Still, every nurse has a story about obnoxious doctors. A few say they have ducked scalpels thrown across the operating room by angry surgeons. More frequently, though, they are belittled, insulted or yelled at ”” often in front of patients and other staff members ”” and made to feel like the bottom of the food chain. A third of the nurses in Dr. Rosenstein’s study were aware of a nurse who had left a hospital because of a disruptive physician.
“The job is tough enough without having to prepare yourself psychologically for a call that you know could very well become abusive,” said Diana J. Mason, editor in chief of The American Journal of Nursing.
Laura Sweet, deputy chief of enforcement at the Medical Board of California, described the case of a resident at a University of California hospital who noticed a problem with a fetal monitoring strip on a woman in labor, but didn’t call anyone.
“He was afraid to contact the attending physician, who was notorious for yelling and ridiculing the residents,” Ms. Sweet said. The baby died.
The hospital I work at has instituted a “code white” that any nurse can call in the OR. A code white means that any available nurses come to the OR room where the code was called and just stand there. It is called when a surgeon becomes agitated and verbally abusive. The presence of other bystanders is, in theory meant to stop the abuse without confrontation. It just seems crazy to me that this kind of thing would go on in any work environment, let alone with care providers.
RE: “It just seems crazy to me that this kind of thing would go on in any work environment, let alone with care providers.”
I agree. I don’t think the problem is limited to the healthcare environment. I’ve worked in two abusive environments — one with a boss who was an absolute freak, and one with a peer who was appalling to her workers and to others as well [including people who reported to me]. She screamed the “f” word and multiple other vicious public attacks that left people terrified and shocked.
HR did nothing that I could see. By the time this woman was demoted — it took about 7-10 years — the company had lost many many employees, whom I know wrote personal letters to HR pointing the finger at her for their departure.
In fact, the thing that I can’t figure out for the life of me is why these people get to stay in these systems when there are clear and manifest and direct consequences for their behavior.
The best I’ve been able to come up with is somewhat disheartening. Companies basically believe all people are replaceable cogs. So the departure of some 12-14 people with letters explaining why they were leaving was greeted with a shrug and yawn. They were “easily replaceable” and therefore it was not worth going to the pain of getting rid of the problem.
Others may have more direct and applicable examples concerning doctors and hospitals.
On a side note — I think that people are more able to deal with arrogant yet highly competent people, if they are not abusive. The system can compensate or “flex” enough for people who are good and flaunt it [although it is embarrassing and unseemly behavior].
But sometimes, arrogance and abusiveness go along with *incompetence* and the two characteristics are then a Bad Sign.
I have yelled at a nurse just once, as an intern. I came in at 5 AM to round in the ICU. The patient was post op day one after a major liver resection. That involves a large subcostal incision. He was on the vent. Usually we keep the patients on the ventilators pretty snowed with sedation. It is uncomfortable for the machine to breath for you, doubly or triply so if you have a huge abdominal incision. This patient was wide awake with heart rate and blood pressure way up. I asked the obvious, “Mr. Smith are you hurting.” He answered with rapid fire, blink, blink, blink, head nods, etc. I looked at the chart and no vitals had been recorded for over three hours. (ICU patients get hourly vitals.) Well, I let the nurse have it. She stated, “how dare you accuse me of not adequately treating my patient’s pain!” She also quickly filled in the missing vitals by looking at the monitor’s vitals in memory. I went off on to finish my rounds. A couple of days later, I found out that the nurse had filed a complaint against me. If I turned around and filed a counterclaim, it would have appeared that I was being vindictive. She knew how to play the system.
Even though I was “in the right”, I learned a lesson. The proper thing to do is to just calmly go to the supervisor. Tantrums, even if justified, don’t help patient care.
People now know me as a Christian physician. I am an ambassador of Christ in the stressful world of medicine. I hold myself to a high ideal. I have heard staff talk about other Christian physicians who don’t control their temper and it is not good.
I have worked as an RN for over 20 years in various fields of nursing, from the big teaching institutions to the local hospital, to home care. I have worked with Critical care docs, Emergency Room docs, Internists, Family Practice docs, Specialists of all sorts. There are kind docs of all sorts out there. Then there are the ones as described in the article. I have never encountered one as severe as to instill fear to the point of allowing a patient death, but they are out there. They love to intimidate, belittle and bully anyone and everyone in their path. Even their fellow physicians will not confront or take them before the disciplinary boards that are available. Many of those docs that I have experienced, in my opinion, are not even fit to be carrying a license. It is a dangerous problem in many areas of our country. In many institutions, doctors are placed on a God-like pedestal by both staff, the hospital itself and the patient they care for. I turned down a position in a hospital because it sounded as if you couldn’t challenge the physicians or give input into patient care. There needs to be a system to keep these kind of people in check. It is embarrassing and looks bad for the institution in question. IT does no good for the patient being treated and puts one more nail in the coffin of the health care system as we know it.
I, too, have been the nurse in those situations. But the idea that the cause is “the brutal training surgeons get, the long hours, being belittled and ‘pimped’ ” is ludicrous. Doctors do have long years of training but they are still supposed to act like medical professionals, NOT exploiters. Some doctors treat nurses like “handmaidens.” Nurses are also medical professionals who have had intense years of education. They are also taught to be professional.
On the other hand, there are some settings that tend to foster that professional approach–and others that tend to hinder it. Medical centers where doctors and nurses are encouraged to work as a team–with other health care providers (respiratory techs, physical therapists) AND the patient–are usually collegial settings where all are working toward a common goal: patient health. Medical centers that are set up as authoritarian with doctors ranking higher than God are not good for nurses OR patients.
As one going in for joint replacement surgery next Monday, I want doctors AND nurses who care for one another and respect ALL on the health care team–including the patient (ME!)
Boards of Medicine (the states authorities which license – or revoke the licenses of – physicians) around the country are trying to develop policies regarding disruptive physicians. Most hospitals have those policies, as well. However, having been on a Board of Medicine and having served as President of our local medical staff, I’ll tell you the line between appropriately irritated and abusive is fuzzy – because it is so affected by the perception of the recipient. I’ve witnessed a nurse accuse a colleague of ‘yelling’ at her – having been present during the event, he did not raise his voice, he did not make any personal accusations or insults, he simply evinced a frown and a tone of voice which made it clear the event which had occurred was unacceptable and would not happen again (it related to what a patient had been told). As to one of the things mentioned in the article, I cannot imagine a place in the U.S. where surgeons throwing anything, let alone sharp objects, would be tolerated these days, though it certainly was ten to fifteen years ago.
Having recently had a baby during which (and it was the same for our first) the fetal monitor was critical, I shuddered to read that line. To have a baby die for want of such a simple adjustment – how awful.
While throwing tantrums is always wrong, personally I am sick and tired of the continuous media efforts to demonize physicians.
Lets try “Arrogant, abusive, disruptive and in the middle of a war zone”.
Surgeons (usually the worst offenders) are dealing with critically ill patients in a life and death situation, and most hospitals have downsized nursing and ancilliaries such that often the only person who has a clue is the doctor.
Few surgeries have a anesthesiologist, most have nurse anesthetists who are NOT nearly as capable. Thus, the surgeon is keeping an eye on fluids and vitals while trying to clamp the aorta. (This never happened before anesthesiologists were priced out of the market by the cheaper (i.e. no medical school debt nurse).
Scrub nurses are rarely the more competant RNs and are now more often LPNs or even “med techs”. The surgeons ask for one kind of device, and get another desined to sever whatever delicate tissue he is trying to navigate. (Who is going to be sued when the surgeon who has asked for a forceps gets a scalpel and finds that the nerve he was trying to tease apart is about to be severed? The idiot nurse who often doesn’t even speak English fluently? No. It will be the surgeon. He’s the doctor. He gets to take responsibility for everything, whether or not it is under his control.
Frankly, the only people who still give a damn in US medicine are the physicians, and that will not last forever. Then the hospitals will be filled with very nice people who will politely tell you that your case is hopeless or at least beyond their competance, and that they suggest you go three thousand miles away to a “specialty center” like Mayo.
“Then the hospitals will be filled with very nice people who will politely tell you that your case is hopeless or at least beyond their competance, and that they suggest you go three thousand miles away to a “specialty center†like Mayo”
When it does, (and it has already happened for most pediatric specialties, and is beginning to happen for the elderly) the pity of it is that the US will not even know what she has lost in her continuous attacks on physicians, but will assume that they are now getting “improved” care, since the numbers measured (which are the numbers measurable) like “did your doctor tell you to stop smoking” or “did your doctor offer you a flu shot” will have “improved”.
But improved or not, the US will be getting, precisely what she deserves.
Personally I think this is greatly exaggerated. Of the numerous times I have been in a hospital, all the personnel from custodians to physicians have been polite, gracious and cheerful. This is written by another mass medial writer who has to sell something. Good news doesn’t sell. There’s a saying in the newspaper world, “If it bleeds. it reads.” That is why we have such trashy television and news, with trollops like Britney Spears and Paris Hilton all over the place. St. Paul warned us that in these days that people would be proud of what they should be ashamed of. And finally, any abusive person in the workplace needs to be dealt with, firmly and quickly by his or her management.
As a chronically ill person with a systemic disease, I’ve encountered countless doctors in a number of specialties and have to say that quite a few did belittle nurses in my presence. I thought that was incredibly tacky and even spoke up once to tell the doctor so, particularly since the nurse was trying her best and it appeared that his orders weren’t complete or explicit. Sorry, but when I’m ill I don’t appreciate temper tantrums and hissy fits going on at my bedside. If the doctor doesn’t have the class to refrain from that behavior, I’m going to call him on it. If they’ve had a traumatic, long day then it’s time for them to go home, not take it out on everyone around them.
Oh don’t worry. Everybody “calls” doctors on it”. However physicians (unlike nurses) don’t have the option of going home and having a nice nap when they have had a traumatic long day. We leave when our jobs are done. We aren’t paid by the hour, and if we are needed on a nightly basis, we come in in the middle of the night. To do otherwise is to “abandon” the patient. (Fifty thousand dollar fine, it really doesn’t matter how tired you are, or how much sleep you have had in the past three nights). I know two surgeons who died in car accidents caused by sleep deprivation after being on call several nights in a row. I crashed my car once after 48 hours in the hospital myself. Fortunately nobody was hurt. We don’t have the option of going home and taking a nap. There is no body to take our place if we are napping.
One can, of course simply refuse to see chronically ill patients or to see folks in hospitals. Many physicians I know now have “concierge practices” which do not accept government insurance. Others refuse to belong to a hospital. This allows the physician to have more time with their patients (and to get more sleep). Others simply tell chronically ill patients with systemic diseases (especially those who make a habit of lecturing their physicians in the middle of the night) that they have 3 months to find another physician. In Missouri it is one month.
Finally there is the usual mechanism of dealing with complex chronically ill patients who think that being sick gives them the right to perfect, pleasant, and unlimited care at unlimited expense at all hours of the night and day, regardless of how many other sick patients the doctor has waiting. This mechanim involves saying “Gosh, I’m so sorry. You are just way too complex for poor little old me. You will need to go to the (name prestigious hospital in another state 1000 miles away) for care. I’m just too stupid to take care of you. Bye.”
This is why I find so many complex, difficult patients at my door who tell me with an air of surprise that “no doctor will see me. They say I’m too complex, and they can’t help me.
[comment deleted — too personal towards another commenter. Please cool it down folks]
Physicians are the ones held responsible. If a nurse is done with her shift she goes home. It doesn’t matter that the patient is critically ill. She signs out and goes home. It’s the doctors problem. He doesn’t get to sign out. It doesn’t matter that he has been up all night, for the past several nights. If a nurse is unable to deal with a patient or a patient’s family, she calls the doctor to deal with them.
“Dr. X, I’m sorry to wake you up in the middle of the night, but Mr. Teatime is really anxious about the procedure he is going to have tomorrow. He really wants you to come back in and explain again what you have explained already to him three times in a row. I told him that you were probably sleeping and could explain it to him in the morning, but he says that he can’t believe you wouldn’t come in for something as important as patient communication.”
If the hospital is full and there are too many patients for a nurse to deal with, the administrator calls the doctor to discharge less sick patients (meaning the doctor is then responsible not only for the discharge, but for coordinating care, and running back and forth from the office seeing a patient who would have frankly been better for another day or two in the hospital, but who is less sick than the folks in the ER.
When somebody other than doctors take responsibility for patients, and will not punt the patient to the physicians, no matter how tired they are, and no matter whether or not they are being paid for sticking around long after their shift was ended, and no matter the snippiness of folks like Teatime who thinks that a hospital is a hotel where he gets service with a smile, then I will say that that somebody other than physicians also gives a damn.
Right now, I see physicians who give a damn, and a bunch of shift workers, most of whom do a very nice job while on shift. I also see a lot of decent folks who need care who wouldn’t get it if I left, and a bunch of snippy assh^%s like Teatime who make me wonder why I don’t leave also.
Right now the only folks who keep the ball are the physicians. And they too (especially the younger ones) are realizing that it makes good sense to punt elsewhere also.
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[i]Clueless, we know this affects you personally, but please take a break. You’re overwhelming this thread. — the elves[/i]
I apologize to Teatime, and I will take myself off.
Yes, doctors as well as everyone else should not explode or act and a**. There are rules against that and the accreditation standards don’t allow it. However, let’s face it, the system is overloaded. The government and the lawyers have set the standard as perfection but these are unfunded mandates. Nurses as a profession have divorced the physicians in an effort to be independent and not “the handmaiden” of those oafish doctors. There are many wonderful, competant and lovely nurses that I deal with daily and we couldn’t get along without them, but it only takes one, incompetant or worse, one who doesn’g give a d*** to kill a patient or set a burned out doctor off. We really have no control over the quality of care from nurses and some just resort to sarcasm, irritability, shouting, or worse. Now that isn’t profitable and is unprofessional, but many doctors are at the end of their rope. This year I quit admitting to the hospital and life got mearsurably better. I got tired, not of writting orders, but writting incident reports that never were answered. If I didn’t love medicine so much and my patients and staff, I would have retired and then there would be no board certified geritician in a 100 mile radius. Some doctors are jerks, but they would have been so in any profession. They should not be tolerated. Most are on salary and not dependant on the free market to make a living. But it will get better. Once we are all working for the government, then we will work like government workers. Enjoy
All I can say regarding Dr. Clueless’ comments is that I think they prove the point the article was trying to make — with demeaning statements toward patients and calling nurses (many with Bachelors and Masters degrees) “shift-workers” who can go home and take a nap when they get tired of work.
And please allow me to rephrase what I stated earlier — Dr. Clueless is severely mistaken if he believes that physicians are the only ones how give a damn. I know this personally as my wife is a RN (BSN) who has stayed many extra hours at the hospital to help with the care of critically ill patients.
Actually, I think I have finally made up my mind. I too will become one of those highly degreed “shift workers” who get to go home. I have a job lined up which will not require call or weekends and I have finally decided to accept it. And you’re right Steve – us shift workers do give a damn. I look forward to putting a few extra, unpaid hours in, and feeling good about myself, rather than taking complete responsibility for my patients and worrying nonstop about them.
It was probably arrogance to believe that I could not be replaced. My patients will replace me with a physician 2 hours north. Except for the ones on Medicaid who presumably Obama will take care of. Maybe I’ll work some at the free clinic. Everybody can be replaced, it is arrogance to think otherwise.
And we know that arrogance is a sin. We don’t need arrogant doctors. We prefer humble ones.
If this is humility it actually is feeling pretty good. It is a real relief to make a decision. I will enjoy being a shift worker. My children will enjoy having their mother back, and I will enjoy spending time with them. Doubtless US health care will enjoy having fewer arrogant docs around also.
It’s cool. Good talking to all of you.
It was probably arrogance on my part to believe that I could not be replaced. Everybody can be replaced.
OK, so Dr. Clueless thinks that it’s perfectly fine for a doctor to dress down a nurse at a patient’s bedside? And that the patient should just shut up and accept it? In other professions, that would get one written up or sent for “anger management” therapy but we’re just supposed to excuse it because they’re, drum roll, doctors?! Yep, this is a good illustration of the problem the article addresses.
[i]We’ve already posted warnings on this thread for getting too personal towards other commenters. But it’s not helped much. We’re going to have to close this thread soon if it doesn’t shape up. Last warning.[/i]
At the risk of wading into a dogfight, I’ll throw my two bits in as a practicing MD. Yes, I’ve been on the receiving end of “abusive” physicians (while in training), mostly surgeons, and have seen the occasional doc who has either poor anger management skills, or an overweening sense of importance, or both. I’ve also “called” other docs on such behaviors when I felt it was impairing the work of the OR team (I’m an anesthesiologist). In an ideal world, all MDs would be fully-rested, graceful under pressure, empathetic, and abounding in humility.
That said, the vast majority of MDs I’ve had the pleasure of working with have been anything but the rogues portrayed in this piece. As another commenter noted, it’s almost becoming routine IMO for the media to trash MDs and the medical profession. And, medicine, particularly surgery, obstetrics, critical care, and the more “interventional” specialties can be high-pressure and high-stress. Spend some time in a cardiac operating room, or a Trauma unit, or a busy ICU, and try walking a few miles in the shoes of the doc who’s a bit sleep-deprived and working his or her butt off to keep your spouse, parent, or child from dying. Now add to that the stress of another member of the team who may not be performing at the level they should be–yes, most RNs, surgical techs, respiratory techs that I work with are great, but, like ANY field, there are a small percentage that don’t give it 100%, and may or may not care.
With all respect to Teatime, there ARE occasions when either the surgeon or I have had to raise our voice, and correct what we perceived to be unacceptable behavior on a staff member’s part–rare, but when you have a patient bleeding out, or otherwise not doing well, the niceties just have to wait. And, I’ve had staff member try to cajole me to write an order to cover a bone-headed action on their part that adversely affected a patient–so sorry, I may be known as a “nice doctor,” but no thank you. And, I’ve also seen RNs who were more than willing to file incident reports for ANY perceived wrongdoing, however trivial, by a doctor who was not on their “favored” list.
Every hospital that I’ve trained in or practiced at has mechanisms to deal with abusive, disruptive MDs, up to and including suspension of privileges, and at least in my neck of the woods, they work pretty well. But I’d also echo what Country Doc said–the health care system is getting pushed to the limits, and it should not shock anyone if less-than-perfect humans in that system respond to the strains as some do. Some days I wonder why more don’t.
I’ve been a devoted follower of T19 for several years now, but reading this article – and especially some of the comments from the physicians – has finally prompted me to register.
I started out as a surgical tech – the very bottom rung of the OR food chain – 20+ years ago and have worked in every conceivable type of hospital, from lage university medical centers to rural “critical access” facilities. I have also worked with every conceivable type of surgeon -from the arrogant sycophants to the genuinely decent. Regardless of where any particular surgeon may fall within the continuum of “personality types,” I maintain a healthy respect for ANYONE who has the “stones” to operate on or assume responsibility for directing the medical care of another human being. Having said that, however, I must take exception with many of the observations posted by Dr. Clueless. I am currently the director of surgical services with oversight of a busy medium-sized OR and 75 staff members. One thing I have learned over the years, as I’ve risen through the ranks, is that no one flies solo in the operating room. Even the best of surgeons performing the most minor of procedures needs an RN (CMS regulation) and a “scrub” (nurse or tech) – not to mention all the people behind the scenes, from sterile processing to environmental services to whomever is responsible for ordering all the special doodads the surgeon has listed on his/her preference cards. And all it takes is for one person to not do his/her job correctly for the whole works to get screwed up. Likewise, surgeons are not the only ones who must be on-call for emergencies – there is a whole team of people who also get that call/page at 0230 in the morning and must come in, irrespective of the consecutive number of hours they’ve already worked…and do so without a reasonable expectation of leaving early the next day (much less being off post-call). I don’t know a single nurse or tech who does NOT routinely make personal sacrifices for his/her job: missed holidays with family; coming in to work with a 101 degree fever because of short staffing; staying well past his/her shift to help Dr. Clueless finish his over-booked operative schedule; spending weekends tethered to the pager and staying within 30 minutes of the hospital because he/she is on-call (for which they earn a whopping $2/hr). Finally, contrary to the impression left by Dr. Clueless, nurses don’t turn into pumpkins at the end of their shift and just leave: like Dr. Clueless, we have a license which would be revoked for abandonment of the patient – and like Dr. Clueless, we can (and are) sued for malpractice.
Pax Christe
I especially appreciate the last two responses. I believe that some of the strident comments and sparring are due to burn out. I would especially advise Dr. Cluless to close down for one month, go off to a safe, quiet place without pager, cell phone, laptop and just kick back and have some fun, study in detail Ecclesiastes, and get lots of sleep. In fact maybe get a good medical evaluation and even a sleep study. After this come back and re-evaluate the practice situation. We are all fallen and finite. We can’t do it all, and if we burn out or succomb to battle fatigue, then no one has our services. Work that is too difficullt, not worth the pay, not appreciated, or too riskey needs to be droped. Medicine is a hugh field and there are many great opportunities to go into, maybe narrow your speciality, teach, locum tenums, on and on. Maybe get a good outsider to look at it for you. Also, go to the Christian Mediical Dental Association website and look in their bookstore and get “Margins” and some of the other burnout resources there. Even Jesus “came apart” and went off and took a vacation from healing and preaching, and he was infinite. God does not expect us to do more than He provides the resources to do. The Lord bless you all. We need to stick together and pray for one another. Think how hard it is for the doctors and nurses who don’t have the Lord or fellow Christians to help. I’ve profited from this from all.
Amen, Country Doc. Jesus is the best example. He did not do everything, rush around or get in a hurry. He often went off by himself to pray. How about Lazarus? I know Jesus had a plan, but he took four days to get a few miles. Read Ann Rice’s latest, Christ The Lord, The Road to Cana.
[i] Comment directed to a specific commenter deleted by elf. [/i]
I’d just like to express my thanks to the many caring, compassionate, dedicated and highly skilled professionals in the health field. Years ago, when my father had open heart surgery, we only saw his surgeon (Dr. Pacifico, UAB, some of you may know him) twice – we know he did a wonderful job in surgery and his bedside manner was also excellent as he made sure my father, and the rest of us, understood what he would be doing and what his expectations were. When there were complications in recovery, he came back to talk with us again. A doctor on his staff was with us once a day almost every day and very patient and helpful in answering questions and addressing concerns. The nurses were with us day in and day out, making sure my father received all the medications in a timely matter, changing out IVs, etc., etc. – they also were constant sources of information and reassurance as well and we relied on them. When my father died, two years later, we received so much compassionate care – I will never, ever forget the ICU nurses who watched with us day after day, who encouraged us, lifted us up, as they cared for my father and, most of all, how they reached out to us at the time of his death. That must be one of the hardest things a nurse or physician has to deal with. As soon as she heard that my father had died, his heart doctor came to us and she, too, showed a compassionate care that made a deep impression on me. There are “rotten eggs” in any field, there are people who have troubles in their work and/or troubles in their private lives, people who are stressed out – whatever. Over the years, we’ve had a few instances of arrogant doctors and incompetent nurses – but they work in a field where any mistake at all is unacceptable and I know the challenges are enormous. To all of you in health care who have posted on this thread – thank you for your lifesaving work and compassionate hearts.