Physician Relations and Communication

Probably one of the most feared aspects of becoming a new nurse is "calling the doctor". It's not easy to do your first time or two, but you eventually learn...sometimes the hard way...but you do learn. Some physicians want very detailed information, some want a very brief synopsis of events, some like to be called with updates (although I haven't met too many of these), and some don't want to be bothered with anything, it seems. We learn by trial and error, appreciating personality types as much as anything else. But why is this? You don't see too many physicians fretting over calling a nurse. None of them try to carry out "cluster calls", whereby questions on several patients from several practitioners are carried out during one phone call. I have yet to hear, "sorry to bother you, nurse..." Now I'm not saying their roles are not important, and their stress level isn't high, but let's face it, we are all in the same boat. Why can one group be allowed to continually "rock" it, without regard for who may fall overboard, while the other dare not even think of "making waves". It's because we have set a double standard, like it or not. The nurse's role has been of the "follower of 'orders'", responding simply with "yes doctor, right away."

There is a time and place for everything. Perhaps in the early days of nursing, when we were attempting to establish ourselves as a profession, and when physicians were the ones training nurses, this is how things were. As our profession has grown, and the field of nursing science has developed, we have yet to break away from the, "at-your-service assistant". Nurses have a very important function within healthcare: to care for patients. Physicians do too. However, it is how we do this, or under what guidelines we practice that makes all the difference. Nurses are not trained as physicians, and physicians are not trained as nurses. Simple enough. Simple enough, right? Well, why do we, as nurses, feel that it is ok for us to be treated as "physician servants", rather than professionals? Now I realize I am making several generalizations here, but I know that many nurses can relate to these issues. I can almost guarantee you that you have witnessed more unpleasant interactions from physician to nurse, than from nurse to physician. We tolerate it because we are indoctrined to do so. It is the unwritten rule.

But why must this be tolerated? Why must we allow this to continue?

Because we want to keep our jobs? Because it's just the way it works? Really? Is it "working"? I'm afraid not.

I am not at all bashing physicians. I have the utmost respect for their education, training, and responsibility to the patient. They are one of the most important components of the healthcare system...but not the most important. I just don't believe it is very becoming of a "profession" to tolerate this sort of interpersonal/interprofessional communication. Ever heard of transference: going home to yell at your family because you were treated in a similar manner at work all day? Well it seems to me that this is very similar to what we have been reduced to. Just look at the phrase "nurses eat their young." Why is that? For a "caring" and "nurturing" profession to make an exception for one of their own? Why do we do that? Why on earth would we allow that? Physicians take their frustrations out on you, so you do the same to the new nurses just because you were treated that way...or perhaps so they will become as callused as you?

There is a great opportunity to be seized when a nurse and physician can communicate effectively and professionally. We have a great deal to learn from one another. When we take the patient out of the conversation, we lose sight of our purpose. We let circumstances and emotions drive our conversations. We should expect to be treated with the same respect and dignity that we extend to others. If we are being berated in a patient care area, in front of family and colleagues, we should respectfully decline to continue the conversation in such a manner. Mistakes happen. Things can be overlooked. Blame is so much easier to give than accept. Perhaps the order was delayed because it had taken 4 nurses to interpret the penmanship, and only then a "best guess" was initiated. None of them dared call to clarify the order...it is just not how that situation is handled. We stop what we are doing to interrupt others to burden them with the task of interpretation. Physicians write constantly all day. I get that. Sometimes handwriting can get a bit sloppy. I get that too. What I don't get is why we do not do what is best for patient safety, and call for clarification. Why? Because we do not want to get our "butts chewed off" over the phone for bothering the doctor for something so "stupid". Really? If your child were the one about to receive someone's "best guess" of an order...or did not receive something because of the same, would you still agree that it is best not to bother the doctor for fear of being yelled at? No way! We all have a duty to the patient. Get that? The patient.

We can all play nice in the sandbox. I have experienced both sides of the conversation...good and bad. But each time a negative interaction took place, I had to reflect on my part of the situation. Did I have the necessary information at hand before communicating with the physician? Did I examine the situation carefully before hand...using critical thinking skills before contacting the doctor? (That's right, thinking.) Perhaps I am the one to blame a few times. I accept the fact that to be the 50th caller of the day, about an issue that did not really necessitate interrupting the physician during his/her busy schedule, may result in a less-than-optimal verbal exchange. I cannot accept being the 50th caller to interrupt the physician for a situation that can only be rectified by a physician, and be the object of frustration and annoyance. Sorry, Charlie, that's my job, and I would do it again in a split second.

We have the opportunity to gain great favor with physicians by following orders as best as we can, and within the scope of our practice. We can do our best to anticipate patient (and physician) needs, and take care of as many as possible with the least amount of "pestering". We can pull ourselves together, get our heads on straight, put our efforts toward practicing professional nursing, and keep the patient's health and safety as our priority. We can also expect to be treated as professionals. We are not "lower on the food chain", unless we allow ourselves to be. We are not "equals" by credentials, but we are by our service to the patient.

I have the opportunity to interact with many physicians throughout my workday. I enjoy the opportunities I have to help educate them on my role and how they can improve their work product. I don't tell them how they should practice medicine. I don't tell them how to do anything. I simply offer suggestions for improving their documentation. That's it. I get to build rapport with the physicians, letting them see what nurses can do, what we can offer, and more importantly, how we can really be of assistance to them. We are there to support them and help them carry out their professional duties to the patient. We are their eyes and ears when they are not at the bedside. We must be effective in our thinking and our communication abilities if we ever hope to raise the nursing profession to the level it should be within healthcare. We have a great deal to learn from one another. Our roles are not interchangeable, but our professional expectations should be.

Thank you.

Steve