ploughboy Posted August 9, 2011 Report Share Posted August 9, 2011 First, keep your cool, don't be antagonistic, and potentially even apologize to defuse the situation (even if you were not at fault). Absolutely. Even if you were right, you were wrong and you should apologize. Grovel if you have to. It's not worth "winning" in the short term. I'm sure there are analogies to marriage in there somewhere, but I'm not going to be the one to make them. Then, file an incident report. That's what they would do to you. Or bring it up with the nurse manager/supervisor. Actually, she would file an incident report and then go on break. I'm totally in the wrong profession. "Break". Seriously? I like your second point ahead of your first one. A few quick words with the charge nurse ("What's up with Gertrude? Why is she so short-tempered tonight?") will go a long way and let you know whether that nurse has a reputation for being difficult with the residents, whether something more acute is going on or whether you are in the wrong. But you're staff and I'm not, so mileage may vary... Link to comment Share on other sites More sharing options...
aaronjw Posted August 9, 2011 Report Share Posted August 9, 2011 Absolutely. Even if you were right, you were wrong and you should apologize. Grovel if you have to. It's not worth "winning" in the short term. I'm sure there are analogies to marriage in there somewhere, but I'm not going to be the one to make them. Happy wife, happy life. There, i said it lol Link to comment Share on other sites More sharing options...
ploughboy Posted August 9, 2011 Report Share Posted August 9, 2011 We interact with a huge amount of different people throughout our training. You are bound to come across a few you aren't going to get along with, or that are just going to be difficult people. I feel very sympathetic toward nurses in academic centres, especially the senior ones. Imaging this: you've been nursing for over 20 years, you've done some ICU, some emerg, some CCU, you've worked in the ass-end of Nunavut where the medical station consisted of some sterile gauze, some tongue depressors, a telephone and you all by yourself dealing with some really sick patients. You've seen everything and done everything and, while you may not be able to generate a 25-point differential on the causes of horizontal white lines in the fingernails, by God you can tell when somebody is sick and when they're not. And then July 1st rolls around, and some wet-behind-the-ears intern is on overnight looking after your ward. You have no idea whether that 'tern is going to be good or terrible; you're not quite sure if he's on-service (in which case you'll be seeing him a lot over the next five years) or off-service (you'll never see him again) but you're pretty sure (s)he has never seen anything like this and doesn't know what to do. Do you do the right thing in the right way ("Doctor, do you think we should bolus the patient, check his electrolytes, get an EKG and order a stat chest x-ray?") or do you let him/her swing in the wind and maybe yell at him/her a bit for being such a dumbass? The former is better for the patient, but the later is so, so gratifying... Link to comment Share on other sites More sharing options...
aaronjw Posted August 9, 2011 Report Share Posted August 9, 2011 The problem with that story is the nurse forgets where she came from. She was once green and a dumbass as well. People all too often forget where they came from when looking down on others for the same things they, too, probably did at one point. I am and have been guilty of this many times in the past. As i get older i learn to recognize situations so that i can be a leader and teacher over a brute and an *******. I feel very sympathetic toward nurses in academic centres, especially the senior ones. Imaging this: you've been nursing for over 20 years, you've done some ICU, some emerg, some CCU, you've worked in the ass-end of Nunavut where the medical station consisted of some sterile gauze, some tongue depressors, a telephone and you all by yourself dealing with some really sick patients. You've seen everything and done everything and, while you may not be able to generate a 25-point differential on the causes of horizontal white lines in the fingernails, by God you can tell when somebody is sick and when they're not. And then July 1st rolls around, and some wet-behind-the-ears intern is on overnight looking after your ward. You have no idea whether that 'tern is going to be good or terrible; you're not quite sure if he's on-service (in which case you'll be seeing him a lot over the next five years) or off-service (you'll never see him again) but you're pretty sure (s)he has never seen anything like this and doesn't know what to do. Do you do the right thing in the right way ("Doctor, do you think we should bolus the patient, check his electrolytes, get an EKG and order a stat chest x-ray?") or do you let him/her swing in the wind and maybe yell at him/her a bit for being such a dumbass? The former is better for the patient, but the later is so, so gratifying... Link to comment Share on other sites More sharing options...
ploughboy Posted August 9, 2011 Report Share Posted August 9, 2011 The problem with that story is the nurse forgets where she came from. She was once green and a dumbass as well. People all too often forget where they came from when looking down on others for the same things they, too, probably did at one point. I am and have been guilty of this many times in the past. As i get older i learn to recognize situations so that i can be a leader and teacher over a brute and an *******. Indeed. The weirdest thing I've found about being a senior resident and having some experience is interacting with juniors who are making the *exact same* mistakes I made as a junior. Talk about teachable moments! Link to comment Share on other sites More sharing options...
Doctor_Strangelove Posted August 10, 2011 Report Share Posted August 10, 2011 The problem with that story is the nurse forgets where she came from. She was once green and a dumbass as well. People all too often forget where they came from when looking down on others for the same things they, too, probably did at one point. I am and have been guilty of this many times in the past. As i get older i learn to recognize situations so that i can be a leader and teacher over a brute and an *******. Exactly... you have to remember that you were near a complete retard too when you started walking the hospital wards. The difficult thing is to differentiate between somebody who lacks experience (like most young clerks do), and somebody who is incompetent and acting inappropriately in a situation that he or she has been trained to handle. EVEN THEN, you don't corner that person and start insulting them; rather, you provide constructive criticism and feedback. Unfortunately, many people are simply pricks and there's nothing you can do about that. Once that ignoring thing happened to me too, and the doctor was completely ignoring me. Let me tell you I scared the **** out of that doctor when every morning I was there to greet him/her with a smile and a big hello (to which he/she sometimes never even responded too haha!). Eventually, they stopped being such an ******* lol Link to comment Share on other sites More sharing options...
Ian Wong Posted August 13, 2011 Report Share Posted August 13, 2011 This is all part and parcel of growing the thick skin that you need to develop in order to function efficiently. Most of the time, if someone's yelling at you, it's for two possible scenarios: 1) You've done something really bad, in which case your job is to never repeat that. 2) It's not really about you, and you happened to be an available target in the wrong place at the wrong time. The most important thing is to avoid escalating the argument further. It only makes you look like a hothead, and particularly if you are the junior person in the conflict (and typically you will be), you end up looking worse for it afterwards. What I've noticed in my short time out in private practice, is that things seem to be a lot smoother in the community. There's less egos, and people seem to be more interested in getting cases done so that everyone goes home, rather than be obstructionist and be rigid in what can and can't be done. From my point of view, if that means figuring out a way to slide a patient into an MRI slot sooner, or to get that staging CT in early so they can make their appointment with the surgeon a few weeks sooner, or staying late so we can do a RLQ U/S to rule out an appy rather than CT a peds patient, I'll do it. In return, I know that if things go south with a patient in our department, I have lots of clinician friends who will be happy to help me out. That feeling of comraderie is huge. Ian Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 13, 2011 Report Share Posted August 13, 2011 Good advice Ian. What I've noticed in my short time out in private practice, is that things seem to be a lot smoother in the community. There's less egos, and people seem to be more interested in getting cases done so that everyone goes home, rather than be obstructionist and be rigid in what can and can't be done. I've heard the same from others, and wonder why this is the case. Is a culture of inflexibility passed down to trainees (which I am trying to change in our program), does the increased siloization in a large centre lead to more feelings of "us vs them" and less interdependence, are the incentives and allocation of work different...? Link to comment Share on other sites More sharing options...
KennethToronto Posted August 14, 2011 Report Share Posted August 14, 2011 Being *shat* on is just part and parcel of being a clerk/resident. In fact, they should start writing it into the rotation objectives. Link to comment Share on other sites More sharing options...
cheech10 Posted August 14, 2011 Report Share Posted August 14, 2011 The incentives are different, at least at the housestaff level. A resident who gets a consult or request for a study adds to his workload, with no increase in compensation, but by delaying it for a day, it may get passed on to a different resident or clinical team. One of the good things about a fee-for-service payment system is that it creates incentives for people to get things done, and altruism alone can be a hard sell in the middle of a long shift. Link to comment Share on other sites More sharing options...
Smurfette Posted August 26, 2011 Report Share Posted August 26, 2011 Good communication goes a long way. ie. Oftentimes, nurses will be upset that a resident takes a long time to put in orders/assess a patient/etc because (unbeknownst to them) the resident is in emerg seeing a sick patient. Tell them. eg. "I will get to it as soon as I can, but unfortunately I am dealing with a crashing patient in emerg." No matter what you do, you'll sometimes be yelled at for no reason whether it's by nurses, other residents, attendings, etc (I definitely have on multiple occasions), but there are things you can do to minimize this. And re: consults from other residents. I think you should never be rude to anyone ever. It's a small world - what goes around comes around. On-call last week, I took a "bad" consult from another service at 3am. I did it with a smile. Two days later, that same resident who gave me the "bad" consult agreed to take on a borderline admission from my service and actually noted that he did this in part because he appreciated me helping him out a couple nights earlier. If you get a rep as that jerk resident, you'll decrease your negotiating power when you really need it and your life will be much more miserable. Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 26, 2011 Report Share Posted August 26, 2011 Fully agree with the above post - excellent points to remember. Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 27, 2011 Report Share Posted August 27, 2011 Also very true. However, things get tricky when what is best for one patient is not so good for others (triage/resource allocation). My main strategy is to be transparent and hope that others are reasonable. Any other thoughts? Link to comment Share on other sites More sharing options...
questforstarfish Posted August 27, 2011 Report Share Posted August 27, 2011 When people treat you badly, often there is a reason although it may have nothing to do with you. Nurses have a lot of reasons to be nasty. I think its amazing that most really are pleasant and professional most of the time. Nurses work long hours doing physically and emotionally challenging work. They get very little glory or thanks. No one ever got rich being a nurse. They have little control over their work. They have to take the patients they are given and work within rigid guidelines created by hospital administrators. They have to take orders from doctors who sometimes give them little respect. Patients and their families often treat nurses very poorly. In addition, nurses have personal lives like the rest of us. You never know what stress they have going on there. Maybe they have a sick parent, a teenager they can't control or a marriage that is falling apart. In addition to all this, nurses have very few outlets for their frustrations. They can't yell at the patients, the doctors or the administrators. In fact, a major problem for nurses is horizontal violence. That occurs when nurses get crap from all around them (patients, doctors, administrators etc). They can't give it back to the people they get it from so they take it out on each other. Now, I'm not saying that any of this gives a nurse the right to ream you out unreasonably. But I do think that if you take a moment to consider where the frustration the nurse took out on you came from it might help you to understand that it wasn't personal and that can make it easier for you to let it go. Bingo. Thank you for that. Just based on what you've said here I can tell you're going to be one of those doctors that people LIKE to be around and WANT to help out! I'm currently in nursing school and working as a care aid (pre med) and I can tell you everything you've said is true...doctors get ******* patients, angry families and rude coworkers but the stuff nurses and care techs have to put up with is unbelievable sometimes. I personally have been hit/kicked/punched/scratched more times than I can count by patients with dementia and mental or emotional issues, screamed at in the hallways by family members, nurses and coworkers, harassed by management and called dozens of horrible things. I know many other nursing staff who have received much worse. There is no excuse for treating anyone badly, but there are definitely reasons there are so many miserable and cranky nurses, just like there are for doctors and just about every other job out there! Don't put up with abuse but trying to see the reasons behind people's behaviors can help make the situation easier not to take personally Link to comment Share on other sites More sharing options...
moo Posted August 27, 2011 Report Share Posted August 27, 2011 I was a care aid for three years once. I know how bad nurses have it. But as a med student, you will get yelled at by nurses. Most nurses are nice, but in general, the transition from textbook learning (which the majority of med students had been doing for 6 or more years) to real life is hard for some. The pinnacle of your career is when you're a first and second year med student; you feel superior to your undergrad cousins but really don't have anyone above you to be accountable to (other than your courses which by this time you've done well enough such that you shouldn't have problems). Once you get on to the wards, real life hits you. When I was a medical student, I took it from everywhere... the patients (there will always be patients who don't want to deal with a student), residents, attendings, nurses (who by and large have way more clinical knowledge than you when you're a 3rd year). Even nursing students seem to have more respect than you. But things get better. By the time you're a resident, you know stuff and nurses start to respect you. It gets better. But third year was hell and I would never ever want to go through it again. Link to comment Share on other sites More sharing options...
Icebox Posted August 27, 2011 Report Share Posted August 27, 2011 thanks moo looking forward to it.. I enjoyed third year - everyone has a different experience. I think most people come to the consensus of not wanting to do it again simply b/c you're going through many rotations that you don't choose, and which have nothing to do with your personal interests and/or future specialty. But it's still something to look forward to, as you'll see and do things that you will probably never have the opportunity to do again as a learner. Link to comment Share on other sites More sharing options...
A-Stark Posted August 28, 2011 Report Share Posted August 28, 2011 I can think of very few downsides to third year and it certainly never approached anything resembling "hell" (well, maybe rounding for neurosurg in the ICU at 5am while on call qualifies). It's been a great experience... I just wish there was some more time to figure out the "big questions" as the CaRMS deadline approaches. I've liked most if not all of my rotations - at least I can think of good sides to all of them despite some negatives. Generally speaking, my interactions with nursing staff have been very positive. Only three weeks left until Med 4... Link to comment Share on other sites More sharing options...
Dany Posted August 30, 2011 Report Share Posted August 30, 2011 R.N. = Reads Notes M.D. = Makes Decisions LMFAO!!!c :D but srsly, sh!t happens, no big deal, anyways it's WAY better than being yelled at by your staff right? Link to comment Share on other sites More sharing options...
OttawaURookie Posted August 31, 2011 Report Share Posted August 31, 2011 i would honestly stand up for myself. i don't let people bs with me. just because you are above me doesn't give you a reason to do ****. Link to comment Share on other sites More sharing options...
Renin Posted August 31, 2011 Report Share Posted August 31, 2011 i would honestly stand up for myself. i don't let people bs with me. just because you are above me doesn't give you a reason to do ****. By the tail end of clerkship, I could care less if someone wanted to yell at me for no reason, below/above me. Trying to be non-confrontational. Slide under the radar... Link to comment Share on other sites More sharing options...
xIcewind Posted August 31, 2011 Report Share Posted August 31, 2011 By the tail end of clerkship, I could care less if someone wanted to yell at me for no reason, below/above me. Trying to be non-confrontational. Slide under the radar... Take note guys, this is how you should go through clerkship. It's much better to do this than to talk back. Link to comment Share on other sites More sharing options...
thehumanmacbook Posted August 31, 2011 Report Share Posted August 31, 2011 For those of you who are interested: http://www.google.com/url?sa=t&source=web&cd=2&ved=0CCUQFjAB&url=http%3A%2F%2Fwww.carnegiefoundation.org%2Fsites%2Fdefault%2Ffiles%2Felibrary%2FCarnegie_Flexner_Report.pdf&rct=j&q=Flexner%20report&ei=GdNdTsaDA5DfgQfU3KnrAQ&usg=AFQjCNGNz3_YeUp5qMzQ1MAdew7ilv1nGg&sig2=B0TEAdTlVZL-6dR2B6RGxQ&cad=rja That's the Flexner Report Brooks was talking about, 1910. And I have to agree with his thoughts. Link to comment Share on other sites More sharing options...
leviathan Posted September 1, 2011 Report Share Posted September 1, 2011 By the tail end of clerkship, I could care less if someone wanted to yell at me for no reason, below/above me. Trying to be non-confrontational. Slide under the radar... Can't say it any better than this prolific writer / anesthesiologist on SDN: "Bow Your Head." http://forums.studentdoctor.net/showthread.php?t=548150 Link to comment Share on other sites More sharing options...
apache Posted September 2, 2011 Report Share Posted September 2, 2011 There's also an amended version: R.N. = Reads Notes, then goes home at 4 to sun tan and have drinks M.D. = Makes Decisions, has to handle the patient and ends up in the hospital overnight and into the next day ... unless he/she's in psychiatry... then it's Haldol and handle in the morning Link to comment Share on other sites More sharing options...
Pantaloons Posted September 15, 2011 Report Share Posted September 15, 2011 Link to comment Share on other sites More sharing options...
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