A couple of days ago I posted a cranky rant that most doctors can relate to. But folks aren’t too interested in what doctors think, apparently, so let’s examine what others think.
I confessed my behavior to a number of nurses in a local hospital, and the summary response was, “I would not wake a doctor up for a throat lozenge, and don’t be such an asshole.”
Responses on the blog were roughly of two types: nurses need to do their jobs so you should take whatever they dish out you arrogant prick; you’re an arrogant prick; and hospitals should create rational policies, you arrogant pig.
I’ve been accused of arrogance before, and I don’t think I’ve denied it exactly, but I have argued that arrogance is a distractor. When doctors make mistakes based on their own sense of infallibility, this is an arrogance problem, but also a systems problem that is fairly easily fixed.
But the criticisms in the comments need some parsing out to find out what in there is most important.
First, any criticism from a nurse rises to the top. Nurses spend the most time with patients and have a big hand in training young doctors. This doesn’t mean that they are always right, but that their opinions often save lives. Several of my friends made the point succinctly, but it boils down to this: no matter how idiotic a call (and some really are), it is never good to act in a way that discourages calls from nurses. If they are too scared of your temper to do their job correctly and fail to call you, you as a physician share a good deal of the guilt.
This responsibility goes both ways, of course. In caring for a patient, the nurse and doctor must work together to do things right, and to maximize their own ability to get things right. As a physician, I can’t stomp around yelling at nurses, and nurses can’t just refuse to follow doctors’ orders without going through a certain protocol. They also shouldn’t call a doctor every time a patient sneezes. It’s not “wrong” to do so, but it’s not a bad idea to ask a colleague first, as you may need a wide-awake doctor later for a serious problem.
This balance usually works quite well, which is highlighted by the fact that we like to tell stories of the few times it breaks down.
Next, I’m sticking to my point of doctors not being locked in a booth like a veal calf being force fed lucky charms and amphetamines. We are a limited resource. We don’t work all day and all night because we love sleep deprivation but because that’s often the only way. We are not paid for this in suitcases full of million dollar bills. We have families, we have our own health to look after, and we have other patients to attend to. To accuse me of being a whiny baby who needs to find a new job is a statement of stunning ignorance.
I have written very often of the special responsibilities we as doctors have. But society must remember, just as we must not behave like gods, you must not have god-like expectations of us. If you think any primary care doc is getting rich working all day in the clinic and hospital and then taking calls all night, you live somewhere I would like to move to.
I have a choice not to care for my patients in the hospital, and some day I may avail myself of that choice. But at present, the balance favors my staying. My patients appreciate it, and I think I bring something to their hospital care that a hospitalist cannot. The trade off is disruption in my family life and my sleep, and the affect on my mood, which I chose to share with you with my lozenge anecdote.
If you’re not sitting in the doctors’ dining room or the doctors’ work room, you’re not going to hear this stuff. It may be a bit too much like sausage making for your taste, but it’s real, and I’m not going to start lying to my readers to make myself look good or to tell you what you want to hear.