Saturday, May 5, 2007

Disruptive Physician Behaviors

My patient was convinced he was on a regular diet. "I can't eat jello and broth for breakfast," he said. "The doctor said I could eat real food today."

His diet orders were written"clear liquids." I paged the surgeon, a difficult task to do at 0900 on Sunday morning. He didn't return my page. I paged again and finally left a message on his cell phone at 0945. Good thing it wasn't an emergency.

He finally returned my call at 1015.
"I need orders for a regular diet," I said.
"He has orders. I ordered it when he was transferred from the ICU."
"No, sir, he doesn't. The only orders are for a clear liquid."
"Fine, give him a regular diet." Slam.

I went ahead and ordered a 2000 ADA diet (which should really be "carbohydrate-consistent" but just try re-writing deeply ingrained institutional habits) instead of a regular diet and didn't page him back to request a correction because he'd just slam the phone down again. We both knew what he meant.

Unfortunately, I had to page him later, this time for a patient experiencing bladder spasms. I have learned to be concise with the surgeon because he becomes impatient. I explained the patient was feeling the urge to bear down and urinate and was telling himself not to do it.

"He already has Ditropan ordered," he said.
"No, sir, he doesn't."
"Well, the urologist ordered it yesterday."
"No, sir, he didn't. When he came to examine the patient, the symptoms were not consistent with bladder spasms and he consulted YOU for input to give a one-time order for morphine and start around-the-clock Toradol."
"Fine. Ditropan 5 mg po TID." Slam.

Barely time to do a read-back and verification. Good thing I have a thick skin and lots of experience with surgeons. I never take anything personally because they're just operating (ha-ha) on a higher plane.

Unfortunately, I have a lot of junior nurses who don't have this experience and they are terrified to call for assistance, to request clarification, to ask for guidance, because the surgeon will condescend, belittle, and in some cases, yell at them. This surgeon is going on leave for two weeks in May. Maybe he'll come back a little less stressed, a little more rested. Then again, surgeons are a different breed from the rest of us---highly driven and deeply superstitious but skeptical perfectionists with poor bedside manners.

In the nurses' station, I laughed and repeated a comment made by the infectious diseases specialist regarding one of my patients whose oxygenation levels hover around 66%: "He's a
facultative anaerobe."

This surgeon overheard me and said, "That's mean. Even if it's the Department Head for Medicine, you shouldn't repeat things like that. That's just mean."

I don't think he grasps the irony.

Disruptive Physician Behaviors

Disruptive Physician Behaviors - Rhode Island

Practicing Excellence

"A healthy physician-nurse relationship is not just a nice thing to have; it is a competitive advantage driving clinical outcomes, patient safety, and staff retention. Interviews of nurses demonstrate that when physicians intimidate and behave disruptively, clinical care is impacted. Ninety-two percent of hospital-based nursing staff have witnessed disruptive physician behaviors and report a compromise in communication, collaboration, and information transfer. Nurses also reported disruptive physicians increase frustration, stress, and the quality of workplace relationships. When respectful, collaborative physician-nurse communication is in place, and nurses are encouraged to speak up in the face of patient danger, errors are reduced and care for patients improves.

“The physician’s role in workplace operations and performance is critical,” says Beeson. “Physicians are in a leadership position and will influence the perception, attitudes, and behaviors of others. A vested physician committed to reward and recognition, who clearly articulates expectations, who gets to know and takes care of staff, and models the behaviors consistent with their organizational mission, will create a high-performing unit.”

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