Ep 56: An ED RN Talks To Doctors
Preamble:
Welcome to It’s An ED RN, on today’s episode we’re going to talk about talking to doctors. For the new nurse, this can be intimidating, for the experienced nurse this can be exhausting, but for most every nurse who’s been around for longer than a minute, this is the source of many a tale told at many an after-work happy hour that is only funny in hindsight. Because being yelled at by physicians is something we all share. It’s common. It’s allowed. But it doesn’t have to be allowed by you.
I’m your host, an ED RN and I hope you’ll stick around to listen;
Intro Song
Episode 56: An ED RN Talks to Doctors
Welcome:
Welcome to my podcast, It’s An ED RN
I am your host, an ED RN and today we are talking about:
This;
If you’re new to the show:
Introductions:
Nurse x13yrs
5yrs Admin
Back to bedside in ED
Talking to Doctors:
Doctors, they’re just like us!
What you allow is what will continue
Robots will take over, so only human communication will be left
Available evidence:
TJC put out a sentinel event alert
“ Intimidating and disruptive behaviors are often manifested by health care professionals in positions of power. Such behaviors include reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions.2 Overt and passive behaviors undermine team effectiveness and can compromise the safety of patients.7,8,11 All intimidating and disruptive behaviors are unprofessional and should not be tolerated.”
“Disruptive behaviors often go unreported, and therefore unaddressed…”
“Additionally, staff within institutions often perceive that powerful, revenue-generating physicians are “let off the hook” for inappropriate behavior due to the perceived consequences of confronting them.”
Even other doctors admit this:
“The American College of Physician Executives (ACPE) conducted a physician behavior survey and found that 38.9 percent of the respondents agreed that "physicians in my organization who generate high amounts of revenue are treated more leniently when it comes to behavior problems than those who bring in less revenue."
A 2022 systematic literature review (love) concluded that:
“Disruptive behaviors among health care professionals are a significant threat to patient safety and quality of care.”
“With respect to the social-labor variables, a study that analyzed the reports of the notifications observed more disruptive behaviors in the category “physicians” (81%) compared to 52% in the category “nursing”. It was observed that these behaviors result in stress (97%), job dissatisfaction and compromised patient safety (53%), quality of care (72%) and errors (70%)”
“one of the main factors which made it difficult to address disruptive behavior in clinical practice was perhaps the “culture of silence”, turning it into a complex process for health workers and institutions, and influencing the safety of the patient.”
But my fave is this 2015 status report on disruptive doc that concluded, in part:
“Most physicians are just trying to do their job and in many cases don’t even recognize the downstream effects of inappropriate behaviors. Many of these problems occur with strong personality traits further perpetuated by medical training that results in dominant, authoritative, egocentric, demanding behaviors with little emotional intelligence about the world around them.”
Damn
Also, huh?
How do we fix this
We don’t
Not our responsibility
Reporting is underutilized (for obvi reasons)
These are grown-ass adults (physician, heel thyself)
The question is not “how do we fix this,” but rather…
How do we respond
Professionally
Directly
Immediately
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Back to the topic at hand: how to respond
What instances of physicians behaving badly have you already experienced?
What instances have you heard about?
Now write those down with an ideal response
Insert yourself to stop the flow of the behavior
Specifically call out the behavior that is happening in the moment
Defined the behavior you need to see instead
Let’s do a case study: a physician is yelling at you because you did not follow one of his orders
The softest response would be: “I’m sorry to interrupt you, but I feel that you are speaking in a very loud tone and I think it would be better for me to understand what you need if you were to lower your voice, please.”
Slightly more direct “excuse me, but you are speaking very loudly and I’m gonna ask you to lower your voice, please.”
The most direct “Actually, I need you to lower your voice if you’re not able to we can have this discussion at a later time.”
Avoiding conflict when you disagree
The “yeah no”
“Yeah, we definitely need that…although” and then all your reasons why you’re not gonna do that
Case study: the Doc is pushing you to go to CT scan, but your patients GCS is a six: “yeah we gotta get this guy to the scanner although according to protocol he’s not really appropriate to go to the scanner right now because his GCS is six”
Specific lingo I like to use when disagreeing with doctors
Per policy
Doesn’t meet criteria
I’m curious, why…
Are you okay? You seem upset.
Or if you really want to get them, “you seem very emotional about this”
Tips and Tricks:
Tip #1: center the patient. The one central thing we can all agree on is that the patient’s best outcome is the shared goal.
Tip #2: center yourself: if it feels too direct to say you’re shouting at me think of how you can say that in a way that centers your own feelings for instance, “I wonder, why do you feel it’s okay to talk to me this way? Because I don’t feel it’s appropriate.” Really important to only use this when you are at the bottom of the power dynamic.
Tip #3: center the doctor. Some thing is simple as saying “are you OK? You seem upset.” “Are you doing OK? Today can really break tension and aggression.” This does not mean that you have to help them with that but somebody should.
Trick: do the rehearsal part of cognitive rehearsal; it’s probably the most important part. You need to act out these scenarios out loud and practice saying the responses out loud. Bonus points if you make it an activity with your closest nurse friends.
Closing:
I hope you’ve enjoyed this episode; if so, leave a review, find me on socials and tell your nurse friends to listen;
Being mistreated by physicians is a hallmark of nursing and I, for one, am not having it any more. Let’s not have it together. If you see something say something. In the moment. To the person.
Thank you for listening and have a safe shift.
