Sunday, March 3, 2013

How to Make an Arrogant Doctor Do What You Want Them To Do

Let me preface this by saying that for most of the doctors I work with, these tactics are unnecessary.  Before this turns into a butthurt shit show, let me acknowledge- yes.  Most adults will usually listen to reason from another adult with similar experience, even if one of those adults went to school for less years. Some of the doctors that I have a really good report with the respect me as a nurse will actually solicit my opinion just to get another perspective on a patient. Unfortunately, others seem to think more experience makes them the one smart person in a sea of bumbling idiots, which... good for you, let's see how that works out.  In my experience, there are a couple of young, cocky doctors out there who still haven't really gotten much real world experience, but won't take any input from anyone ever, especially not a lowly nurse and especially especially one that looks like a high school kid.   I've dealt with several of these guys in my career and watched some of them make some pretty catastrophic decisions in relation to patient care.   Like, shit that'll get you sued decisions related to patient care.  Anyone can miss something, but most people are humble enough to think twice about it when faced with overt concern.  The ones that won't- well.  That's where the power of manipulation comes in, which I am really just kind of sad to say I've mastered at this point.
The key to all of this, sadly, is to feed the arrogance.  Gross.  I know.  But let's say, for example, you have a patient, who is, say, obviously septic.   Their vitals aren't in the shitter yet, but you know they're headed in that direction.  If Dr. Arrogance is taking care of your patient, you can usually gauge how seriously he takes this in proportion to how many billable procedures are done on the patient/ how many times he actually goes back into the patient's room.  When I know something legit is getting blown off, I usually try to nip it in the bud by trying to intervene/test the waters early.  This is the important step- planting the seed without blowing your cover.  It may seem to make more sense to just go on the record saying, "this dude is totally septic and shit's about to go down", but with people like this, that can very easily backfire.  See, the Dr. Arrogants of the world have to be right about everything, and nothing feeds their egos more than shooting you down when you throw out a medical diagnosis like "septic"or "anxiety" or "A-fib with RVR".  Nope, with these people, as a nurse, especially a young one, you have to trick them into thinking it was their idea as to not disrupt their fragile self-image.
I generally start by touching base before any kind of decision has been made, because it's a lot easier to subliminally steer them in another direction before they publicly proclaim a decision, say to discharge a patient you know is sick, than to convince them to go back on it.   I'll usually catch them at a stopping point and pretend to pick their brain.  "Geeze, Dr. Arrogance, what do you think of that patient in bed ten?" If the response they give me is obviously not the one I want, I usually put on my best worried/sad face and act like I'm trying to do long division in my head.  Then I'll say something like, "Man, I don't know, I just have a bad feeling. "  At this point I will drop all my empirical evidence in the form of a question and be like, "Yeah, like, he got that fluid bolus from EMS, but his blood pressure keeps dropping a lot from when he came in, and he's real sleepy and just acting different and I just don't like how he looks." At that point I usually bite my lip and shrug, and ask "What do you think we should do?' This performance 90 percent of the time gets me what I want. When it does, I nod my head emphatically and run off like I'm going to do something that I've probably done anyway.  If it doesn't, I usually just stall discharge until the vital signs are actually abnormal enough to get an admission and then play stupid like I didn't know I was supposed to let them go, or I'll play the "patient wants to talk to you" card to trick them into going back in the room and seeing how shitty they look now.
Part of me feels disgusted with myself for playing dumb, but I take comfort in the fact that 1- I got shit done for the patient that needed to be done- and 2-that I have the ability to play an arrogant douche into being putty in my hands.
So, there it is guys.  The power of tricking someone who doesn't listen into doing what you want.  Only use these tricks for good.

15 comments:

  1. I do that to my asshole organic chemistry TA. It is nice to know that this is a basically universal skill.

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  2. It's so sad that we have to use these tactics. Thanks for this post... I will try to use these techniques for a couple of our arrogant fellows (I work in an ICU) who can't possibly take advice/suggestions from a nurse, especially since I also have a baby face.

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  3. They never taught us this in nursing school. One of those things you learn on the job. It's sad but sometimes you just gotta do what needs to be done. And that's why you rock!

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  4. Either way, document communicating pt. status to the Doc.
    Some Dr. Arrogants think the iceberg will swerve out of their way, even when you point it out to them.
    Then when things go south, they'll throw you under the bus with both hands overhand ("The nurse never told me the pt. was THAT bad..."), and far too often charge nurses and higher look at you like you must have lost your mind, grown another head, and assume you're guilty until proven innocent.
    I've had two run-ins in 20 years, and charting saved my bacon both times.

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  5. My mother was an RN. She graduated from the Cadet Nursing program right after WWII. That was back in the days when nurses had to stand up in the nurses' station when a doctor came in, like he was royalty or something.

    Anyway, she told me a story once about a young pediatrician who was just full of himself and insufferable. She worked with this nurse everybody called Sparky because she was always on the ball with practical jokes and stuff. Anyway, Sparky paged Dr. Insufferable one evening to tell him one of the babies in the nursery had just passed an enormous bowel movement.

    The pediatrician came to look at it, and Sparky showed him the diaper, said worriedly, "we've got to find out what it is!" and took a big hunk from out of the diaper and started eating it.

    It was a Baby Ruth candy bar. Sparky had chewed it up and then spit it into the diaper before Dr. Insufferable got there. :)

    The other nurses half died from laughing and Dr. Insufferable's pin was pricked for a good long time after that, my mother said. Heck, for weeks all he had to do was walk into the nurses' station and all the nurses laughed. He also got called Dr. Baby Ruth behind his back. LOL

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  6. this is 100% accurate! you know a doc is good when he or she asks the nurses what they think. because guess what? we're the ones actually in the room with the patient.

    the other population that this tactic works really well for is the spacey docs who are just incompetent and are ignoring a super-sick patient because they're chit-chatting or excited about casting or somebody's yelling at them about not getting narcs. that's when i'm like, hey doctor whatever, what do YOU think? it's amazing how you can just see the gears grinding in their brains!

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  7. I have totally done this same thing. We had one doc for whom the best method was to just proclaim the opposite of what you wanted done. eg: Doc I don't think this guy is really having a stroke why don't we just discharge him? - guaranteed admission every time. BTW the word is "rapport" not "report." :)
    -whitecap

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  8. this also works on husbands, or men in general. As long as you let them think it is their idea, it will get done the way you intended!

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  9. I'm taking notes on this shiz, foreal! I agree with Anon above about the reverse psychology trick, it definitely works sometimes.

    Sometimes when you chart "MD aware" it's really tempting to add on "...and don't care!" at the end. Ugh.

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  10. If it saves a patient's life, I think it's worth it... even if it only feeds the problem with the doc.

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  11. On behalf of all doctors, I apologize to you (all of the nurses on here) for the Dr Arrogances in your hospitals. I sure hope none of them are ones I trained. Any time I caught a trainee in that behavior, I jumped down their throats instantly. The doctors and nurses are a team and need to function like one.

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    1. Thank you. I wish you worked at our hospital.

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  12. *sigh* I wish none of this had to be done! Usually, I go for the blunt tactic first. "I don't understand your reasoning, doc. Please explain. Why are you not doing (this or that) instead?" If the doc continues to be an arrogant ass, and doesn't want to do something *just* because it was my idea... I just start going over his head, to his senior, or the fellow, or to the charge nurse who can talk to the fellow.

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  13. I agree with the last post. I usually don't try to feed into their egos. I go to them with my concerns and if I don't get the results I am looking for I chart exactly what was said word for word. I usually end the conversation with the doc by saying, "Ok, I'll go and chart that." That usually gets them going.

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  14. I wish I could swallow my pride well enough to play the putty. I generally end up settling with passive/aggressive. My "MD aware, doesn't care" is charted "MD Shitforbrains notified of BP 79/32, HR 162, rhythm change noted on monitor at 1826. No orders received. Rapid response called at 1827."

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