Last week I was accepting a transfer patient from a surgery service. The notes were terse, which is both good and bad, and there were abundant notes from consultants that were hard to decipher. But no summary note. No list of the patient's active problems. I couldn't even figure out why the patient was no longer a surgical candidate based on the notes that had been left in the chart.
So I called the resident. I had to dig a bit before I found an actual extension to call.
And he was very polite! Gave me a fabulous summary! Clarified everything!
And then he asked me if I was the patient's nurse.
I wasn't offended by this. As a medical student I know way WAY less about most things having to do with the nitty gritty of patient care than the nurses do. I rely on them to give me updates about my patients and to care for them. And frankly, I am lower on the totem pole than everyone in the hospital. Residents, nurses, nurses aids. Even the people who clean the toilet.
But I still tell the nurses what to do. It's been a weird transition for me since they know so much more than I do. It feels weird for ME to tell THEM what to do. But it is what it is. That's just how things work in the hospital.
And I do know some things better than they do. On occasion.
Well anyway, I wondered why this surgery resident had thought I was a nurse. So I asked him whether he'd thought that because I was female.
I immediately regretted my inquiry. He was embarrassed, and got kind of terse after that.
So I apologized and thanked him profusely for his help.
But truthfully? I think that WAS why he'd assumed that I was a nurse. It's weird. On one hand, I have enormous respect for the nurses. On the other, I want people to realize that I am (or will be) the DOCTOR. It feels disrespectful to the nurses in a way to feel that way, but when it comes down to it, as awesome and invaluable the nurses are, the doctor is fundamentally the "boss."
After all of this training? I want the respect of being the "boss." Not yet, but eventually. I want people to know that I'm the doctor. Not to assume that I'm the nurse because I'm the woman.
Is that incredibly snotty of me?
22 Pearls of Wisdom:
If you think that "fundamentally" doctors are the "bosses" of nurses then you have a rough road ahead. Nurses and doctors are team mates in the game of patient care, each with roles that are unique and critical in that game. At every point in your career a nurse could very well know more than you, if not about clinical management then certainly about the individual you are treating.
Your thoughts aren't snotty, they are arrogant and dangerous.
By the way I am a woman and a physician.
I wouldn't worry. Take too much either way and you'll get the above commenter's attitude from everyone. It's likley b/c you're female, but it's unfortunately not changing anytime soon.
Anon -- Of course doctor and nurse are a team. If you read something else from my post, you clearly have a major axe to grind. I might add that you are a coward for not signing an actual name with a link.
Troll.
Thanks for the comment, RAG.
I definitely understand what you mean... I told a random person I was going to medical school a few days ago, and they were like, "oh you mean to be a nurse?" Shouldn't have bothered me but did. I love your blog.
Interesting that anonymous felt the need to clarify that she's a physician. So a nurse's comment wouldn't have as much weight, then?
My own attitude? I don't get upset when people mistake me for a nurse. But then, my mom was a nurse...
What makes me angry is when people are nasty when they think I'm a nurse and then all of a sudden, their tone changes when they find out I'm the doctor. Abusing the nursing staff? Not cool.
I don't think it's snotty for you to be want to be called what you ARE. Nurses and doctors are two different jobs. And yes, you're right that doctors are the ones who give orders to the nurses and call the shots, not vice versa.
I've read posts like this before, but what I find interesting about this is the fact that the resident gave you this whole detailed summary on the patient and he had no idea who you were. I'd certainly be embarrassed about that if I were him. Also, I have to be honest and say that if I had a nurse on the phone, I'd probably be more respectful to her (or him) than I would be to a med student.
I don't think that it is snotty to want people to recognize your role and your education. That is totally reasonable. You work hard to have MD after your name and deserve the title.
But as I nurse I have to say I don't see the doctors as my 'bosses' I see them as my physician colleagues. The nurse manager is my boss.
A boss is someone who hires you, tells you when you can take holidays, and gives you performance evaluations. Doctors do none of these things for nurses.
Doctors determine the care plan, nurses help to carry it out. Different positions on the same team, working toward the same goal.
True, ABB. Not a "boss" in the literal sense of the word. I don't see it that way myself. But there definitely is a hierarchy. Since I can't put my finger on what exactly this means, let's just leave it at that for the moment.
It does sometimes feel however, that female physicians are supposed to pretend that this hierarchy isn't actually there.
Fizzy -- Perhaps you just hit on why I don't like working for many female physicians. They treat me like ASS, and for no good reason, really. Not so much the case with the men, most of the time at any rate.
OMDG: I don't want you to think I treat med students like ass. I am actually super nice to them, in general... for example, I recently did an informal teaching session with a student and bought COOKIES for us prior. I also wrote a glowing letter to our PD to get one of my favorite med students to match with us (I adored her). I'm the nicest resident you'll ever meet. I've treated one or two like ass, but they definitely deserved it (I mean, who shows up over an hour late every day? You can't get lost EVERY day, WTF?)
But I really go out of my way to be nice and respectful to nurses, maybe cuz I know they get shit on a lot, and I don't feel as much of a need to do that with med students OR other residents, maybe cuz I relate to them more.
But I hate to hear you say that you dislike working with female physicians, because we women need to stick together. It's something I've realized more and more recently.
I agree, there is clearly a hierarchy, and within that several mini-hierarchies. It's one of the things that I find so grating about the health care system...the constant alpha female/alpha male dance that goes on.
I have been thinking a lot about your comments...it's something that has been irking me lately and I am also trying to put my finger on it...but it comes from how I am treated by some physicians once they know I am going to medical school. It's like my IQ jumps 20 points suddenly and they start talking to me as a peer instead of subordinate. Yeah, I had just as much experience and interest in this patients case 15 minutes ago when you thought I was 'just a nurse' but NOW you are willing to talk about things like why the alk phos is up and explain why you chose the treatment you did...
Bottom line, the power plays are unnecessary and I think detrimental to patient care. We shouldn't use one 'voice' or degree of respect to talk to the med students, one for the residents, one for the housekeepers, one for the attendings, and one for the unit clerks.
Sorry, that was kinda rant-y. I don't mean to use your comments section as my personal soapbox...I'm glad you addressed this issue though, there needs to be more discussion on the matter...I'll save the rest of my long winded opining to my blog for now... :)
Fizzy: ASS. Just kidding. I should clarify that I've actually only had a few difficult people to work with. Mostly women, but a few men as well. I've been thinking about a post on this topic for a while, but haven't figured out how to address it yet. I wholeheartedly agree that we women need to stick together. It is my greatest fear that I will be come "one of THOSE" female bosses whom everyone hates.
As for talking to nurses and doctors differently, which ABB and Liana both mentioned, I think by definition it happens, given the nature of the job. But it's SO TRUE that some nurses get treated disrespectfully. I always try to go out of my way to listen to them and be nice. I'm learning to walk the line between being authoritative and appearing confident and avoiding being walked upon, and being too direct and not soft enough. It's hard!
OMDG: Don't let the OB/GYN bitches get to you :) I hated female residents for a while after that too. But the fact is that I personally am willing to go out of my way for a female med student (or junior resident) in ways I will NOT for a male. I figure the guys have enough advantages already. Some women can definitely be catty, but I feel strongly that we need to look out for each other. I feel bad that I myself haven't found any good female physician role models, but I haven't yet given up.
Snotty - no.
'Cause you're a woman - probably.
Your post makes it appear that you didn't introduce yourself to the resident when you first called him(?)
Maybe if you introduce yourself with a title you're happy with, you won't get the nurse question as much.
I always introduce myself but often still get the question, "Oh, so you're the nurse?" It doesn't stop when you're an attending physician, and it's DEFINITELY gender-related. Never seems to happen to my male physician colleagues.
I REALLY enjoy the confused look people get when a male nurse comes with me to the bed side, introduces himself, then introduces me as "Dr. T." People don't seem to know what to say sometimes. It's a little bit funny.
I agree with Fizzy. There's nothing wrong with wanting your role and education/training acknowledged. You're earning it fair and square.
Hmm.
When I visted Korea, I had the chance to meet a female ENT surgeon. Over there, medical school is still very much an all boy's club, despite whatever progress has been made in other circles. To say nothing of surgery. She pretty much told me that she had to work twice as hard as any other surgical trainee to win her superior's terse approval. She still has to have her whites with her at all times. There was even one instance when a patient didn't believe she was the surgeon. I guess those experiences justify a certain level of defensiveness and need for recognition, but are American and Australian medical systems just as primitive? I'm sure the hill's steeper, but I doubt it's the same vertical cliff drop as is the case with Asia.
Female or no, I'm cautious towards those doctors who really insist on their titles and get overly defensive about being mistaken for a nurse. Yes, there's been sweat, blood and tears involved in earning those magical letters following one's name and there'll be more to come whilst living up to them, but surely one doesn't need a random's approval to validate all of that? I'd be hard pressed to continue in medicine if respect was such a big portion of my motivation.
Medical school's no walk in the park but it shouldn't be an instant respect generator. I'd be skeptical towards a doctor who relied on their title moreso than their actions. The female physicians whom I've come to be in awe of are confident in their abilities. They don't need to be called doctor to know it. When they do get mistaken for anything but, it doesn't irk them.
Honestly, when I hear about some of the antics that the in-your-face feminists get up to, I feel like shaking them by the shoulders. Surely there's more important things to be getting one's knickers in a twist over?
I think that by mentioning that she was a woman physician, anon was say she was not a male trying to blow off gender-related discrimination. Although I understand and agree with your views, I was disappointed with you replying by insulting her rather than replying civilly to her comment.
A - I have no idea what you're talking about. If you're referring to comment #1, I don't give a crap that she said she's a doctor. The rest of her comment was what was troll-like, and that was what I addressed.
As for your disappointment, why should I care what you think if you don't even have a name?
I am eight hundred years late here, but:
1) Hee. To all of the above.
2) No, you're not snotty. I feel the same way. Then again, I'm not a nice person. But for fuck's sake. I respect the *hell* out of nurses. They know more than I do, and will continue to know more than I do, for a very long time. The good ones make my life easier; the bad ones make my life hell. And yet... I dunno, there's something about being summoned as "Nurse! Nurse? Nurse!" that is just fucking patronizing. And the boys never get that.
haaaaaaaaaaaaaaaaaaahahahahahahaha wowwww
this whole conversation is hard to follow. all ive gathered is that you like to beat down anyone who contradicts. Thats AWESOME!!! :)
abc, I also had a hard time following this conversation. It was interesting reading all of the wacky things people took from this post.
In general, if people start calling me out for something when I explicitly state that I've done the opposite.... then yes, I will call them out.
Thanks for the appreciation. ;-)
Since the early 1990s more than half of all new medical students have been female, which is amazing. Although i do believe that male doctors are still perceived as the more successful in the field. Especially by other male doctors, at least thats how it is in our hospital.
Also, since the "do female medics hurt productivity" survey its been ridiculous. which resulted in things like the fact that female doctors work less clinical hours than their male counterparts, with a five hour difference a week.
It does suck but if you work hard enough you'll get to be the boss!
I say bravo to the resident who thought he was giving his summary to the RN, knowing that she is at the bedside caring for the patient.
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