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Surviving Modern Healthcare: Dealing with Intimidating Physicians

Throughout our lives, we are always going to be in situations where we will need to deal with difficult people whether they are physicians in the work environment, co-workers or people in our personal life. In my 35 years of experience in healthcare administration and as a CNO, I never tolerated abuse of my staff in any way, and over these years I had been involved in several investigations that have led to the discipline action or loss of privileges for abusive physicians. Abuse of physicians by nursing staff was also not tolerated and probably as many nurses lost their positions for inappropriate behavior over the years. Especially with the need for healthcare workers to function as a team, it is critical for people to treat each other with respect and dignity. All that said, there are still going to be situations where nurses are abused by physicians and other people in the work environment and there are things to do to prevent, minimize and resolve such issues.

Abuse from physicians is difficult to handle because nurses are, for the most part, under pressure throughout the course of the work day. When abusively confronted, there is a loss of balance and personal control that arises first followed by an assault to the ego, which evokes an emotional response of anger, hurt and insignificance. Because the ego needs to feel accepted at all times, this response is intensely uncomfortable and painful. There are three choices when confronted with this type of situation: we can run from it or avoid it, handle it poorly or handle it well. The choice is ours but it is important to introspect and remain in control.

Patteron, Grenny, McMillan and Sentzler (2002) in their book Crucial Conversations identify several strategies to help you decrease your emotional response and keep you in control. They include:

The first step is to first introspect and analyze what the problem is and what your feelings are toward the situation, which now identifies your stand in the conversation. During this step it is critical to place the patient at the center of the conversation and the only goal being a positive outcome for them. It is important to realize that this is not about you but the patient. The next step is to find your bearings and get ready for the discussion, as well as controlling your body language to stand straight, do not retreat and continue to exude an aura of self-confidence.

Learn to Look

When dealing with difficult people, oftentimes it is not a surprise that they will act poorly and you can be ready for that. When we learn to look proactively for situations, it is easier to handle. First of all, you can watch the conditions that lead to poor behaviors. Is it a surgeon that usually acts badly when there is a difficult case on the board or when it is excessively busy? Also be aware of safety issues. Will a bad confrontation affect the quality of patient care? Will it endanger the safety of other patients or staff? How serious do you think the outcome of this communication could be? It is important to prevent silence to violence in the work environment

Make It Safe

With difficult confrontations it is important to keep the conversation safe, by establishing a mutual purpose which, in this case, is the patient. Always behave respectfully toward the physician in the hopes that mutual respect will be returned. Apologize only when appropriate and apologize only for the individual’s perception of the situation and not for something you did not do. Step out of the conversation if you need to, by simply saying “I am choosing to excuse myself and we can pick up this conversation with others in the room.”
Master Your Story

Be prepared and know your story that you will present. Also, understand your personal feelings and be aware of the fact that it is common to be upset and off balance in such situations. In the conversation, stick only to the facts pertinent to the conversation and leave other topics, especially those that are emotionally charged, out of the discussion.

State the Facts

Throughout the confrontation stick only to the important facts and keep the conversation as simple as possible. Always attempt to return the conversation to the important facts at hand and to focus on what is important for the patient.

Lastly, when all else fails, it is important to reach out for help when necessary. It is not acceptable to be treated poorly by anyone in the work environment and all organizations should have a zero tolerance policy to this type of behavior. Speak to your manager, and if the manager does not address, you need to go up the chain of command. In my experience, it always frustrated me when someone would say, “that’s just the way he/she is”. My response was always, “well, that is not acceptable”. Over time, adopting an expectation of mutual respect and dignity will tremendously improve the work environment for all.

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