Why do physicians behave badly? Maybe because they’re scared.

Why do physicians behave badly? Maybe because theyre scared.

A dozen set of eyes stared upwards.  The nurses ate their pizza and glanced back and forth between me and the dry erase board that I had recently filled with incomprehensible scrawl.  I had given this lecture many times and said the words over and over again.  And yet the response was always surprising.

“Why do you think physicians get angry and annoyed when you call?”

A simple question.  Every day clinicians yell at nurses.  They bully, they prod, they rush off the phone before fully answering questions.  I have done it many times myself.  The phenomena is so common that most nurses and secretaries accept it as part of the job.  That doesn’t mean that it doesn’t hurt.  It doesn’t mean that they won’t cower the next time they have to call that physician again.

I waited patiently for the audience to venture a guess.  In all the times I have asked this very same question, I have never had any one volunteer an answer.  And this befuddles me.  Because most physicians go into the profession to help others.   Most truly want to be there for those in need.  So why when the cards are on the table, when a nurse or patient calls in crisis, is the response so negative?

I threw out a few possible answers myself: “They’re tired, had a bad day, didn’t get enough sleep last night?”

I few half-hearted nods from the crowd.  All possible explanations, but I could tell that no one was really buying it.  Slices of pizza were now frozen halfway between plates and mouths as the audience waited attentively.

“Maybe because they are afraid?  Don’t know what to do?”

A look of astonishment and then understanding flashed across a dozen faces.  It was like a weight was lifted off their overburdened shoulders.  Faced with difficult and life changing decisions, physicians often react with anger and annoyance due to frustration.  It rarely has anything to do with the nurses themselves.

This reaction is neither professional or acceptable.  And I try to modify my own behavior accordingly.  Some days I am more successful than others.

But at least today, a good day, a handful of caring people left the lecture room with full bellies and a sense of well deserved vindication.

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.

Image credit: Shutterstock.com

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  • guest

    This is very on-target, but get ready for a chorus of responses expressing the opinion that doctors have no right to have feelings such as fear or anxiety, etc, etc.

    • Lisa

      I am just glad the OP stated that such behavior is neither professional or acceptable It is one thing for doctors to have such feelings; it is another thing for them to behave badly because of those feelings.

      • guest

        I rest my case…

        • Lisa

          I didn’t say that doctors shouldn’t have feelings such as fear or anxiety. I implied that such feelings shouldn’t be used as an excuse for behaving badly.

    • Patient Kit

      They should read Dr. Danielle Ofri’s book titled “What Doctors Feel–How Emotions Affect the Practice of Medicine,” Twas a good read. I’m one patient who, not only accepts that my docs are human, but I want them to be human.

      • guest

        Thanks! Some of us find it a little disturbing that there seems to be a growing expectation that we behave robotically. I myself don’t feel comfortable seeing a doctor who projects an overly “professional” demeanor. I find that frequently they are using so much energy to produce the appearance of professionalism that critical thinking goes out the window and I feel like I just get very preprogrammed responses/recommendations for my medical problems.

        • Patient Kit

          I’ll take a warm imperfect human over a cold robotic human, always, including my docs. If either doctor or patient has a bad day or bad moment and their emotions get the best of them — (radical suggestion coming…..) — we can always apologize for our “bad” behavior. That, to me, would be a sign of strength, not weakness. In this world, I think it has to be a priority for all of us to hang on to our humanity and our humanness, no matter what. Docs included.

          • Lisa

            I think the idea we can always apologize for our ‘bad’ behavior gives license to people to behave badly. Bad behavior causes harm; I know from first hand experience. I think admitting feelings and emotions is good, but using them to excuse unprofessional behavior is just wrong.

          • guest

            I think unless you have a job in which you are asked, on a regular basis, to make life and death decisions, frequently in the middle of the night after having been awakened from sleep, you don’t have an ability to make judgments about what’s reasonable to expect in terms of behavior.

            Certainly it’s unacceptable for doctors to verbally abuse others. But the concept of “professional behavior” is increasingly defined as projecting a cordial, unruffled demeanor under any and all circumstances, which is simply not a realistic expectation to have. A doctor who maintains a professional conversation with a nurse, but has a slightly edgy tone after being asked a redundant question, is these days at risk for being labeled “disruptive.”

            It’s a slippery slope, which appears not to take into consideration the fact that doctors are human beings, working under tremendous pressure.

          • Lisa

            When I think of bad behavior, I think of verbal abuse, not of projecting an unruffled demanor, no matter what.

            I’ve worked with several people who yell at their subordinates. It is just awful to be the target of such behavior and it doesn’t help the work get done. But I’ve also worked with people who express their irritation, their frustrations, or that they didn’t have an answer. While they weren’t always unruffled or calm, they weren’t difficult to work with.

            I don’t know what the answer is, but the idea that you can just appologize for yelling at a co-worker or subordinate is seems wrong to me.

          • guest

            My experience as a physician has been that, although I have never in my life raised my voice to a co-worker, let alone said anything abusive, the occasions on which I have betrayed any annoyance or irritation through my tone frequently result in my receiving “feedback” about the fact that I showed that I was frustrated by something going wrong.

            The standard of behavior to which physicians are held is already quite high, and it concerns me to see even higher expectations being written into official policies regulating “professional behavior” at healthcare facilities and organizations.

          • Ladyimacbeth

            They are way too fragile if they get upset over you being annoyed or frustrated. I’m not sure what kind of work utopia they are looking for.

          • Lisa

            Tone is so subjective that you open a Pandora’s box which shouldn’t be opened when that is taken into consideration. I think the only things which should be considered abusive are yelling and calling names.

          • guest

            Well, you may have that opinion, but medical staff regulations across the country are beginning to include problems with “tone” in their written descriptions of “unprofessional behavior.”

          • Patient Kit

            I’m not advocating or excusing truly abusive, bullying or disrespectful behavior by docs toward nurses or patients. Those kind of people rarely apologize for their bad behavior. I’m just acknowledging that we’re all human — including our docs — and we’re all going to have some bad moments and bad days. I don’t see the ability and willingness to apologize as a carte blanche free pass for bad behavior because we can always apologize after. But if people could learn to apologize more often, it would defuse situations that too often fester and then sometimes explode.

        • Reese

          The same is expected of nurses. I sat through a meeting where we were reminded to be “On stage! On stage!” We were to mind our facial expressions, posture, body language. We were to use the Disney model for customer service. All of this, from people who can hide in the comfort of their cushy offices, where missing lunch is unheard of, and working late and on weekends would be laughable. I know what I signed up for when I became a nurse, and difficult patients and family members are part and parcel of the job. I do expect, however, to be treated with the same consideration physicians demand from me. Fortunately, the good ones far outweigh the ones who make me roll my eyes.

          • guest

            Yes, in many ways, we are all in the same boat as medicine becomes more corporatized, and so no longer in the control of the professionals who actually do the work…

  • John C. Key MD

    Good post Jordan. Been there, done that. Been iritated, angry, and have not known what to do.

    • Lisa

      My question is what do you do when you’ve been there? How do you handle the feelings without taking things out on other people?

      • John C. Key MD

        Usually take them out on others LOL. I have no strategies to offer.

      • lurking for answers

        Actually, if you just go in and tell the person/patient “look, I have to apologize, I’m having a really bad day…” you may be surprised at the positive response. I was in a grocery store line and the clerk automatically asked me how I was: I responded “I’m in a terrible mood and just want to get out of here as soon as possible (adding a sheepish grin.) Her mouth dropped open, and her shoulders dropped down (I hadn’t noticed they were up around her ears before) and she “Thank you! You are the first honest person I’ve dealt with today! I’m in a really bad mood too!” Somehow, by the end of the transaction both our moods had lifted.

        The best doc I ever had voiced his frustrations and frequently said “I don’t know.”

        • Patient Kit

          I like “I don’t know, but I can find out for you.” :-D

  • Ladyimacbeth

    The vast majority of physicians I’ve worked with over the years have been respectful. I think physicians learn which nurses they can trust, and with trust comes respect. Everybody has an off day, and I think most people can understand that. If they don’t understand that, then they’re probably too thin skinned to work in the medical field.

    Luckily, I have only worked with a few over the years who were bullies. The best way to handle a bully is to be assertive and very calmly let them know you’re not going to tolerate their obnoxious or abusive behavior. When they learn they aren’t going to get by with it, they generally stop. Several years ago, I started a new job at a particular hospital and one of the nurses asked me if Dr. so and so had made me cry yet. (He was notorious for his rude, obnoxious behavior and had been counseled for cursing at staff). I said no, and he’s not going to make me cry. He tried it on me once, and I let him know in a professional way that I was not going to put up with it. I never had another problem with him after I stood up to him. In fact, I think he respected me for doing so.

  • Ladyimacbeth

    I would add, that sometimes (probably many times) their frustration is warranted. I remember when I was a new nurse I called a physician and didn’t have some important data like vitals in front of me that I should have had. So, he expressed frustration (and rightfully so) because I had wasted his time and was going to have to go locate the information he needed and call him back (thus interrupting a second time). He was right to be frustrated, because even though I had not intended to be disrespectful it was disrespectful of his time. I made sure from that point forward that I had my ducks in a row before I called.

    I think respect goes both ways. Nurses have to be respectful, too.

    • Lisa

      Did the physcian express his frustration or did he yell at you? Big difference. I’ve had people I work with express their frustration with me when I didn’t understand them or didn’t give them the informationt they wanted, in the way they wanted. That is fair and allows me to correct what I do. But yelling is beyond expressing frustration.

      • Ladyimacbeth

        I wouldn’t say he yelled. I would say he raised his voice and ranted. He wasn’t abusive, he was just mad. And, I don’t really blame him. I learned from that.

        You’re right there is a big difference between expressing frustration and yelling. I don’t condone abuse. When I read the original post it made it sound like physicians are yelling at us every day, and that’s just not been my experience. People getting mad, irritated, frustrated – yes, but verbally abusive rarely. I’ve been treated respectfully over the years, with very few exceptions, and I try to act in kind. In fact, I can think of three physicians off the top of my head who I’ve worked with who have on multiple occasions taken me and other staff out to lunch on their own dime. I work with good people.

  • Thomas D Guastavino

    Interesting. So I guess the presumption has been made that whenever a nurse calls a doctor, and there is a disagreement, the doctor is always wrong and the nurses are always fautless. Here is a short list of some of my “disagreements” that have occurred over the years, most of the calls occurring in the middle of the night.
    1) A call from a nurse at 6 AM because a patient wants a sleeping pill
    2) A nurse calling asking to give a medication to a patient that I specifically ordered never to be given.
    3) A nurse calling for admission orders that I had already given. When I asked if she found then she admitted that she had but decided to call anyway.
    4) A nurse calling to ask to feed a patient who was NPO and going to surgery because the patient was hungry.
    5) A nurse calling to tell me a patient was admitted to the hospital from the ER when I specifically requested to her earlier that I wanted to evaluate the patient in the ER prior to admission.
    6) A nurse calling in the middle of the night to tell me that a post-op patient accidentally pulled out their hemovac drain when I left specific orders that I need not be called in such an event.
    I could go on. Mind you I am not defending poor behavior, but to point out that there is fault on both sides.

    • jpsoule@hotmail.com

      Have had many such calls, reflecting ignorance and/or insecurity by the staff nurse. But I try to educate the nurse without becoming angry. I also try to tell patients, families and nurses when any problem is something beyond my knowledge or simply unfix-able.
      But if the nurse (or anyone) has acted in such a manner as to hurt the patient (very rare), action without vitriol is needed.

    • Celticrose

      Seems like you have an overabundant problem with nurses! It would seem as if, with so many really “disagreeing” calls from them, that maybe they are afraid of you and are calling to cover themselves because they never know which way you will turn? Just my opinion from over 35 years of nursing, that when a Dr. is experiencing what you are with nurses, that they are extremely intimidated by something in your behavior and attitude and are trying too hard to please you so. Patients and/or families are always insisting that the nurse call the MD. They complain later to the MD if they do not get what they are requesting. Maybe they have learned that if they don’t call (generally because the patient and/or family is insisting) the outcome is more disagreeable with you than if they do call.
      Maybe in some of the other situations you cite, there are other extenuating circumstances that you are not aware of because you get angry when being called and the nurse just takes the brunt of it.
      Really, stop and think about it…have some COLLABORATIVE conversations with the nurses to problem solve these issues…in a less intimidating way. You will be pleasantly surprised at the outcome!

      • Thomas D Guastavino

        Where do I start. OK
        First: Where in any of my examples did I mention my reaction? I never said I got angry. All I said was that there was a disagreement regarding the need to call given the circumstances.
        Second: Since I share call with other doctors many times the nurse has no idea which physician will return the call. Therefore, the reason they are calling has nothing to do with me personally and the call can’t be because they are afraid or intimidated by me.
        Third: Collaboration is a two way street. As I said in a previous post the nurses that seem the least likely to get yelled at, and they are being pressured into calling by family members are the ones who start the conversation by saying “Sorry to bother you doctor, but the patients family insisted that I call”
        Finally, if you have been a nurse for over 35 years can you honestly explain why any of the examples I gave for calling would have any validity whatsoever? During my “disagreements” I will question why I was called given the way the orders were written. Rarely do I get response showing that there were any “extenuating circumstances”

        • J Rizzo

          Maybe you should quit. Clearly working around imperfect human beings frustrates you.

          • Thomas D Guastavino

            Im sorry, this post is resrved only for those capable of having an intelligent discussion.

          • J Rizzo

            You sound like a remarkably pleasant physician to work with

          • Thomas D Guastavino

            To those capable of having an intelligent discussion, I am.

          • querywoman

            Yep! I hate snap judgments and misinterpretation!

  • William Viner

    Not sure I’m buying the reasoning here. The times that I have been fearful is when I get an emergency call and don’t know the full story of what I’m about to encounter. There usually isn’t enough time to be rude to someone. That’s when your training kicks in and you go through the procedures that you have studied and practiced numerous times. The times when I don’t have an immediate answer is usually not an emergency and I can ask to ring them back in a few minutes.
    The most aggravating is when you are called and are given so many irrelevant facts, that you have to start the whole conversation over in order to get the important info. And yes, it’s usually when you are awakened from sleep or already deprived.

    • JR DNR

      I think the point is just to help someone see another potential point of view of the same situation, and by doing so, humanize them.

  • QQQ

    My physicians have been respectful to me! However, what happens when I’m gone? That’s another story!

  • Thomas D Guastavino

    At times the calls are at the incidence of a family member but that is rare, especially middle of the night calls. When it did I have had nurses that started the conversation , “Sorry to bother you, doctor, but Mary Jones family insisted I call you” I have noticed that these nurses are the ones who are least likely to be involved in yelling incidents.

  • Karen Ronk

    Why should a doctor’s annoyance/crankiness be different than anyone else’s during a stressful encounter? Most of us can get annoyed or ruffled at unnecessary questions or lack of adherence to what we have requested. The idea of fear being the driving force is also relevant in that the fear of all the “what ifs” come into play during many ambiguous situations – even those that don’t involve life and death. The important thing is to explain the reason for the annoyance and work to eliminate the offending action. Unless the behavior is chronic and/or abusive- which is unacceptable – it hardly seems worth getting worked up over.

    • guest

      Because doctors, unlike absolutely every other worker, are expected to perform their jobs in the middle of the night after having been awakened from sleep. I find it really amazing that this important fact is so little recognized or commented upon. Probably because all of us doctors just take sleep deprivation as a matter of life, after having it be a part of our training and our professional lives for so long.

      • Patient Kit

        I think there may be a general disconnect between docs and patients on this issue of accessibility because most patients genuinely don’t know that doctors get called in the middle of the night routinely. It this true of all doctors or just certain specialties/work models?

        Docs clearly feel like they have to be accessible 24/7 while many patients feel like their docs are often very inaccessible to them. The perception is that docs are busy with other patients during the day and then they are unavailable after office hours unless it is a super-emergency. So, from the patients’ POV, where is that 24/7 accessibility? Together, these two wildly different perceptions equal a huge disconnect.

        • guest

          Just because a doctor’s patients are not able to call the doctor directly in the middle of the night doesn’t mean that the doctor is not getting called by lots of other people.

          The original post is talking about doctors whose jobs involve being called by nurses and being awakened in the middle of the night, and how the doctor’s demeanor can be influenced by fear/anxiety. Not all doctors have jobs like that, but a lot of us do, for example those of us who are employed by a hospital, or who practice specialties where we have to be available for emergencies in the middle of the night.

          It is true that your typical PCP or oncologist in private practice, may not have call responsibilities that involve being awakened frequently, or taking a lot of calls from nurses. Or maybe they do, but that doesn’t mean that patients are able to call them directly. Hence the perception on the part of patients that doctors are slumbering peacefully through the night.

          If you consider that even a doctor who is only available at night for “super-emergencies” may have a practice of thousands of patients meaning that every night there are a few “super-emergencies,” that adds up to some significant sleep deprivation that your typical patient who hasn’t had a “super-emergency” will not be in a position to appreciate.

          • Patient Kit

            I do understand what you’re saying. I actually have no idea whether my particular docs are routinely called in the middle of the night but, since they are all currently hospital-based, I will assume they are. I’m just saying that because patients, in general, perceive doctors to be fairly inaccessible to them much of the time, they do not understand that many of you are accessible 24/7 to somebody most of the time.

            Perception — and misperception — are powerful things. If you want patients/the public to understand the whole sleep deprivation thing, you have to somehow communicate that to us. Because right now, as I said, there is a major disconnect on how we both perceive doctors’ accessibility.

          • guest

            You know, I think this may be the sources of one of the major misunderstandings between doctors and everyone else–because we are socialized to uncomplainingly accept that we will be sleep-deprived as a part of our job, it does not occur to us to point this out as an extenuating circumstance under which a lot of us have to practice.

            Because we take it for granted, everyone else does, too, but they also expect us not to be affected by sleep deprivation, which is a physiologic impossibility.

            I don’t take call any more, because I came to realize that lack of sleep badly affected my ability to remain affable in the face of frustration or stress, so I found a job that (for now) doesn’t require call.

            But when I did take call, I was, every single week, amazed by the fact that nurses would call me in the middle of the night and appear to be completely oblivious to the fact that they had just awakened me–probably because I like any other doctor, am trained to sound alert immediately upon being called no matter how soundly I was sleeping a minute previously. Some nurses would just talk on and on and on for several minutes at a time, giving me all sorts of completely unnecessary information while not letting me get a word in edgewise to ask for the information that I actually needed to have. It was completely maddening, and I am sure that there were times when I ended up sounding irritated.

            But of course we are taught that it is “unprofessional” to complain about this sort of thing, and so everyone remains unaware that we have a very specific set of working conditions that almost no other profession does.

        • Maddie D

          My husband is a surgeon who’s on call (unpaid) every other night and every other weekend. On a good day, he usually gets 5-6 “routine” calls during the evening and about the same number in the middle of the night. These are related to medication issues, lab results, changes in patient status, etc. If there’s an issue with any of the patients, he gets many more calls, sometimes 1-2 an hour, and if there’s a chance one may need to go back to the OR, he doesn’t sleep at all. Some of these calls pertain to his own patients and some are for his partners’ patients. He also gets called in the evening/middle of the night for emergency surgeries, either a new patient or a post-op patient who has to go back to the OR immediately. For some of those cases he’s on and off the phone for 30 minutes-2 hours as test results come back and the referring doctor (usually the ER doc) gathers more information; for others, he’s out of the house in less than 2 minutes. When he’s not on call, he still manages calls for all of his patients in the first 1-2 days after surgery or for their entire hospital stay if they’re struggling or are more complicated. He gets called every 1-2 hours with labs and/or vitals on the ones who aren’t doing well.

          He usually leaves for work at 6/6:30 in the morning and is home by 7:00pm on a good day, midnight on a bad day. He rounds for 5-6 hours every other Saturday and Sunday, in addition to emergency surgeries and frequent calls throughout the day and night. He occasionally gets calls from patients through the answering service, but since his patients tend to need him most when they’re in the hospital, most calls come from nurses or other physicians.

      • Karen Ronk

        Not sure I understand your reply. I am not criticizing doctors, but rather showing appreciation for the fact that they are like the rest of us. But others such as shift workers, new parents, people with chronic pain, etc , suffer from sleep deprivation as well. Which just makes us a very cranky society.

        • guest

          But the entire point of the post is that doctors are not treated the way the rest of us are. They are expected to maintain a calm and pleasant demeanor even when being awakened in the middle of the night either with unnecessary requests, as Dr. Gustavino described, or serious medical problems which require their intervention. Other workers do not have these work circumstances, or these expectations for superhuman equanimity.

          The post is about understanding why doctors, under those circumstances are not always calm/pleasant. If everyone were as understanding as you hypothesize, there would be no need for a discussion of this matter.

          • Karen Ronk

            Thanks for the clarification. I just don’t agree that people expect superhuman equanimity from their doctors. Or at least I don’t. I just expect the same level of respect, civility and competence that I look for in many other situations. And job expectations are relative of course, pressure comes in many forms and stress from whatever source is still felt as strongly. I think a more interesting debate would be doctor’s expectations of their patients.

          • guest

            But the discussion is not about how doctors interact with their patients. It’s about how they interact with other healthcare workers, for example nurses.

          • Karen Ronk

            Right – which is why I said that would be a more interesting debate – we are always reading posts like this on KMD about all the “burdens” placed on doctors. I would just like to see the other side for a change.

          • guest

            Well, I can’t really change what the discussion is about, since I didn’t start it. :-)

          • Suzi Q 38

            “……..The post is about understanding why doctors, under those circumstances are not always calm/pleasant…..”

            I don’t expect them to be calm and/or pleasant at all times. I would expect them to be polite, and think that the person wouldn’t be calling if it weren’t important.

            If I were the nurse, it would be tempting to “mirror” their immature, bad behavior outburst.

            Since I was not a highly regarded doctor, I would probably get retaliated against, written up, or fired.

            There is a double standard.

      • querywoman

        I have had trouble sleeping due to medical neglect. Then I had to go to work and earn the money to pay them.

        • Brunhilde

          And then you went to their blog and commented…

          • querywoman

            Blogs were not rampant some 20 plus years ago when I had these kind of problems. I had no recourse againt sorry treatment.
            Years later, I have given a few of ‘em lousy reviews. They earned every word of them.

  • http://www.myheartsisters.org/ Carolyn Thomas

    Oh, please. When I read: “physicians often react with anger and annoyance due to frustration”, it reminds me yet again that some physicians (*some*, not all of course) must be living in a precious bubble where they believe being frustrated should be a never-event. Ask taxi drivers, probation officers, lawyers, teachers, police officers,
    journalists, and just about all service workers what they know about relentless frustration and they’ll tell you it’s a non-stop component of everyday
    life – and that it does not give them license to “bully” or behave badly
    towards the source of their frustration unless they want to get fired.

    • FEDUP MD

      I wouldn’t get a police officer frustrated if I were you. If you pick the wrong one you may end up dead.

      • querywoman

        FEDUP MD, you are very, very smart.

    • guest

      The difference is that most of those service workers do not have jobs where, on a regular basis, their mistakes could cost someone’s life. And of the service workers who do have those sorts of jobs (police officers, fire fighters, probation officers), I think you will find lots and lots of examples of heated behavior under pressure. Furthermore, absolutely none of those workers are expected to perform while sleep-deprived, as physicians are.

      The problem is not being “frustrated” which as you point out is a universal situation that all of us must tolerate to some degree. The problem is tolerating frustration while at the same time being expected to live up to extremely high standards of technical skill, knowledge, efficiency and ability to tolerate sleep deprivation.

    • querywoman

      Heh! Ask public welfare workers!

  • Lisa

    Simple enough when you know what information they need and how they want you to present it.

  • Patient Kit

    Thank you. I enjoy the discussions here. We’re talking about some really important things. In the short time I’ve been participating on KMD, I’ve learned a lot from many who post here and I’ve been happy to share my personal experience with our hapless healthcare system. I don’t expect everyone to agree with me about everything and I realize that I may even have some unpopular opinions. ;-) Usually, I can take the heat (although I have been called a few names here by docs that I thought crossed the line). But whatever — it comes with the territory, I guess. It would be very boring to only talk to people who agree with me — and very unproductive. Cheers to you!

  • guest

    I have worked now in two hospitals that use the SBAR technique and have to say that it is a classic example of administrative micromanagement which mostly serves to confuse all involved as well as waste everyone’s time.

    For example, how is the “situation” different from the “background”? How is the “assessment” different from the “response? The construct applies to some clinical situations, but not others. Nurses either waste their precious time trying to organize the information into the format when they don’t really need to
    ( or can’t), or it ends up making them include redundant/unnecessary information during the call, thereby wasting the time of the doctor as well. Everyone ends up feeling more aggravated than they were before.

    But, I am sure that some group of nursing administrators was able to squeeze at least a few publications out of having devised and promulgated this “technique.”

    And teaching, and enforcing the use of this “method” provides countless other nursing administrators with important nursing administration tasks to accomplish, thereby ensuring that there will be a plentiful supply of nursing administration jobs available for those nurses who burn out on clinical practice due to such nonsense as described above.

    It’s a paradigm for what’s happening across our healthcare system: when 25% of personnel are administrators, they serve mostly to generate added administrative tasks for clinicians, who then become less efficient, thereby necessitating the addition of even more administrators in order to assist the workers to be efficient, etc, etc. ad infinitum.

  • guest

    No offence to football players, but I would venture to state that the body of knowledge that physicians are expected to have at their command and be able to deploy in the care of their patients, far outweighs the knowledge that a quarterback has to have about the game of football.

    At a certain point, it’s unrealistic to expect a human being to be a highly skilled knowledge worker with a quick command of a wide range of medical information, available to be deployed at a moment’s notice upon being awakened in the middle of the night, and also to be a highly skilled communicator/team leader. The rare physician will have the ability to do both, but our training tends to select for those who are best able to memorize and synthesize medical information.
    The ability to tolerate interpersonal frustration and communicate empathically with other members of the treatment team doesn’t help you pass your Step 1, 2 or 3 exams.

    • Suzi Q 38

      I am confused.
      If you are being called in the middle of the night about a patient, aren’t you the doctor “on call?’
      If so, isn’t that your job?

    • Jason

      Quite to the contrary, when it is part of one’s job to be woken up in the middle of the night, turning around and berating the caller because “you did not give me the information in the manner I just decided I wanted it in” is the height of blind arrogance. For reference, that caller has already been up all night. The callee’s convenience is not the goal here.

      As for doctors’ ability to memorize a wealth of medical information and synthesize it at a moment’s notice – kudos. You chose the path and you’re (mostly) well compensated for having done so. But, the clinician’s job is one of dealing with people. That wealth of medical information is being applied to treat sick people, in conjunction with other people. If the clinician does not have the necessary interpersonal skills and/or refuses to acquire them, there are plenty of other non-people facing positions in healthcare that could use this person’s prodigious memorization and synthesization skills – perhaps a research position in a lab somewhere will be more suitable.

      Sadly, I also know of several people with room temperature IQs who managed to pass their Step 1-3 exams and have gone on to become excellent clinicians. Or perhaps, that sentence should begin with “happily”. Passing the steps does not grant one a license to be a jerk and I can happily state that such characters, in my experience, are a minority. That said, it always amazes me how people pussyfoot around these characters.

  • guest

    Actually I got mildly curious and looked up the SBAR in a couple of places, which I had never done before. It was never intended to be used as a construct for presenting information when calling a physician about a patient, but for nursing handoffs between shifts. For that application, it makes a lot more sense–as it is critically important for the next shift to have a detailed rundown on their patient, especially one who is unstable.. Using it for a call to a doctor whom you are awakening the middle of the night for a quick order is a recipe for irritation for all concerned.

    And may I ask just exactly what you think it would be about a nurse including all this redundant/unnecessary information would “limit one getting frustrated??” Seems to me that it would maximize frustration.

  • Kaya5255

    I have witnessed physicians, firsthand, humiliate, berate, diminish, denegrate, and physically assult their colleagues, and other staff members. It is common for management and administration to turn a blind eye to the behavior.
    If I acted like that, I’d be fired,

    • rbthe4th2

      Amen – or support them. I’ve seen that too especially when a doctor brings in $$$ for the organization.

  • Patient Kit

    That photo is starting to irritate me. ;-)

  • Ladyimacbeth

    Yeah, patient/family demands are a big part of the problem. There’s something about the clock striking midnight that makes some patients want to suddenly deal with things like constipation that have apparently been a problem for a over a week. Now that it’s midnight, it’s a crisis. Never mind that they have seen the physician (or physicians) and the NP daily over the past week and said nary a word. Now, that everyone is in bed it’s time to deal with the constipation. And, no it cannot possibly wait any longer. It must be dealt with at once. I don’t miss working nights.

  • Suzi Q 38

    I have seen nurses fearful of calling the doctor/hospitalist who was on call when my mother (the patient) became paranoid and combative while experiencing withdrawals from high dose steroids.
    I was asking if the doctor would give her at least 75% of her former dose, so that she could get used to the decrease slowly.

    The nurse knew she had to call him, and did so, but “chickened” out and handed me the phone without even preparing him for our conversation.
    I had to tell him that I was the daughter of one of his patients, and told him what the problem was. I ask him what did he thought about putting her back on the steroid.

    He was sooo angry, because I happened to call when his son was supposed to pass by while performing in a parade. I told him not to talk, just watch his son, as I could wait. I then asked me to call me back when convenient as it was important.

    He did so, and he was still a jerk.
    He started to yell at me, LOL. He asked me what medical school I graduated from. I told him that I didn’t need to answer that, but I had one point to make….I will admit I raised my voice: “What you have ordered is NOT WORKING. She is hallucinating, is very paranoid, and needs a 24 hour “sitter” in her room.”

    He finally acquiesced, and agreed to put her back on the drug temporarily, until there was a better plan.

    In this case, he was personally busy and didn’t want my call, but he was the doctor on call.

  • Suzi Q 38

    When your family member is out of control and needs a 24 hour “sitter,” and you want to make a change with her medication, the doctor has to be called.
    The nurse knew it, but was too fearful to call.
    I had to do it.
    Then the doctor yelled at me!
    That’s O.K. I felt like telling him: “Kiss off,”
    but I had enough “fights” ahead of me with my mom’s grave condition. I didn’t have time for his immaturity or “power play.”

  • querywoman

    I think I was terminated as a patient by doctors several times because they afraid of me because I had an illness with real symptoms. They only knew how to do preventive medicine.

    • JW

      I think some of my doctors haven’t liked me because they can’t put on label on my symptoms that they can understand.

      • querywoman

        Haven’t they told you that your problem is “depression?” Impotence used to be a mental problem. Also ulcers. No more!
        High blood pressure is sooo handy for them. They can whip that cuff, get a figure, and have a reasonable chance of finding a chemical to get you to digest that will change it.
        They should be taking several readings.
        If they give you an antibiotic, it probably has an 80% chance of being the right one. That’s an easy educated guess. If it doesn’t work, they can usually find another.

        • JW

          Oh yes, they make up all sorts of silly stories. Either I’m psychiatric (depressed, somatoform, anxiety, eating disorder, whatever, but I meet actual criteria for none of those–I had one PCP who was so confused because he kept giving me depression screening surveys and never got the “right” result); or because I don’t have MS & etc., I’m quite well or will be soon if I just keep a positive outlook; or it’s some kind of personal, rather than medical, problem. In any case, the doctor can go back to the patients s/he understands, and not have to break their mind over me any more, and they don’t have to confront the idea that they and science don’t know everything.

          Never mind the tests (that I eventually got by prompting doctors what to order), or the exam they just finished last visit where they said I had “clearly an immune and neurological problem, but it doesn’t fit in any boxes [that I know of]“. They “treated” this with reassurance, so it’s now fine. Next visit? My test result was caused by deconditioning. Uh-huh. I would argue, but there is no point. I just will do without a neurologist again, as that specialty is clearly unprepared to help me anyway (I have seen about a half a dozen neurologists, and only one I would go back to, but even he could offer only symptomatic care, and only for obvious things like pain). So I ask my primary care doc: do they tell MS patients their problems are caused by deconditioning? She said: no, never!

          • querywoman

            I am as confused as you are. Hope you get better. Maybe you are impotent (even if female) and have ulcers and have some weird symptoms related to ‘em.
            Do they check your blood pressure each time and offer you cancer and cholesterol screening?

          • JW

            Thank you. I hope you’re ok, too! I will hopefully get at least some better in a few years when the docs doing the research figure out what to do and the best tests go mainstream.

          • querywoman

            You have seen a bunch of clowns – I hope you feel good enough to laugh at them!
            Good luck with the impotence and ulcers!

          • JW

            I learned to be a duck and let it slide off. I’m unfortunately not a humor writer like others here. :)

            I do have some good docs, though; they’re just a rarity (at least for those disabled with no major diagnosis and/or a looked-down-on diagnosis) and it took me lots of years to find a good PCP in particular.

            What I really want to do is on the one hand, send most docs back to school, make sure they learn critical thinking and how to read and evaluate research (loads of it is rubbish), how to manage undiagnosed patients & those with no official standard of care for their diagnosis (with supportive medicine, and so on), etc…. Oh yes, and how to not stigmatize or stereotype women, minorities, teens, people with low-regarded diagnoses, or anyone else.

            And on the other hand, revamp the work environment so doctors (and other HCPs!) have the support (and the sleep! and meal breaks!) and the decision power they need to make appropriate medical decisions in collaboration with the patient.

  • Thomas D Guastavino

    Thank you for acknowledging that there may be many reasons why physicians get frustrated or become angry, other then they are “scared”. An experienced nurse such as yourself should be attending one of Dr Grumet’s pizza meetings. The nurses there seem to have a hard time coming up with useful answers.

    • Reese

      I didn’t realize this was a tit-for-tat discussion. After being a nurse for nearly 30 years, I’ve got some whoppers on physicians, too. That would do nothing to improve the dialogue between disciplines, but if that’s your “intelligent” way of playing, I’m game. (Just not tonight. I’m still recuperating from surgery, and spent most of the day calling my FMD trying to get a Coumadin order from him. I called at 0830, it is now 2000, and the office is now closed, so I guess I’m on my own until we start the rodeo all over again tomorrow.)

      • Thomas D Guastavino

        Im confused. Are you saying that you agree with me that there is fault on both sides?

        • Reese

          Of course there is room for improvement on both sides. The difference is bad behavior from doctors is largely overlooked, whereas a nurse who is disruptive quickly finds him/herself unemployed.

          I find it somewhat amusing that you used this article to lay the blame for the behavior of abusive physicians at the feet of nurses.

          • Thomas D Guastavino

            If you read my first response to Dr Grumets original post you will see that I was objecting to the implication the nurses were blameless when physicians became angry and frustrated. Physicians were just “scared”. At no time did I “lay the blame for behavior of abusive physicians at the feet of nurses” To quote myself: “Mind you I am not defending poor behavior but to point out that there is fault on both sides”

          • Reese

            I read your post. To me it sounded like you were deflecting. Doctors need to be responsible for their behavior, regardless of the circumstances.

          • Thomas D Guastavino

            I totally agree. Do nurses need to be responsible for their behavior, regardless of the circumstances?

  • querywoman

    Good for him.

  • Thomas D Guastavino

    Agree about the high turnover. Seems to be a worsening problem. A lot of the experienced nurses are moving up into many of the newly invented administrative positions or retiring early. I miss working with them.

    • jpsoule@hotmail.com

      Turnover and inexperienced nurses without proper supervision is a problem, but is very similar to what I see in many young physicians with the current training restrictions today.
      On a new hospital floor staffed with fresh RN grads I had an eye opener of NOT being called when I should have. On rounds my patient had not been up to chair or walked as I had ordered. When I asked why, his nurse said his blood pressure was 70 lying down and he passed out every time she sat him up, all shift. Seriously.
      Incredulous I asked her why had no one called me. She said they knew I would be coming and did not want to disturb me. On exam the patient was obviously septic and had to go to the ICU. When I told the charge nurse to get an ICU bed stat (another new grad) she just asked why?

  • jpsoule@hotmail.com

    I disagree that fear on the physician’s part is often the cause of bullying or bad behavior towards nurses.
    Rather traditional medical training uses anger, aggression, humiliation and fear (fear of failure/disgrace) as a primary means of education and motivation.
    Trial by fire so to speak. Winnow out the weak. Survival of the fittest.
    Damn the method or praise it, it usually produces capable but often warped or mal-adjusted human beings…
    NO EXCUSE, just an reason for those unfamiliar with physician training.
    The doctor’s peers AND nursing staff need to call the individual on unacceptable behavior to reeducate them or lose their right to practice.

  • buzzkillerjsmith

    Scared?

    Well, maybe some of the time. But how about just plain mean? Mean as a snake. I’ve worked with a lot of docs like this. And a fair number of nurses like this. Been pulled over by some cops like this.

    There’s stress, fatigue, and so on. But usually the guy who is a jerk in the middle of the night is a jerk when he is refreshed as well. And when he’s at the post office, in the hardware store, behind the wheel, with his wife and kids, you name it.

    Motto: If you want to be a petty tyrant, you have to tyrannize! Or maybe you get to tyrannize.

  • J Rizzo

    I’m sorry but this article and some of the subsequent discussion is spectacularly insulting. It’s like asking “why do I abuse you?” As MD’s have power over RN’s, they are in a position of authority. The onus is physicians to behave professionally to those taking their orders when they are frustrated or stressed. When they do not behave professionally they are then ABUSING THEIR AUTHORITY. Nurses are stressed, just like you, I would argue with more responsibility, and we don’t yell at MD’s because we would be fired for it. Why is it different for MD’s? Cuz you guys are super important? Phsycisians who do it a little usually are the ones who do it a lot. I regularly see staff members screamed at, grabbed, scalpels thrown, nurses systematically antagonized and humiliated, threatened at the hands of MD’s who feel entitled to this kind of behavior. Nurses do not give this behavior back to MD’s. We internalize it and then eat each other up. Hence, nurses eat their young.
    I wold also like to say this: When I was a male ICU nurse (6’2 210lb) I got considerably less garbage from habitually abusive MD’s then my female coworkers.

    In regards to the call issue: You docs can’t have your cake and eat it too. If you don’t like the call I’m an idiot. If I don’t call (because you spoke to me like I’m an idiot the last time I called) then you will report me to my supervisor for poor performance thus tarnishing my reputation and potentially ending my nursing career. A nurse at a local hospital ordered a simple CBC for a pre-op patient who was scheduled for surgery. She did this without permission from the surgeon. She did this because the last time HE forgot to order a CBC he berated her in front of her colleagues for her utter stupidity, and how the surgery couldn’t be performed and how she had let everyone down. So rather than call the doc at 0300 (who was scheduled for surgery in four hours) to remind him he forgot the CBC (again) she ordered it stat. Nursing supervision found out AFTER THE SURGEON COMPLAINED THAT SHE ORDERED THE LAB WITHOUT HIS PERMISSION and not only was she fired but she was put in front the board and suspended for three months. Should the nurse have called, for sure. Was this fair, not at all.
    I am now in a position where I get to speak to MD’s about their behavior. They complain that they don’t get respect like they use to. Insurance companies push them around. Their patients talk on cell phones during appointments. Their coworkers don’t communicate clearly with them leaving them in the lurch. They should be making more money. They are micromanaged by people who don’t listen to them and don’t know any better. To these complaints and many others like it I say “You reap what you sow.”

  • leslie fay

    In my 40 year career as a respiratory therapist I witnessed more doctor tantrums than I care to remember. Sometimes it fell into the “absolute power corrupts absolutely” category. As others have pointed out the nurse was frequently stuck between pt, pt’s family, hospital policy and the doctor. A losing proposition for her always. My personal favorites were always pediatric intensivists. Whenever there was a code in PICU they would scream at everyone, of course making people more nervous leading to more problems. When you choose such an incredibly stressful specialty you must be prepared for the inevitable. Such behaviour is not acceptable. If the physician treats everyone with the respect they deserve it is amazing how much better everything works. Frequently other members of the ‘team’ have good ideas if the physician listens. After all it’s not whose idea it is but what the results are-does it benefit the patient?
    This conversation will go on forever, sometimes the physician has a right to be angry, though screaming at someone(frequently not the person who committed the infraction) is not productive. It should be a learning experience, figure out why it happened and how to keep it from happening again.

  • SteveCaley

    I am very disturbed by the comfort we have in characterizing this or that class or group of people. We pretend we have defeated “racism” and “sexism” when we have only learned how to be less condescending and more oblique in our patronizing behavior towards each other. Whether talking about “doctors” or any other imaginable class of individuals, we seem comfortable in lumping them together.
    All people can change; all people can choose to behave in one manner or another. Why do we explain away unwanted behavior as idiotypic, rather than ask where it came from, and how it might be changed?
    Culturally, we seem to have an odd customer/salesman bias to all our relationships – one person has the permission to unload all sorts of rude and juvenile behavior; the other has to “put up with it.” That is how people who care for two-year-olds have to tolerate; why do we set it up so high as acceptable behavior in our culture?
    Many people equate being famous and rich with the freedom to exhibit abysmally bad behavior, and regress into public infancy. Why?

  • Reese

    Nurses get tired, have bad days, have problems going on at home. Yet in nearly 30 years of being a nurse, I have never seen any nurse have the kind of meltdowns I’ve witnessed from physicians. Screaming, swearing, throwing scalpels, syringes (needle attached), throwing charts (back when we had charts to throw)…no, I never saw that, and you can be sure any nurse who did that would be fired. Somehow, however, doctors are supposed to be given a pass for this behavior. A slice or two of pizza, and all is well…till the next time the nurse winds up being the doctor’s punching bag.

    Doctors have a difficult job, and we get that. Is it so difficult, when you get that sort of call, to just ask for a few minutes and then call back when you’ve collected your thoughts? Would you be placated with pizza if a nurse screamed at you? Nurses are professionals; you don’t buy them off with treats as if they’re your pets.

  • buzzkillerjsmith

    Several times a shift? You need a new job. Lots of jobs out there for NPs.

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