Disrespect from doctors

[AnthonyM83]

Follow-up:

Maybe the reason you don't see doctors talking down to each other about what they did is there's less of a variance in education and thinking ability than amongst medics. While many are smarter or went to better schools or have more experience, most know the same standard stuff and know how to deduce stuff from what they know.

There's only a EMTs I know, where even if it's something off the wall, I know they checked their sources or logically deduced it as I would have. Similar to how I trusted information from most fellow biology majors on science topics...even if unrelated to biology, if they told me a fact, I know it was as true (as could be) b/c they wouldn't buy into random sources.

[EMSDoc]

The one time I was bringing in a nothing MVC -- minor chest wall trauma from the airbag. Patient was fine but had some ectopy on the monitor so I ran a 12 lead. I went to the local community hospital and was directed to fast track. I started to present to a nurse after dropping off the patient, and stated... "and there was some ectopy on the monitor so I ran this 12 lead which looks fine..." The nurse abruptly cut me off, started questioning where I learned medicine, and then started mumbling something about having to move the patient up to the main ED.

I took a deep breath, and I walked calmly out of fast track. My EMT partner was flipping out that I hadn't chatised her, but what I would have said would not have been professional. Instead I walked to the ED doc I knew on the main side, and showed her the EKG, and told her the nurse's reaction. The doc immediately apologized, found the nurse, pulled her aside and explained to her that this was not her decision, and who she has just yelled at. Needless to say I received an apology, but it was all done without embarassing the RN (even though she certainly deserved it).

Most of the time if you find a way to make your point without making a scene your message is better received and it can help build bridges instead of destroying them. If you do your best and the the person is still unprofessional... hey you can't argue with an idiot. Doesn't mean you should stoop down to their level. Play the high road, and it will serve you and our profession well.

EMSDoc 8)

[EMS49393]

I must be lucky. I rarely have problems with doctors. I occasionally get blown off by a nurse every once in a while, but I take into consideration the caliber of medic they see during a shift. Honestly, I believe my co-workers have the problems they have because they constantly display incompetence. We have very few medics that run 12-leads when indicated. We have very few medics that bring in patients with IV's when they are indicated. We even have medics that bring in alerted mental status patients without checking a blood glucose. I try to put my self in the nurses position. "You were treating this patient for forty minutes and you don't even have a blood glucose, IV, any ECG?"

My fellow paramedics in this area argue with me over the value of an immediate 12-lead on a patient with chest pain or cardiac like symptoms. They'll tell me it takes too long. They tell me they don't need one. They give NTG out like candy, no ECG, no IV in place. I actually had one medic argue with me today about how low the incident of RVI actually is, therefore to run a 12-lead before you start treating the patient is wrong. I argue that you can not treat until you assess. Call me crazy.

I have a lot of approachable ER doctors and nurses. If I have a question, it doesn't take me long to find a doctor I'm comfortable with and ask them. When I call a report to the nurses, they are pretty confident that what I'm saying is what is going on. They give me a lot of respect on the radio.

Incidently, my absolute favorite clinical rotation in paramedic school was my physician mentorship. I got to spend 24 hours in the ER with a doctor that wanted to teach the student that wanted to learn. What I learned from him is invaluable. He was patient, witty, kind, and respectful. I wish I could do another physician mentorship. I've often stated that I feel a paramedic may be able to understand the bigger picture better if they had the chance to really see it from the ER doctors view. I also believe that a program like that may strengthen our relationships with the doctors.

It really boils down to respect. I would never call out a nurse, doctor, or other paramedic in front of anyone. I would wait to be alone with them, and present my inquiry at that time. You have to give respect to get respect.

[DwayneEMTP]

*(Note: Those of you wishing to stay on topic should skip all of the blather and read the last sentence of this post only. But it's late, I have no papers due, no PCRs to catch up on, no tests to prepare for, and I just quite my job, so needed something to do with my hands. (Yes, besides that.)So I ended up telling this silly story. You've been warned. DW)

The only time I really got angry was at a nurse during preceptorship. It was 4th phase, so I was pretty comfortable with reports and patches and such.

We brought in a phych pt with minor wounds to her wrists, had taken a couple of prescription sleeping pills and claimed to have ingested about a pint of vodka. Started out a basket case, but by the time we got to the ED she was comfortable admitting that she just wanted her boyfriend to have to think about living without her.

I got her settled in bed, hung her IV, when the nurse came in with her clipboard and went to the patient. As I started to give my report, without looking up she gave me the finger flip thing that girls sometimes do, that I've come to understand means, "Be gone. I no longer wish you to be in my presence."

It ticked me off, but I wasn't sure exactly what to do, especially being a student and not yet a medic. My medic grabbed my arm, the calmest, smartest medic I was fortunate to work with, and pointed to a chair at the other end of the ED...about 100-125 feet or so away. He was WAY pissed, and I'd never even seen him irritated before. He said, "You are not in trouble, but I'd like you to go and sit in that chair. You will not move unless I tell you to do so! OK?" I said, "Sure."

So I sat in the chair and worked on my PCR, and after about 10 minutes the nurse came out and looked around. Seeing me on the other side of the ED she gave the the crooked one finger 'come hither' command, to which I looked to my medic for advice. His face made it clear that I was very comfortable where I was and I had no intention of leaving. Usually I only let my wife make up my mind for me, but he seemed pretty confident that he knew what he was doing, so I sat. It's one of the few things I feel completely qualified to do anyway. I didn't know what to do about the nurse though, and I have a hard time simply ignoring people, so like an idiot, I waved at her. :shock:

Should you find yourself in this position, I can't really recommend this strategy, as it seemed to make her face pretty red...and kinda fat and her lips got really, really, skinny.

Finally she went over to the medic. I saw him shrug his shoulders in a 'beats me' kind of way, and went back to his report. (He told me later she asked him for his report and he told her, "I have no idea, my student tech'd this call.") So she looks at me and now makes the effort to use her entire arm to wave me back across the ED, presumably to give my report.

I'm now catching on. I'm not going to leave my chair...I know which side my bread is buttered on, and I've learned my lesson on the whole waving thing, so I go back to staring at my PCR. Finally she comes over, with my medic staying close enough so he can hear what goes on, (but not close enough to be of any help should she decide to scratch my eyes out), and says, (Still very red faced), "I'm sorry I was rude to you before, would you mind giving me a report?" To which I replied, "No ma'am, not at all." and proceeded to do so. She ended up calm, I ended up calm, and with a funny story to tell (at least I get a kick out of it) and everyone went back to their lives.

I learned a lesson about demanding at least minimal respect, even as a student, and I'm guessing she learned a lesson as well, but I've found that these instances are so few and far between that to take them seriously would just tweek my attitude towards the other 99% of Docs and nurses and RTs, etc, etc, that took me seriously and treated me with the utmost respect.

*I've got to go with many others here. If you find this kind of treatment is part of your daily diet, perhaps you need to take a check and see if you're contributing in some way.

Have a great day all.

Dwayne

[WelshMedic]

I occasionally get blown off by a nurse every once in a while

:shock: :shock: :shock: That, my friend, has a very different meaning in the British version of the english language.

Still, you're the lucky one......

WM

[air.stump]

I am happy to say that I have had little to no issues with the ER staff of any hospital I have transported a patient to.

Maybe this is because I usually don't take anything that is said to me about my patient care by the ER staff too seriously. I know who my boss is and if I screw up badly enough, I know I will get a visit from him.

Maybe it is because when I do screw up, I don't let the ER staff discover the mistake, I tell on myself. This takes the wind right out of their sails, real fast.

Maybe it is because I have worked in peds and adult ER's and understand the "verbal sniping" that goes on between the crews and the staff. It is only the "stress" check valve popping off. Think of it the way a nurse or doc sees it: I just finished working up X amounts of patients, I got to go to the restroom, and you are bringing me one more.

I just don't ever buy into the hype. I remember that the "emergency" that I was called for is the patients, not mine, not the ER staffs'.

[spenac]

*(Note: Those of you wishing to stay on topic should skip all of the blather and read the last sentence of this post only.and I just quite my job, You've been warned. DW)

Dwayne

Wow, Hope you find a job soon. Or if you won the lottery can I have some money?

[akflightmedic]

Wow, Hope you find a job soon. Or if you won the lottery can I have some money?

Yeh Dwayne, I echo that...hope you get a job soon buddy!! :wink:

[VentMedic]

air.stump made some excellent points.

Those of you who take it personally when you occasionally get snapped at by a nurse and/or doctor in the ED should not consider a career inside of the hospital as an RN or RRT.

Inside the hospital you may have some days that are truly blessed and everyone plays very well together. And then you will have days when one bad attitude or event can write the script for the rest of the day. Or, there are days when no matter how perfect you are, no one can be pleased.

A day can start with a Cardiothoracic surgeon having a difficult pt in the OR and then blasts every RN, RRT and MD in a 25 foot radius when the pt is brought to the CVICU. Now the RNs, RRTs and whatever doctor responsible for recovering that patient must do their best to see that he/she also survives whatever the happened in the OR. And, they also may have another case from that surgeon to look forward to in a few very short hours.

A valuable piece of equipment might go down like the CT Scanner and even if there is a 2nd Scanner, it will be taking a full schedule of patients. Tempers will get unconsolable with Doctors yelling "Stat" or NOW! The nurses will do the same to the Radiology department and eventually RRTs will catch hell just because the patient is on a ventilator for lack of any other reason.

Then the Cath Lab will get their knickers in a knot because the one time they allow the Paramedics to bypass the ED on a STEMI alert for a 30 something white male runner with CP and questionable EKGs changes, it turns out to be a pneumothorax which quickly develops into a serious respiratory emergency upon entry into the lab. Luckily, this cath lab have their own RRTs. This then ties up the lab until he is stabilized. Then, you have the cardiologist of another pt pissed because he held his pt who truly needed an emergent cath to allow the one from EMS to enter. The other 3 rooms are also full of emergent and scheduled caths.

And then, you have all the hospitalists and med-surg RNs who are slammed with admissions as the ED frantically tries to clean out their holding areas. Each med-surg admission may take each RN over an hour while they also have 7 - 9 other pts to care for. ED RNs with very little if any ICU experience are trying to do the many pages of ICU orders on patients away a Critical Care bed. The ICUs are trying to triage out their least critical pt so the hospital doesn't have to go on divert.

Many times we growl at co-workers we truly respect out of the reaction of others. Fortunately in most situations in the hospital, even though we are upset at the time, we understand the frustrations and all will be better if the black cloud ever lifts.

I still truly enjoy doing EMS or Interfacility transport because I only have to concentrate on one patient. I do not have to cover 45 med-surg patients and/or 6 ventilator patients at one time while trying to please 10 physicians and 20 RNs as well as Dietary, Speech and Physical Therapy.

Consider yourself lucky you can walk away from a situation regardless of whatever respect you believe to have gotten or not, provided you did your best to do a good transfer of care, and go on to the next patient.

Dwayne, good luck! You'll be a good catch for some lucky employer.

[DwayneEMTP]

Thanks all. No worries here, thanks to friends I've got some pretty good options available.

Dwayne