconsider his tone so that no one's pride is hurt unnecessarily.

Or he could just be a jerk who will never change!

[Jules A, MSN]

It is possible that the doc meant no disrespect, and was just covering all his bases. Hopefully sharing your thoughts will cause him to reconsider his tone so that no one's pride is hurt unnecessarily.

Or he could just be a jerk who will never change!

I agree and I don't take it personally when they run down the list of things to check during a crisis. It is their job to make sure A, B and C have been addressed before jumping on D, imo. I'm very out spoken but haven't ever confronted abrupt behavior because I don't think it does you any favors in the long run. It isn't my issue so I will continue to do what I need to do to advocate for my patients and if the doctor acts like I'm a dope well so be it. Usually even the jerks relax it a bit after repeated encounters with a competent nurse. Hang in there and gee don't take this personally!

[jjjoy, LPN]

You could try this next time... (I did this with a Doc I used to work for)

Doc: "Your problem is that you take things way too personally."

You: "WRONG ANSWER Doc. You were supposed to say, I had no intention of leaving you with that impression, sometimes I am abrubt when I work, and I don't mean to be"

I love this! Have you got any other good comebacks like that? Ones that make a point with a bit of humor and without shame or blame lumped on either side.

[caliotter3]

I think what you felt like in these interchanges is less important than what was going on with the patient and getting the patient the help he needed.

[BabyLady, BSN, RN]

1. I call troll.

2. Anytime O2 sats are low, common sense says you increase some to see if that fixes the sat levels.

3. A temporary swing from 81% to 95% is not earth shattering.

4. Physician had a valid question...before you call the physician you need to make sure that the oxygen is STILL connected at all points and the nares are patent.

[lindarn]

My concern with a patient in Afib, is he on Coumadin, because when one is in Afib, you are prone to clots, that can cause a stroke; next, I would be concerned that he DID indeed have a stroke, with change in his mental status.

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

[ImThatGuy, BSN, RN]

Who really cares if it's a doctor in question. Treat them like you would any other person. I don't have any special respect for them. Heck, I value a good mechanic more than I do a good doctor quite honestly. Doctors are just regular people. They just need that pedestal they try to stand on knocked out from under them every now and then.