Why do doctors get to play by different rules?

[asilmk]

I filed a complaint about two respiratory therapists and a doctor who came to visit my ICU patient and were dressed unprofessionally. One therapist was wearing scrubs with the pants too low and the shirt too high, leaving his red boxers visible. The other RT had on street clothes and a lab coat (which he only put on after I asked him who he was.) The on call surgeon came in wearing flip flops, khaki shorts, and a white t-shirt. He didn't have a lab coat, name tag, or stethoscope or any other item identifying him a a medical professional. I know him from another hospital, or I would have been asking him the same "who are you" question when he waltzed into my pt's room and started pulling back blankets. I told all this to our charge nurse, who naturally was upset at the RT's and left a message for our unit manager. When I got to the doctor part, she said that they play by a different set of rules and they can do whatever they want.

It's a rhetorical question, but why is it that MD's are not held to the same accountability the rest of us are? He still has a responsibility to my patient to look presentable, whether he's a surgeon or not. How hard would it have been for him to throw on a lab coat (at the very least) on his way in the door? There are so many instances where doctors can get away with stuff that we "grunts" never could. If I talked to doctors the way they have talked to me, I'd be fired. If I was as abrupt and rough with patients as I've seen some doctors be, I'd be written up. When are we going to hold our doctors accountable for their actions?

[SuesquatchRN, BSN, RN]

I don't permit anyone to treat me rudely, neurosurgeon or cleaner, and I don't treat anyone rudely, either.

I see no need to fight for the right to be a slob.

[cardsRN]

well, i have seen a cardiac surgeon operate in jeans in one of our rooms on a saturday night. wow what a doc. i'd have his skills in jeans (or a tutu if he preferred) any night of the week.

OTOH, it's the open toed shoes that get me. gross. what are you going to step in? what's been on that floor? what could splash on you/fall on you. i'm pretty sure there are OSHA regs about open toes in direct care areas, but i see it time and again from MD's and NP/PA types.

[core0]

really????

I laughed so hard when I read that.... how do you forget pants????!!!!!

You have to know the guy. Very driven, very technically proficent. Not to socially adept. He got a call and leaped out of bed and came in. At least he was wearing boxers.

David Carpenter, PA-C

[RNOTODAY, BSN, RN]

I don't permit anyone to treat me rudely, neurosurgeon or cleaner, and I don't treat anyone rudely, either.

I see no need to fight for the right to be a slob.

Huh? What do you mean by this? Who is being rude? And who is fighting for the right to be a slob?

[RNOTODAY, BSN, RN]

You have to know the guy. Very driven, very technically proficent. Not to socially adept. He got a call and leaped out of bed and came in. At least he was wearing boxers.

David Carpenter, PA-C

It still had me laughing about it today, at work, not even near the computer...... really.....

[asilmk]

I haven't been able to check in for a while, and I appreciate all your replies! The replies are about what I expected. Some of you completely missed the point of my post, some of you got it and are complacent, and some of you see the more global aspects of what I said. The issue boils down to the fact that nurses are generally regarded as easily replaceable assets, and docs are treated as irreplacable, precious resources. I agree that it doesn't really matter what people wear, as long as their care is up to par. But the broader picture is that docs are allowed to do whatever they want, including dress, treatment of nurses and pts, etc. and the whole dress issue is just a small part of it. Yes, I understand that docs are not employees of any hospital, they make the hospital money, and the hospital is reluctant to tango with then. Docs should be required to give respectful care to their pts. If RT's are required to give respectful care, so should docs. I do feel that being presentable is part of respecting the patient. I know hospitals view nurses as liabiltities and an expense. The fact that nurses are viewed in this light, in my opinion, has lead to a lot of the problems in our profession and the general lack of respect we endure from docs, our pts, their families, and the community at large. We all know that good nurses who deliver excellent care will make the pts want to come back which will, in turn, make the hospital money. Why do pts come to hospitals? Because they need nursing care, not because they need a doc standing over them 24/7. If a pt. loves their doc but hates their nurse, how likely will they be to come back to that hospital? I know I will probably get berated for this and be seen as taking things too seriously, but maybe that's how the state of affairs of nursing got to this place to begin with.

And the situation I originally posted about was not an emergency. The doc was there for rounds, as he was covering for the group over the weekend. My apologies for not making that clear.

[Ruby Vee, BSN]

as a nurse, i prefer seeing physicians professionally dressed -- if they've been out and about they can at least throw on scrubs before making rounds! but in an emergent situation, i'm happy to see them regardless. i must say, i have problems with docs wearing shorts and flip-flops even if it is an emergency -- throw on scrubs and shoe covers! the jeans and cowboy boots while not totally professional, at least they're decently covered.

as a patient or family member of a patient -- if a doctor isn't professionally dressed, it makes me wonder if they know what they're about. when my husband went to the er in the middle of the night while we were on vacation in montana, the doctor came in wearing cowboy boots, jeans and the biggest rodeo belt buckle i've ever seen. i made sure that everything he said made sense to me . . . was pretty relieved when it did!

[algebra_demystified]

If you want to dress any way you want and have the hospital kiss your butt all the time, go to medical school and get your MD.

There must be HUNDREDS of people that have done it, right here in the USA alone.

I'd rather be a nurse. Much more freedom, more off-time, the pay is good, etc.

[Selke]

... Some of you completely missed the point of my post, some of you got it and are complacent, and some of you see the more global aspects of what I said. The issue boils down to the fact that nurses are generally regarded as easily replaceable assets, and docs are treated as irreplacable, precious resources. I agree that it doesn't really matter what people wear, as long as their care is up to par. But the broader picture is that docs are allowed to do whatever they want, including dress, treatment of nurses and pts, etc. and the whole dress issue is just a small part of it. Yes, I understand that docs are not employees of any hospital, they make the hospital money, and the hospital is reluctant to tango with then. ... I do feel that being presentable is part of respecting the patient. I know hospitals view nurses as liabiltities and an expense. The fact that nurses are viewed in this light, in my opinion, has lead to a lot of the problems in our profession and the general lack of respect we endure from docs, our pts, their families, and the community at large. We all know that good nurses who deliver excellent care will make the pts want to come back which will, in turn, make the hospital money. Why do pts come to hospitals? Because they need nursing care, not because they need a doc standing over them 24/7. If a pt. loves their doc but hates their nurse, how likely will they be to come back to that hospital? I know I will probably get berated for this and be seen as taking things too seriously, but maybe that's how the state of affairs of nursing got to this place to begin with. ...

:yeahthat: :wakeneo:

This mentality that MDs generate revenue and are the primary clients of hospital corporations -- NOT RNs, other staff, even patients -- enable them to not only not be bound by rules the "employees" are bound by, but they can pretty do whatever else they want. Treat staff poorly, throw tantrums, take your pick of entitled bad behavior. The hospital system is a huge example of how our economic system works: there's the ownership class (stockholders, corporate management of the hospital, MDs) who control and manage the capital (revenues, budgets). Everyone else, INCLUDING NURSES, are EMPLOYEES who are paid as little as the corporation can get by with to attract just enough to work to minimally cover patient care. The hospital and its division of labor is like a factory. Nurses are not managers, they are workers who do not control the means of production, they follow orders, do not shape the overall management of the organization. Classic nursing behavior is manipulated by management to keep them infighting, to get the most possible work out of them, by appealing to "the good of the patients" and other "altruistic", emotional-rewards based theory of nursing compensation. Employees are subject to the myriad of rules and regulations we've been discussing. Nurses can be replaced (although this is getting harder and harder). MDs share in ownership of the hospital in a sense, in that they bring in revenue/patients. They DO play by different rules. They are not employees. It's all about the power, baby. An individual MD is worth far much more in society than an individual RN. The ones with more class and graciousness treat the "hired help" well, the a@@&*les and boors don't.

Incidentally, I've observed the most well-dressed MDs are plastic surgeons, and they are on the whole very gracious to nurses and staff. I think they are very aware that RNs talk word of mouth about their work and can bring in patients.

In reality, the community is aware of the kind of nursing care they get and will return to the hospital for the nursing care, although advertising and in hopsital propaganda emphasizes "The Doctor" and all that ##$$. These attitudes are, amazingly, internalized by nursing staff. I have been told by RNs in more than one hospital (one in New England) that my job was to "serve The Doctor and anticipate his every needs." I nearly threw up and of course got out of that place ASAP. I suspect magnet hospital designation is a way to attempt to recognize the visible role of nursing in the relations of the hospital with the community.

In regards to clothing, clothing is also a class marker and poorly dressed MDs violate that, as well as "dress code" standards. However nurses shoot themselves in the foot by wearing childish print scrubs to work, not cultivating a more professional, polished image; how can they expect to be taken seriously as adult women? Many RNs call each other "girls." You won't find management or female MDs calling themselves "girls." Just some of my pet peeves. I would love to hear someone like the What Not To Wear people make suggestions as to how bedside caregivers can upgrade their professional image at work and change their verbal interactions at work, to learn how to play hardball with the big boys and girls. :wakeneo:

Yeah, social class is integral to all this. There must, or should be, more socioeconomic studies on the class relations and political and institutional power of different players and types of caregivers in our health care system in America, how these factors play out on the job. I think the approach of the California Nurses Association and NNOC are headed in the right direction to change the balance of power in the health care system.