The other day, Theresa Brown, an oncology nurse who has somehow finagled a quasi-regular column in the New York Times, wrote about, you guessed it, another unpleasant encounter with a mean doctor.
Her patient was about to undergo a stem-cell transplant when he developed what she called "textbook symptoms of a heart attack." A cardiogram had been done and while awaiting the arrival of a cardiologist (apparently a myocardial infarction can only be ruled out by a cardiologist at her hospital), the patient's doctor, a big bad oncologist, arrived on morning rounds.
He took a quick look at the EKG and said “This does not concern me.” In the hallway, Nurse Brown challenged him in front of his team of doctors and he had the temerity to ask her why in an intimidating way.
After another 600 or so words about collaboration, blah, blah, teamwork, blah, blah, we come to find that the cardiologist confirmed the oncologist's impression that the EKG did not show a heart attack and the patient went for the procedure.
OK, I'm not saying that doctors don't intimidate nurses. And I'm not saying that it's all right to do so. I realize that some physicians can be annoying, overbearing and even disruptive. I just blogged about this myself today on another site. But was this really the best anecdote that Nurse Brown could come up with about how she rose to the defense of a poor patient?
When I was in practice, I had no problem with nurses questioning my actions if the question was based on a legitimate concern and (this is important) the nurse knew what she was talking about.
Unfortunately, the latter feature was often not present in the discussion. This is because as Nurse Brown points out, "Doctors and nurses are trained differently."
She also says, "Some nurses reject the whole idea of doctor’s orders; they think the term makes nursing sound subservient." Excuse me? What would be the alternative? Nurses deciding what should be done? Anarchy?
Maybe it would have been better if she had said to the oncologist, "Can I have a word with you in private?"
How do you think a nurse would feel if I confronted him in front of all of his colleagues at the nurses' station?
Nurse Brown laments that there are no protocols to resolve disagreements between doctors and nurses. I disagree. Since the overwhelming majority of orders are not of a life-or-death nature, one can simply go up the chain of command. When this has happened to me, I have spoken to the nurse's supervisor to help sort things out. It works in reverse too. The nurse can talk to her boss who can talk to the doctor's chief of service. It's called "communication," one of the very things Nurse Brown says is lacking.
One of the reasons so many doctors are depressed and burnt out is the seemingly endless supply of articles like Nurse Brown's blaming us for everything that is wrong with medical care in the United States.