Thursday, May 11, 2006

Subjugate

It had been a fairly routine vaginal deliver, performed by an OB resident with a medical student assisting. I'm pretty sure the medical student was new to OB, because I hadn't see him before at deliveries. Apparently a hemostat was missing, and the circulating nurse was asking around for it. "There's one in the bucket," the medical student said. Instead of thanking him, the nurse went off on a bit of a harangue about how it would have been nice if the med student had told her earlier, and the importance of that, and blah, blah, blah....

If a doctor harangued a nurse like that over a small thing, he or she would be appropriately criticized. Doctors, at least some of them, can be labelled as haughty egotists who fly off the handle and really lay into people. Sometimes that criticism is accurate and deserved. However, it's not just doctors in hospitals who can belittle another person. I think it's anyone who has a position of authority over another person.

I remember as a medical student being scolded by nurses; scrub nurses in the operating room come especially to mind. My first month in the NICU as a resident was no picnic, either. It's a strange new environment, and although most of the nurses were pretty nice and understanding, there were some who used their familiarity with things and our unfamiliarity to give us a hard time and make us feel ignorant. Also, I worked as an orderly during summers in college. Trust me, nurses can be just as snippy and hard on orderlies as doctors can be to nurses.

So if you're not a physician and get disgusted when you see one acting like a pompous ass, think twice about how you would act towards a person subjugate to you in the same situation. Although we don't condone it, probably most of us at one time or another have been hard on someone lower than us on the social totem pole at work. Doctors just happen to be higher on that totem pole than most people. That's not justification for bad behavior, of course, but perhaps might give us pause before we're too critical.

13 Comments:

Blogger CGI-angel said...

This comment has been removed by a blog administrator.

9:24 PM  
Blogger CGI-angel said...

"Doctors just happen to be higher on that totem pole than most people."

......not a very nice thing to say, somewhat implies whoever has the bigger bank account is worthier as a person in society. (Doctors hardly save lives for free).

Apparently 58% of workplace bullies are women.

http://www.canada.com/globaltv/national/story.html?id=2f7bca02-f43d-4a41-bab8-e273c78a1b98

...........must be fun for med students to be working in such a high estrogen charged workplace.

9:27 PM  
Blogger Flea said...

Jeez, who's below me?

Flea

10:28 PM  
Anonymous maribeth, CNM said...

Classic oppressed group behavior, and nurses ARE terrible about it (to one another, as well). But I will tell you, residents who know how to 'play the game' do just fine. That means.... bring Krispy Kreme.

No, kidding. That actually means 'treat the nurse like she knows something for goodness sake'. Residents are struggling with power plays (understandably) but are often too proud to treat nurses as experts. They can not have a CLUE, yet still be too proud to ask the nurses' opinion. It's a swinging pendulum of abuse. Sooooo glad I'm out of that.

11:34 PM  
Blogger That Girl said...

I have always gone out of my way to treat anyone who is under me on the food chain with the upmost respect. Id be far more likely to be mean to my boss.
Perhaps this is why I have a hard time in a populated work environment.

9:14 AM  
Anonymous Shamhat said...

As you've described it, I'm not convinced that it was inappropriate. It's rather convenient for the medical student to learn that it's a good idea to speak up about having put a hemostat in a bucket at a vaginal delivery, where the patient isn't laying there open waiting for the X-ray.

I had a medical student walk into the room while a laboring patient was getting an epidural. She introduced herself and stuck out her hand! Of course the patient's head snapped up and her arm went out and the anesthesiologist began cursing...the student just didn't know enough about the routine to realize that it was poor timing.

9:37 AM  
Anonymous Anonymous said...

My father, who is a retired physician, is always reminding me, a nurse, to play the "dr-nurse game" a concept he read about in a medical journal in the late 60s.

This goes something like this:

Dr/resident: Let's start NG feeds of 50ml progestamil q4 on this baby.
Nurse: Yes Dr, certainly Dr. But Dr, maybe we should start gradually. Shall we start at 20cc and go up by 5 each feed?
Dr: Er, yes nurse, we'll start gradually. I'll write the order.

That's perhaps not the best example, but you get the idea- the nurse gently reminds and directs, so that the resident/Dr feels respected and almost that it was their own idea.

When my father first gave me a copy of this article (he had kept it all these years!), when I was in nursing school, I was horrified, it all felt so "handmaiden-ish" and old-fashioned. But now with some years of experience, I have to admit it can work very well, especially with less-experienced residents.

I think things vary by state as well. Having worked in a couple different regions of the country, I would say there are vast differences between how nurses and doctors interact depending on the overall healthcare environment of the state. And it varies by specialty as well.

10:21 AM  
Blogger NeoNurseChic said...

I'm not a pushover by any means and most certainly not afraid to speak up when I disagree with something in health care, but I'm never mean. In fact, a certain ER resident rotating through the NICU can thank me for doing all of his total fluid calculations each time we needed to make a change because he wasn't quite figuring it out. I'll help out - no problem with that. If I have a question or don't understand the rationale behind something, however, I'm going to ask. I'm not a blind lemming who just "follows orders." ;)

That being said, I've been working in health care since I was 16 years old. Started out as a volunteer in transport. Once a nurse was annoyed that we'd been called a day early to take a patient to a test and pushed the stretcher over my foot. I went on to spend 3 years working in dietary/nutrition. A doctor once was mad that I had a 200 pound metal food cart apparently in his way and shouted at me, "Some of us have places to be, HONEY!" and proceded to shove the cart into a wheelchair. I was constantly berated by nurses for being too early, too late, bringing the wrong tray, missing a new admission, etc. Thankless job - it really was. I spent a lot of time talking with patients in order to improve their experience, and they were the appreciative ones.

So I made a decision not to become bitter and then rip on everyone else as I continued to move "up the food chain" as it were. Next I became an extern. I worked first in renal/urology/transplant. One day I was given 11 patients on my list, 4 of which needed complete bed baths. One was a homeless guy with the bed alarm on. Another woman had an "accident" all the way from her chair on one side of the room to the bathroom on the other side of the room. Housekeeping doesn't clean up human waste. The nurse was too busy to help. I got to do it. I got stuck with jobs well over my head. So I quit after 2 months.

Even as a student, I was treated rudely or acted like I was just in the way. I love working with students, and I was surprised when this clinical instructor rushed down recently and said, "Oh YOU'RE the one that's been taking them around...they called you the best nurse ever!" Errr....really? I wouldn't go that far, but it was nice to hear. I do love teaching students - they only get a one day experience in the NICU and that's all the exposure they get, unless they are doing critical care there. If we want them to know what it's really like, we need to at least take them around and show them everything that's going on. I love it.

So I learned a lot by being yelled at, pushed around, dumped on, treated like scum. I don't do it to other people. I am appalled by the rudeness some people use when communicating to others. If my parents heard me act the way I hear some people act towards others, they'd be furious. It always shocks me, even though by now it shouldn't (especially since I work in Philadelphia which probably should be the city of brotherly hate, not love). Even if someone does something blatently wrong, it's always better to react with a level head and take a deep breath first if it makes you really angry. We've all been there.


Carrie

1:06 PM  
Blogger Ex Utero said...

Hey NeoDoc,

I'm using your site for educational purposes

http://talesfromthewomb.blogspot.com/2006/05/medical-student-blog-crawl-1.html

(write something professorial)

4:40 PM  
Blogger neonataldoc said...

Thanks, all. Let me start by saying that my personal philosphy is that we should judge people not by their income or social status but by their character. I don't mean to be not nice, cgi-angel, but in the social structure of a hospital, doctors tend to be placed fairly high, lthough it does vary from hospital to hospital. Actually, someone could write a book about the sociology of a hospital, and the doctor-nurse relationships, and resident-nurse relationships, etc.

And I'm not saying all people are mean to those under them. I can think of many nice people who helped me on my way to being a doctor.

Shamhat, it was okay for the nurse to tell the med student that hemostats don't belong in the bucket, but she could have done it in a nice way. That makes all the difference.

11:53 AM  
Blogger glorified midwife said...

i'm a med student about to graduate and be a doc...my worst experience was as a completely green third year when a surg nurse SCREAMED at me in front of everyone in the room after i touched something in the sterile field. i was nervous and very apologetic, but she never let me (or anyone else in the room) forget how i made everything "so much more difficult" for her. luckily i had plenty of other examples of great, helpful staff that could correct without being cruel. she will definitely serve as an example of what NOT to do now that i'll be in position of 'authority' (whatever that means).

6:39 PM  
Anonymous Dr Sidharth Sethi said...

hi !
good post indeed reminded me about my NICU days. the first days when strange sisters behind those masks wud ask me to keep this needle here , that syringe there, and teach me aspects of asepsis. but sometimes feel they were there 10 yrs back also , the time when i was in school.
so bottomline, we learn from all. no use of bossing around. but ya we god's priviliged ones to get someone to boss on and give orders
Well me a pediatrician in india
dr sidharth sethi
www.pediatricsinfo.com

4:23 PM  
Blogger The MSILF said...

I'm a med student, and I always try to be nice to everyone and learn from the nurses, and am shocked when doctors are jerks to them. However, some nurses are great, but some are absolute bi-otches, especially in the OR. I do get that it's hard to work with surgeons all day...but still...

All I think about when they do that to me or another student is, "...and they wonder why doctors abuse them!" Don't they realize that we are going to be co-workers someday? Seeing that makes me think, even though I hope I never get to that point, "Just wait til I'm in charge..."

4:35 AM  

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