Consults

I have had many good conversations with specialists over the years.  Orthopedists who have been extremely helpful.  General surgeons who come to the department to evaluate a case.  I have worked with oncologists who kept me updated on the status of a patients' course after a diagnosis of cancer in the ED.  But then there are the few who make me want to scream.  The docs who huff and puff on the phone, swear about being called at home at midnight, and generally make my life a nightmare.

The question I have is, why?  Why you gotta be so mean!  I just don't get it.  I think I have lost my patience with staff about five times in the nearly twenty years I've been in the ED.  I get asked all kinds of stupid questions.  I am interrupted a hundred times a shift.  I have to direct new nurses and techs as they assist me in procedures.  I have to explain things all the time.  I don't yell at them.  I don't swear at them.  I generally stay calm, answer questions, and move on.

I don't understand how these specialists can be such jerks.  I can't imagine getting on the phone with someone I don't know and swear or scream or just generally be an asshole.  For instance, just last week a family refused to have me repair a lip laceration on their eleven year old son.  It was, admittedly, complicated and would be best managed by plastics.  So, I called the plastic surgeon on call that evening.  I gave him a brief run down of the injury: "The family wants you to come in.  It is a complicated repair.   We will need you to take care of this".  His response - "I can't believe this! And what if I refuse to come in!!" This was followed by about fifteen seconds of silence and then he hung up on me.  He barreled into the ED about fifteen minutes later yelling at everyone he could find and making a real fool of himself.  But, we needed a plastics consult.  So we held our tongues and just dealt with him.

My kids learn all bout bullying behavior in school.  They learn to get an adult to help.  They learn that it is never OK.  They learn to tell the bully to stop.  They are told the adults will intervene.  What do you do when the bully is the adult?  This kind of stuff makes me crazy!  This is the stuff that leads to burnout.  

When I was a new NP I felt pushed around all the time by specialists, hospitalists refusing to admit patients, etc.  Then one day I had hit my limit.  A patient was being admitted and ortho would need to consult in the morning.  The orthopedic surgeon returned my page swearing and screaming.  I had no idea what his deal was.  It was way out of line.  It made me anxious and agitated all night.  I have a hard time letting this stuff go.  So I found his work email and contacted him.  I told him straight up that his behavior was completely inappropriate and it was his job as the on call doc to answer questions and see patients.  If he ever acted that way towards me again I would report him to my department head as well as the Chief Medical Officer.  He acquiesced, apologized, and thanked me for giving him the opportunity to correct his mistake.  What!!  That's all it took - standing toe to toe with this guy and calling bullshit.

I guess I forgot that lesson with Mr. Plastic Surgeon.  Next time I will strap on my big girl panties and go toe to toe with the consultants when their behavior is juvenile and inappropriate.  It's just like we teach our kids about bullies.  Bullies back down when you get in their face.  But seriously, why you gotta be so mean?!