Yelling Doctors, How do you handle them?????

eriksoln, BSN, RN · Mar 8, 2009

Hmmm. An additional 3 years in jail? So he was in jail already? I'm sure there is more to this story. I'm sure he did more than yell to get another 3 years in the slammer.

No, he was 3 months removed from jail. Was in for stabbing someone over...........I dont even know anymore. Was on parole. So when the arguement with the bus driver got heated and he got loud........the driver refused to let him on the bus anymore........reported it to his supervisors and a police report was made. Police went to his house to get his side of it, he admitted yelling at the driver, and the parole officer decided it was in violation of the behavioral standards. I'm sure the police knew this was going to be the end result. I couldnt understand how they knew it was him from a description by the driver to the point where they went right to his house. But, then he got on his high horse and was all "Yeah, I did it. He needed yelled at" and stuff and away he went.

UM Review RN, ASN, RN · Mar 8, 2009

Don't do it too often, but off the top of my head:
1) Patient acutely decompensating, I asked for critical piece of equipment (pericardiocentesis needle, ET tube, etc) that is not in the room. The quality nurses and techs are busting their behinds to get done what needs to be done and can hardly drop it to run to the supply room. The 5 "lookie-loos" standing by the door just stand there staring and chatting.
2) Fellow physician begins performing OR procedure . . . incorrectly
3) Intern/medical student makes potentially dangerous error (I've been on both the giving and receiving end of this one)
or, my favorite
4) Walk on to a neuro ward one night, and CNA is announcing in a loud voice at nurses station that he is "sick and tired of cleaning up these old people's " and that he wishes "someone would just take them out back and shoot them like dogs".
The first 3 are patient safety issues requiring strong and rapid intervention. The last one was just cathartic.

Cool. We're sharing. Let me tell you the top three I got yelled at for:

1. Called 8:30 pm to clarify Med Rec form med. It was a pain med, it was scheduled per the patient, and the patient was VERY upset that the admitting doc hadn't Ok'd it. This was noted by the ER nurse. I call the doc -- not only does he yell at me, but then he demands to be transferred to the charge nurse so he can scream at her. "Orders" me to write incident report ON THE ORDER SHEET before he's transferred.

2. Rec'd patient from ER. Orders: Pt to go to OR stat. ID called the dx to me and gave orders and I started running. Literally. I started Vanco first. Surgeon came in and asked me to run the Clindamycin first, so I took the Vanco down and started the Clindamycin. Transporter comes for the patient, asks if he can take the Vanco off the pole because it's "not connected", I say no about 3 times, but I cannot go observe or help because I'm on the phone with ID again. Transporter takes off with Pt. I get a call from the surgeon down in OR, screaming from the middle of the room (I could tell he had me on speaker) --- WHY DID YOU TAKE DOWN THE VANCO?? :banghead:

3. Picture it: so hellishly busy when I come on shift, I have to slide through a crowd of people in the hallway. I'm trying to get report, the day shift nurse is new, the techs are trying to get vitals. Monitor tech calls and says a patient's in AFib RVR @ 140. I ask how long, he says "since he got here, tx from ICU at 2 pm". Great. I go into the room, patient appears fine. I try to take a BP, can't. The manual cuff in the room has a hole in the tubing. Go out to find BP cuff, see a tech writing in chart, ask, did you get a BP on this patient, tech says yes. I look. She did not write BP. I go to get a cuff. Can't find one. Day shift nurse insists she'll get it. I say OK, and call the doc. But she got sidetracked and never got the BP. Guess who got yelled at. :banghead:

Summary: In all three of these examples, I was doing my job--taking the best care of the patient that I knew how. Please show me how yelling at me got anything done better for the patient. In fact, I still get upset when I think of those examples. It upsets me to think that each of those docs yelled at me because they did not trust me to do my job and they did not respect me enough to ask me about the situation before jumping to conclusions.

UM Review RN, ASN, RN · Mar 8, 2009

PS With your last example, you'd have gotten much better results for the patients if you'd simply written the incident up and given it to the manager. That person didn't need to get yelled at, he needed to be fired.

hypocaffeinemia, BSN, RN · Mar 8, 2009

I wonder how many of us decrying yelling routinely use passive-aggressive behavior when they are upset at someone.

I ask, because I've experienced or witnessed this far more often (usually from nursing), and quite frankly I'd take being yelled at any day over it.

Neither is particularly professional, but at least one mode doesn't beat around the bush.

BabyLady, BSN, RN · Mar 8, 2009

The other night at work (I work 7PM shift), I admitted a new patient. She was seen at her doctors office a couple days before and was started on PO antibiotics TID. She did not take her antibiotic all day. At my hospital we are to clarify meds upon admission and she could not remember the dose perscribed. So I had to page her doctor, which has a reputation of being mean at 11PM (not that late). He interrupted my question by yelling/screaming at me, asking me how he would know the dose (he prescribed it), demanding I answer why it couldn't wait till morning while huffing and puffing on the phone!!! I know if I didn't address it, the charge nurse or someone would of had my neck due to policy...Can't win!!
I've only been a nurse for 8 months and I haven't had much experience with this.
My question is... How do you respond to a doctor who talks to you this way- I mean screams at you this way?

I have to agree with the physician...they see hundreds of patients and it wouldn't be safe for him to guess, nor should he be expected to keep in working memory what he has done for all of his patients.

In fact, it would be UNSAFE for him to guess.

A better alternative would be to ask the patient where she got her prescriptions filled and hope it's a 24-hour pharmacy...call and ask what she was prescribed. Also, see if a family member can go to her house and bring all of her meds.

One thing they press very much in my hospital, is for patients that come to the hospital frequently, to use the same pharmacy, and every time they get their prescription changed, to get the pharmacy to print off a med list...and keep it in their wallet, purse, just like they do their driver's license and insurance card.

UM Review RN, ASN, RN · Mar 8, 2009

I wonder how many of us decrying yelling routinely use passive-aggressive behavior when they are upset at someone.
I ask, because I've experienced or witnessed this far more often (usually from nursing), and quite frankly I'd taken being yelled at any day over it.
Neither is particularly professional, but at least one mode doesn't beat around the bush.

I think nurses use passive-aggressive behavior because of the professional enculturation that we all are subject to. There are certain things we may do, and certain things we may not. I may suggest, "Doctor, would you like to order an Xray, lasix, and a BNP for that patient whose sats are dropping and who has rhonchi so loud I can hear him gasping with respirations of 44?" but I may not say, "Gee doc, this fella's in CHF. We need a stat CXR, IV lasix, a BNP, and a move to ICU." One's out of my scope, the other is not, even though I have come to the same conclusion the exact same way.

So we're set up to be passive-aggressive right from nursing school. JMO.

morte, LPN, LVN · Mar 8, 2009

I think nurses use passive-aggressive behavior because of the professional enculturation that we all are subject to. There are certain things we may do, and certain things we may not. I may suggest, "Doctor, would you like to order an Xray, lasix, and a BNP for that patient whose sats are dropping and who has rhonchi so loud I can hear him gasping with respirations of 44?" but I may not say, "Gee doc, this fella's in CHF. We need a stat CXR, IV lasix, a BNP, and a move to ICU." One's out of my scope, the other is not, even though I have come to the same conclusion the exact same way.
So we're set up to be passive-aggressive right from nursing school. JMO.

yup! and inculturation, of being the "nice" girl, doesnt help

sbic56, BSN, RN · Mar 8, 2009

We need to remember that we are ALL human and we all have our bad moments. Please don't tell me that none of the people on this site haven't yelled at someone about something. It's not just about docs, it's about everyone. I've yelled myself. Like TiredMD's example of the lookie-loos that hang around the doorway while watching people bust their rear with a patient. I've yelled at them "You gonna stand there and watch or are you gonna help? IF not, get out." It probably wasn't nice or appropriate but I don't think it's nice or appropriate to watch people bust their humps and not offer to help.

Of course I've yelled at people when frustrated, but in retrospect I know it was not an effective way to communicate. It was a mistake in judgement during a time of my own stress.

SharonH, RN · Mar 8, 2009

People need to stop making confrontational posts. This thread will be closed if they continue. There is NO NEED to attack TiredMD for his views/opinions.

With all due respect, TiredMD is being provocative. So let's make two suggestions: 1) People need to stop making deliberately provocative posts and 2) People shouldn't respond confrontationally.

SharonH, RN · Mar 8, 2009

We need to remember that we are ALL human and we all have our bad moments. Please don't tell me that none of the people on this site haven't yelled at someone about something.

I have never yelled at a co-worker. EVER.

leslie :-D · Mar 8, 2009

Don't do it too often, but off the top of my head:
1) Patient acutely decompensating, I asked for critical piece of equipment (pericardiocentesis needle, ET tube, etc) that is not in the room. The quality nurses and techs are busting their behinds to get done what needs to be done and can hardly drop it to run to the supply room. The 5 "lookie-loos" standing by the door just stand there staring and chatting.
2) Fellow physician begins performing OR procedure . . . incorrectly
3) Intern/medical student makes potentially dangerous error (I've been on both the giving and receiving end of this one)
or, my favorite
4) Walk on to a neuro ward one night, and CNA is announcing in a loud voice at nurses station that he is "sick and tired of cleaning up these old people's " and that he wishes "someone would just take them out back and shoot them like dogs".
The first 3 are patient safety issues requiring strong and rapid intervention. The last one was just cathartic.

first 3 examples, 'almost' justify yelling...

or at least, justify being angry.

these adrenaline-generated scenarios, only serve to abrade the response.

the last example, while infuriating, does not warrant being yelled at.

there are ways to call someone an idiot, professionally.:)

I wonder how many of us decrying yelling routinely use passive-aggressive behavior when they are upset at someone.
I ask, because I've experienced or witnessed this far more often (usually from nursing), and quite frankly I'd take being yelled at any day over it.
Neither is particularly professional, but at least one mode doesn't beat around the bush.

i'm with you, hypo.

passive-aggressive just sends me over the edge.

much rather someone deal directly with me.

if they yelled, i then could deal directly with them.

as for the overall 'brainchild' of yelling, it is totally ineffective if used as a means of intimidation.

communication is efficacious when the speaker is in control of themself.

yelling connotes a lack of control.

however, if yelling is a sequelae of being upset, and not used as a means of bullying, then i too, have been guilty of raising my voice.

the difference being, i do not 'strategically' yell.

it is spontaneous and always regretted.

and is seldom done.

fwiw, i'm not finding tiredmd's posts provocative.

he's being truthful and forthright.

as with all other posters, we always have the choice to take it or leave it.

leslie

Vito Andolini · Mar 8, 2009

Whoa, don't think I'm equating yelling with threatening. Threatening is clearly out of order and obviously criminal.

Women probably find being yelled at more frightening than men do. However, men who are just trying to do their jobs are still not going to like a dressing down.

BTW, it is ok to apologize to someone you've yelled at. Just say, "You know, I'm really sorry I yelled at you. I'm just so exhausted most of the time and I really have a hard time being coherent and pulling my head together when I get calls while I'm sleeping. But that was still not an excuse to yell at you. I'm really sorry. Please accept my apology?"

You'll have made a friend for life.