So, about two weeks ago I had a very unpleasant interaction with my patients primary provider. I was in the patients room with him and they were talking about the care plan, when the patient directly asked me a question. It was nothing medical related, and not anything relevant to what they had been talking about, but I answered the question. I then went to the nursing station to chart while they continued. The doctor came raging out and started to yell at me for undermining him in there. This is in front of about 15 people. According to him, I should not even talk when he is in with a patient. In the middle of his rant. I interrupted him and frankly said, " There is no reason for you to be so disrespectful towards me, and if there is anything else you need to let me know, feel free once you decide to behave like a professional." and left. I was later pulled aside by my charge (who witnessed the entire thing) and told that it was unprofessional for me to "point" and raise my voice in front of everyone.
I just cannot believe that I was pretty much being told not to stand up for myself.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Why the heck did the charge not stand up for you??? I had a Doctor do me the same thing, difference circumstances because I forgot to do a lab or something and he came to the nursing station and embarrassed me, I said ok I will get it done, then the charge stood up and said doctor you are way out of line for talking to my nurses like that. There is really no need for a doctor to treat you like that. He/she is not your boss.
Your charge should not be siding with the doctor regardless of who was right or wrong. If I'm in the room I interrupt doctors if they got something wrong, or to clarify their plans, its your JOB to ADVOCATE for the patient. I'd go to your nurse manager to have this resolved.
Going to the nurse manager isn't going to end well for the OP, who admitted to the unprofessional behavior of raising her voice and pointing. Which is precisely why the charge didn't stand up for her. Because of her unprofessional behavior. It does matter who was right or wrong. Because of her unprofessional behavior, the OP was wrong. The doctor may also have been wrong, but he didn't ask for our advice.
Specializes in Psych, Addictions, SOL (Student of Life).
One has to remember that weather we like it or not modern medicine in a consumer driven big business. I'm not saying it should be but that's the reality. As such Patients and Physicians are the customers of the hospital and need to be treated with respect. After all the customer is always right! I know a lot of very hot headed Doctors but once I set professional boundaries we get along fine. Your initial post (and correct me if I'm wrong) indicates you responded to his raised voice with a raised voice of your own and that you pointed a finger at him while doing so. Finger pointing is always unbearably rude. One should never counter rudeness with rudeness. I know you were upset and there really was no excuse for the physicians behavior - but there's a way to stand up for yourself without lowering your professional standards. Just food for thought. I would have most likely said something like "Dr X, I am sorry you feel I spoke out of turn, but the patient asked me a direct question and I saw no harm in answering. In the future I will let you be the one to address these concerns."
I wouldn't want to place a judgment on you or the MD based on one encounter. I've seen the nicest professionals lose their cool at times and I've seen some of the crankiest professionals do and say things that are just short of saintly. It'd be great if everyone could maintain a perfect demeanor all the time, but in all my years, I've just not ever seen that happen. There's just so much pressure working in the medical system, especially the modern medical system where the MDs are really feeling a crunch they never felt before with the insurance changes and pressure from administration. This is my experience, anyway. I'd love to say that no one will ever act out of line, but that's probably not really realistic. You'll act out of line once or twice yourself, as well, is my guess. It usually happens when your workload demand outweighs your ability to humanly perform it all and one innocent person will say or do the wrong thing and .... ugh. We all try for it to not happen, but I haven't met a person yet that it hasn't happened to.
I hope I don't sound like I'm enabling bad social behavior, I'm not. Bad social or unprofessional behavior is never good or "ok". There are reasons for it, but no "good excuses" for it, if you know what I mean. I do think, depending on the severity, it should be addressed and corrected. If it's habitual, it probably should be reported, depending on the circumstances.
I can't help but be curious why the MD was so concerned about being undermined with that particular patient. It's hard to tell from your post if there was an underlying reason for the MD's concern. Clearly he didn't handle it well, he escalated a situation that he should have known wasn't a good idea. Not only did he not communicate to you what he might have wanted to communicate to you, he undermined himself by losing his cool so publicly.
I wish I could say that I've never had an MD or another nurse or other professionals yell at me or embarrass me in front of a group, but that wouldn't be true. The truth is, I have, and more than a couple times. Most of the time it's in the heat of a moment and there's a miscommunication at the core of the issue. Sometimes it has been in a high pressure situation and it was the last thing I was worried about because our focus was on the patient. Sometimes it was someone who was misdirecting anger or frustration that I was the unlucky person to walk past. There has been a time when it was out of line, very unprofessional, and consistent and reporting it and correcting through those means was the only viable option.
I'm very glad that modern workplace culture is starting to respect and value the communication between professionals. It wasn't always like this, so this is a step in the right direction, if you ask me. At the same time, I think it's wise to keep a certain level of understanding that when humans work in high pressure situations, sometimes they do make mistakes and are less than stellar with one another, and sometimes they are just plain in the wrong. That doesn't make it right, but it also doesn't have to define a person, either.
In really high tension situations where I'm pretty sure nothing I say is going to be heard or valued at that moment and the other person is clearly triggered emotionally, I try to take deep breaths and calm myself and try to hear at least something worthwhile the person is saying. This is a skill I found very helpful with patients as well. This is probably my "type A" personality shining through, in that, if I have to be there listening to someone lose their cool at least I'm learning something from it so I don't feel like I'm wasting my time. If that doesn't work for me, I do something that I remember from the Brady Bunch. I imagine the person in their underwear as they are doing their thing, yelling at me or disrespecting me. If you ever do that method, be careful not to smirk or smile towards the person you are imagining in their underwear, they probably won't see the humor in it. At least not in that moment.
Good luck working through this one, it's never fun to be yelled at or embarrassed, I hope you find some insights from those of us who have also been through it, or maybe who have even done it.
OP, you were completely correct to answer the patient's question when they asked it. It was obviously of pressing concern to the patient, and we are to be practicing "patient-centered care." If the patient needed to ask you right then, he or she was anxious, and anxious people can't hear what their MD is saying. Then the MD could have continued with whatever he was saying. He was wrong to yell, and you were wrong to yell back. Practice "iceberg" - be the "ice queen" if you are being yelled at, and tell him what I used to tell my son - "I can't hear you when you yell (or in my son's case whine.) When you can talk to me properly I can hear you." And then walk away.
In the time it would have taken to say to the patient, "The Dr. is here now, I will discuss transportation with you later" you could have already answered his original question! This has nothing to do with what you said. This is about the Dr. and his precious feelings. He's a jerk looking for reasons to get angry so that he has an excuse when he loses control and explodes. You had every reason to raise your voice. You weren't screaming. Raising one's voice can be completely appropriate and professional depending on the situation, and in this one, it absolutely was. Staying silent and cowering when someone is lashing out at you is being submissive which is where the Dr. wanted you.
It's great to know that you care how a patient is going to travel when they are discharged. That shouldn't ever be called "unimportant" by nurses OR doctors. Simple question, simple answer, that doc should just be even the *slightest* bit flexible when it comes to having the opportunity to participate in a SHARED conversation about discharging a patient from the hospital (which is an area that often times an awful lot goes wrong--its nice to know the patient, the nurse, and the provider are all on the same page about the transportation)
Seriously. Doctors are not above knowing their patient feels secure with their discharge.
A great number of my patients do not have the capacity to comprehend their plan and many of the nurses that I work with don't realize that it is all of our responsibilities to make sure our patients get out ok. I have followed more than one of my patients to the lobby or parking lot to help them trouble shoot a poorly conceived train wreck plan.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
The title of this thread should not be "why is it inappropriate to stand up for myself" "why is it inappropriate to escalate the bad behavior by doing the same thing the doctor does except louder and with hand gestures?
The OP herself stated in the beginning "It was nothing medical related, and not anything relevant to what they had been talking about, but I answered the question." Not a "team conference" or SHARED anything as many seem to believe.
"Simple question, simple answer". We weren't there, but I believe many nurses find it isn't always that way. Patients often come up with an amazing array of auxiliary non-simple questions and answers about their mode of transportation.
Again, nobody has said the patient's question was unimportant! :hdvwl:
We don't know if anxiety came into play here, but if the patient is anxious it means the better course of action is to dig deeper, rather than to answer their anxiety-fueled question and leave it at that
Both the reference to deficient "patient-centered care" and the bit about nurses not understanding what the whole discharge thing is all about are condescending and insulting.
PedsRN, your post helped me figure out what annoyed me so much about some responses. The physician, in this case, was held in higher regard over not only the nurse, but also the patient!
Some told the OP she should redirect the pt to listen to the doctor, as if the pt's concerns were insignificant to whatever the doctor was saying. "Oh, no, Ms. Patient...time to be quiet, the doctor is speaking now! I'll answer you later...after he's finished!"
Good lord.
Some told the OP it wasn't about her...she should listen to his yelling, try to understand his viewpoint. Ok, then, it's all about him, his time, his need to dress her down in front of people.
But she pointed her finger at him! *pearl clutch*
There's no excuse for the doctor's behavior, and I believe the OP definitely had the right to defend herself. But..... I think saying "We can talk about that later", or something along those lines, is ideally what the OP should have said in this situation. The physician was discussing vital medical information with the patient, and how the patient was going to be transported to the nursing home was of no importance at that moment.
Im sure part of the reason the doctor lost his temper was because this patient was well known for being hard to focus and for being fixated on trivial details. Which can be dangerous when they're so focused on the minutiae of hospital life that they miss the big picture of their condition and medical plan.
Again, the doctors arrogance and rudeness cannot be excused, but I don't think redirecting the patient's attention back to the doctor and the vastly more important matters at hand constitutes as being dismissive to the patient or as being meek and submissive.
The title of this thread should not be "why is it inappropriate to stand up for myself" "why is it inappropriate to escalate the bad behavior by doing the same thing the doctor does except louder and with hand gestures?
The OP herself stated in the beginning "It was nothing medical related, and not anything relevant to what they had been talking about, but I answered the question." Not a "team conference" or SHARED anything as many seem to believe.
"Simple question, simple answer". We weren't there, but I believe many nurses find it isn't always that way. Patients often come up with an amazing array of auxiliary non-simple questions and answers about their mode of transportation.
Again, nobody has said the patient's question was unimportant! :hdvwl:
We don't know if anxiety came into play here, but if the patient is anxious it means the better course of action is to dig deeper, rather than to answer their anxiety-fueled question and leave it at that
Both the reference to deficient "patient-centered care" and the bit about nurses not understanding what the whole discharge thing is all about are condescending and insulting.
"Shared" conversations are often not linear if you expect actual communication to happen. Of course patients need to be re-directed at times (we all do)-- but sometimes addressing simple interruptions in the moment can help everyone refocus. It depends on the situation, and of course if it's not a simple question both the doctor and the nurse can help to redirect. If the nurse also needs redirection, the doctor I'm sure can help to refocus the conversation.
Basically--no reason for anyone to not be decent to each other.
I don't know if you are addressing me with the "nurses not knowing what the whole discharge thing is about" but that is not what I said. I have known more than one nurse to not have a clue how a patient is getting from point A to point B (in one case letting a patient get wheeled down to the hospital lobby without knowing if someone was picking her up) just as I have seen doctors and residents failing to know how patients left, or even where they went. I don't see this often, but it does happen--so why not take an opportunity to answer a patient's question about it (if that can be done quickly), and then get back to whatever else was being discussed?
Specializes in Peds/outpatient FP,derm,allergy/private duty.
.....Basically--no reason for anyone to not be decent to each other.
I think this is something we all agree on. Being yelled at, especially in front of others is never appropriate. I don't believe anyone has excused that. Beyond that, what happened between the 3 people in the room, all we know is that the doctor reacted with anger, inappropriately expressed. To say more than that without more details is further speculation. I can imagine a number of scenarios in which a quick detour is fine, and others in which it would be detrimental, so I think it's best if I just bow out of this discussion now.
Ruby Vee, BSN
17 Articles; 14,051 Posts
Going to the nurse manager isn't going to end well for the OP, who admitted to the unprofessional behavior of raising her voice and pointing. Which is precisely why the charge didn't stand up for her. Because of her unprofessional behavior. It does matter who was right or wrong. Because of her unprofessional behavior, the OP was wrong. The doctor may also have been wrong, but he didn't ask for our advice.