Thursday, September 21, 2006


I have noticed lately that most of the people I am forced to speak to during my day seem to have no understanding of language.
Words are powerful things. Tone and inflection bring words to life and help us interpret the meaning of those words. Lately I have lost any tolerance for a certain subset of language manglers.
They are the people that when confronted with specific facts always reply "really? Are you sure about that?". This makes me crazy.
I am tempted to reply "why of course not, I just made it all up".
When I am forced to speak to a doctor I stick to the facts. So why do I have to listen to "Really?" "Well I am not so sure about that".
What are you not sure about? That the patient has a temperature? Or the lab reported a positive culture or the patients blood pressure is really low?
What the hell? I am reporting facts. This is not a subjective opinion or some new philosophy I dreamed up.
It's a language problem. Most people have no idea how irritating this is. Hell, they aren't even aware of how damn insulting is.
I am attempting to devise new strategies in my replies.
I have tried not responding at all. This confuses the hell out of them. It has the benefit of making me laugh. I enjoy watching the expressions flit across their face. First the puzzlement, then a flash of irritation. Some figure it out and smile and say sorry about that and we both have a laugh. Sometimes they just repeat the same accusation. Then I ask them what they wanted me to say. They are befuddled. I offer different variations of the facts.."Would you like it better if I said the patient doesn't have a temp and that culture thing? I just made that up?".
I try to tell them that communication is important. When you communicate poorly the patient suffers for it. Professionals need to speak properly to one another.
They all nod politely and agree and the very next day it starts again.

This group also has another failing. They want their hands held. They want nursing to get everything for them. They want progress notes or doctor order sheets or they want everything set up for them to do a procedure.
I wont do it much anymore. The only time I get notes is during your first week in the unit and I take the doc with me and show them where everything is. After that they are on their own.
I do the same for procedures . I discovered that if you handhold your docs they are disasters in an emergency. They are helpless and useless because they don't know where anything is or how anything works.
I figure if you are a fellow you know how to put in a line. You also know how to set up a tray so you can do your procedure efficiently.
I have been proven wrong a few times.
In nursing we are taught over and over how to set up our trays so that we wont have to take off our sterile gloves to go gather some supplies we didn't know we needed. I have seen some docs so completely clueless it freaked me out.
I know that every doc has to do a surgical rotation. This is when they learned all about sterile fields and dressings. I think a few docs slept through this rotation or they had nurses do everything for them.

I am not heartless to the new guys. Everyone needs an orientation to their surroundings so the first few times I take them with me as we gather up all the stuff they are going to need. Once I am reasonably confident they have their bearings they are on their own.
They don't like it. They want everything set up and me standing at the ready to fulfill their every whim and I call bullshit on that. I am busy as hell. I don't have time for handholding or servitude.
Line insertion prep isn't brain surgery. The tray is prepackaged. All they need to get is some sterile gloves and some sterile towels which helpfully are on the procedure cart. A cart that is devoted to procedures, it even has wheels so you can roll it right to the bed! Everything else is in the damn package. But they want me to open the package because in a true dumb ass move they put their sterile gloves on first and are standing impatiently at the bedside waiting for someone( a nurse) to open the tray they could have opened themselves.
This behaviour is mostly a power play. The implication is the nurse has nothing to do but service my lazy ass.
I just tell them to get another pair of gloves because they forgot to set up their tray.

The other day I had to arrange a test and I was passed through seven different people, each one declaring "it's not my job". More than a few were doctors. The test was emergent and the patients life depended on it's results. One doctor I talked to gave me a lecture on how to use the hospital phone book because he was a very busy man and it wasn't his job to give me the phone number of the only guy who could arrange this test.
I explained the situation and he point blank told he didn't care, I was wasting his time and he was a very busy man. This man was a radiologist, a doctor that has no patients, has no responsibility for any patients and spends his day sitting in a dark room reading films. But he believed he was more important, his time was more valuable than mine or my patients. Incidently he was the only guy who knew the guy I desperately needed to talk to.

I cannot tell you how this just blows me away every time it happens. Sometimes it happens a few times a day.
It's all about language. I am sure this doctor is a caring and compassionate man that does a great job but when he opens his mouth he chooses words that make it impossible to see him that way.
Sometimes docs will respond to something you say with flippancy. That galls me too. They don't listen. Sometimes they have their answer ready before you have finished explaining your concerns..It's always a flippant response.
I had to stop the group one morning and say "that is not the response I want to hear". I carefully explained the problem again and the potential tragic outcome if the problem was not addressed. They stopped being flippant and understood...This is someone's wife, daughter, mother. We all are flippant sometimes but nurses are more careful about it.
We are quietly, privately cynical. We don't share that during rounds when every subspeciality is present. It's unprofessional. It's dismissive.

I want to be a constant patient advocate but I am sick of doing everyone's job for them. I am tired of walking doctors through possible treatments for life threatening events.
I want to be surrounded by confident, exacting, brilliant and experienced doctors . I want to be able to do my job and have them do theirs so we can work towards a common goal.

I think after four years of medical school and four years of residency you should know how to treat symptomatic rapid afib. . You should be able to set up a dressing and procedure tray all by yourself with a minimum of hand holding.
I went to nursing school and learned this in three years.

I know that the docs have a huge responsibility. They have thirty patients to my one. That still doesn't release them from the responsibility of language.
Using a dismissive tone or tossing out a flippant response causes me no lasting damage but for the patient? How can anyone be dismissive of the needs of someone so completely helpless?

I take a lapse of language as an affront to the dignity of my patient.
When we are on rounds discussing my patients needs that is the time to be serious. When we are all standing around the nursing station eating donuts it's time to be flippant.

Language is all about time and place. It's about your relationships. Language reveals how you feel about things.
I would think that the hospital is truly the one place where you should take the time to consider carefully what you say and how you say it.

Maybe it's just the unit I work in that is so incredibly dysfunctional.I like to think that somewhere someone is doing it right.I wish I could find that place, I think I would love to work there.


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