Dealing with Physician Arrogance

[OldSquidNewNurse]

Note: This is from a nurses blog. Under the comments there is discussion if foreign doctors are worst than American ones.


Beka - Last night wasn’t a bad night -- no 2 am discussions, but a good selection of Jamaican food for a middle-of-the-night “dinner.” My assignment wasn’t too tough - a gentleman who was easily extubated the day before and a 62-year-old frail female who had undergone a bowel resection and had been intubated 12 hours before for respiratory failure. As the night went on, she developed a growing metabolic alkalosis with a ph level nearing 7.67 due to her high NG output - pure green bile.

I called the surgical resident several times asking him to come and assess her. He took his time. When he arrived he decided an argument with the respiratory therapist was due at 3 am. He refused any diuretic therapy or ventilatory changes, and actually instructed me to begin tube feedings on her despite her distended abdomen and increasing ileus. TPN or HAL was already infusing, but the patient was also showing signs of sepsis.

By morning she was in visible distress although the resident had given every textbook answer there was to resolve her ileus. He refused any sort of motility agent. His arrogance, rudeness, and disrespect for nursing was obvious. I was left wondering, as a I tramped down 7 flights of stairs to street level at 8 am - what are nurses supposed to do with colleagues such as this? Have physicians always shown a belligerent attitude toward nursing? Is it in their history? Before I left I had her comfortable, but felt irritated by this resident who thought he had all the right answers.

What have your experiences been with arrogant physicians? And how have you dealt with these types of situations? Can we stop it? Do we have the power to do so?

[ICUruthie]

As a nurse, I still consider myself as my patients advocate! I have had a few of these "run-ins" with residents as well as proper physicians... I tend to dive straight into an argument- if I think the physicians orders are wrong. Or atleast tell him/her my thoughts of what I think is right and if they end up "winning" the argument I make sure to document everything that has happened thoroughly. But the feeling of discontentment after work is still always there..... So, an afterwork jog/run is my best medicine for getting rid of some of the frustrations. I wish there was an easy answer in how to deal with these situations/physicians!

[cougarnurse]

And we are the ones who see the patients on a consistant basis. True, doctors review the lab results, etc., but WE also see much more. Yes, there are a few who ruin it for many.

[gracie1]

This is a situation to utilize the chain of command. Since you were dealing with a resident, there must be someone over him, pgy 2 or 3 or something similar (do you really want me to call your senior?). I would involve my charge nurse as well. I've never worked nights, so I realize there are dynamics at work here that do not occur in the daytime when everyone is around.