When Physicians Dis Us to Our Faces . . . A Serious Question

[jmj11]

On Monday I had a very negative encounter with a neurologist that reviews disability claims for Aetna. I was completely blind sided. I had a message to call this guy back regarding a patient. When I called him, he started a very condescending rant lecture about me (and PAs in general) . . . being a just a PA and caring for this, what he considered a complicated patient. Actually, this patient has a very simple migraine disorder and represents the easiest 10% of my patients. But this neurologist couldn't believe that I, meager PA, saw this patient alone without "running it by my supervisor." He eventually pissed me off and we got into a verbal fight on the phone and I hung up on him. (sorry this tablet doesn't allow me to do paragraph breaks) This took me by surprise for several reasons but the main one is that I have not had such an ugly encounter with a physician in many years. Most of the physicians in my area treat me very well and I could not ask for a more supportive SP. Honestly, I'm tired of this. I've been a PA now for 31 years and I never, in my wildest imagination thought that in 2013 that I would still be meeting physicians who think we are simpletons who extend them and do paper work and must "run by our supervisor" every patient that we see. But there are *******s in every profession and that is life. But this got me thinking. Is there one clear strategy for dealing with these types of arrogant *******s? I mean, over my 30+ years I've taken about every approach you can imagine. I've screamed back at them (when they start screaming at me first) like I did on Monday, I've completely ignored them, I've laughed at them, I've remained calm and pretended that they weren't saying the stupid things that they were saying and just focused on the real patient-oriented problem. I even took a group of physicians to court with a lawsuit (and won). I know that this doesn't have a simple answer but what has been your experience? Which style of response do you think is most effective? Now, please don't say that you are such a wonderful PA that no physician has disrespected you. This isn't about us. It is usually an encounter with a physician who has some serious self-doubt that he/she must deal with by stomping on people to prove that he/she is superior, like a short-man syndrome or short something. Any discussion? Oh I also wrote head of his department (a non physician) whom I had previous contact with, over this same patient. Now, I'm not even sure I should have written the letter as I doubt it will amount to much.

[EMEDPA]

I've seen this type of doc too. the best revenge is to outlast them. they are dinosaurs and going extinct.

I used to get this all the time; "have a physician examine this patient then have them call me back".

as an em pa I just don't call specialists like that when ever possible and they lose business(as well they should).

[ventana]

I tend to pull out the big words and newest studies that I have read and try to confuse them..... amazingly enough most the time it works... They can trump the degree, I can trump the knowledge..... always seems to be with Insurance Company Doc's (guess that is what you do when you no longer want to do anything for real)

 

If they are in the community I simply refuse to ever again referrer to them - honestly I am with JMJ on this one - my reputation helps me and cuts through most of it....

 

For the occasional time it still occurs - I am curt and professional and call them up short on it

 

 

Funniest one I remember is a retired from clinical practice pathologist that was calling me to discuss an MRI LS spine request on a WC claim... patient had a loss of sensation (I think - it was a long time ago) and he had denied the MRI - got on the phone with him and simply asked his name, clinical position, specialty, and last time he examined a patient in the office....... tone of the call changed pretty quickly when it was identified his patients were all dead and he was retired to an insurance company..... he approved the study.... I was quick to point out to him that it had been something like 30 years since he had seen a living patient........ and he was out of his league....

[cbrsmurf]

This neurologist is someone who works for a private insurance company that probably routinely denies treatment for monetary reasons to save his/her company money. This type of person probably has shtty morals to beings with.

[jmj11]

This neurologist is someone who works for a private insurance company that probably routinely denies treatment for monetary reasons to save his/her company money. This type of person probably has shtty morals to beings with.

 

You know, when these things happen so fast, so many things go through your mind. I had on the tip of my tongue some statement about, "So you work for an insurance company because you couldn't make it in the real world" but I didn't. The point I made with his boss was that the whole phone call came across as an attempt to intimidate (which the spell checker just changed to "inseminate," LOL) me and to suppress facts, which the patient's lawyer might find interesting.

[cbrsmurf]

insemination is also a form of intimidation

 

remember, 'no' means 'no.'

[Boatswain2PA]

Gotta look at what the consequences would be of pushing back too hard, but I treat other's with respect, and I demand people treat me the same. Got me in trouble as a student, but ya can't change who you are.

[jmj11]

One thing I really appreciated about Mayo Clinic, was that they had a "360 degree" eval. That meant someone above you, your peer and a subordinate would do your annual eval. I remember a surgery tech telling me that Mayo had hired a famous cardiovascular surgeon from Cleveland Clinic. He had written the book on several procedures. However, he behaved like the one you mentioned. He threw instruments at surgical assistants and swore at them all during the procedure. When his first annual eval was due, a scub nurse and this OR tech were picked to do part of his eval. He was fired immediately after the eval came in with the letter, "all our employees are valuable to us and we do not tolerate this behavior." or something like that. He was profoundly confused as he thought he was above the rules.

[SHU-CH]

Was it Mark Twain who said something to the effect: "Don't argue with a fool. They will drag you down to their level and beat you with experience."

[whoRyou]

:mad: This neurologist needs some serious counseling

[gleannfia]

One thing I really appreciated about Mayo Clinic, was that they had a "360 degree" eval. That meant someone above you, your peer and a subordinate would do your annual eval. I remember a surgery tech telling me that Mayo had hired a famous cardiovascular surgeon from Cleveland Clinic. He had written the book on several procedures. However, he behaved like the one you mentioned. He threw instruments at surgical assistants and swore at them all during the procedure. When his first annual eval was due, a scub nurse and this OR tech were picked to do part of his eval. He was fired immediately after the eval came in with the letter, "all our employees are valuable to us and we do not tolerate this behavior." or something like that. He was profoundly confused as he thought he was above the rules.

Good for Mayo. Cleveland Clinic is one of the most overrated institutions in the country. They are great if you are the Sheik of Arabia and need heart surgery. They also act as if you should be grateful to work there from what I have heard.

[wjm7]

One thing I really appreciated about Mayo Clinic, was that they had a "360 degree" eval. That meant someone above you, your peer and a subordinate would do your annual eval. I remember a surgery tech telling me that Mayo had hired a famous cardiovascular surgeon from Cleveland Clinic. He had written the book on several procedures. However, he behaved like the one you mentioned. He threw instruments at surgical assistants and swore at them all during the procedure. When his first annual eval was due, a scub nurse and this OR tech were picked to do part of his eval. He was fired immediately after the eval came in with the letter, "all our employees are valuable to us and we do not tolerate this behavior." or something like that. He was profoundly confused as he thought he was above the rules.

 

 

Wow. What a fantastic example. Go Mayo Clinic!

[gleannfia]

On Monday I had a very negative encounter with a neurologist that reviews disability claims for Aetna. I was completely blind sided. I had a message to call this guy back regarding a patient. When I called him, he started a very condescending rant lecture about me (and PAs in general) . . . being a just a PA and caring for this, what he considered a complicated patient. Actually, this patient has a very simple migraine disorder and represents the easiest 10% of my patients. But this neurologist couldn't believe that I, meager PA, saw this patient alone without "running it by my supervisor." He eventually pissed me off and we got into a verbal fight on the phone and I hung up on him. (sorry this tablet doesn't allow me to do paragraph breaks) This took me by surprise for several reasons but the main one is that I have not had such an ugly encounter with a physician in many years. Most of the physicians in my area treat me very well and I could not ask for a more supportive SP. Honestly, I'm tired of this. I've been a PA now for 31 years and I never, in my wildest imagination thought that in 2013 that I would still be meeting physicians who think we are simpletons who extend them and do paper work and must "run by our supervisor" every patient that we see. But there are *******s in every profession and that is life. But this got me thinking. Is there one clear strategy for dealing with these types of arrogant *******s? I mean, over my 30+ years I've taken about every approach you can imagine. I've screamed back at them (when they start screaming at me first) like I did on Monday, I've completely ignored them, I've laughed at them, I've remained calm and pretended that they weren't saying the stupid things that they were saying and just focused on the real patient-oriented problem. I even took a group of physicians to court with a lawsuit (and won). I know that this doesn't have a simple answer but what has been your experience? Which style of response do you think is most effective? Now, please don't say that you are such a wonderful PA that no physician has disrespected you. This isn't about us. It is usually an encounter with a physician who has some serious self-doubt that he/she must deal with by stomping on people to prove that he/she is superior, like a short-man syndrome or short something. Any discussion? Oh I also wrote head of his department (a non physician) whom I had previous contact with, over this same patient. Now, I'm not even sure I should have written the letter as I doubt it will amount to much.

Don't feel bad. I have 26 years experience and have had this treatment from only a handful of physicians. Like you said, they are usually very insecure. I have also had this problem more with DOs because I think that they are inherently defensive about their position on the food chain. Which is sad because I have worked with some fabulous DOs, and I don't believe that credentials always equal superior clinician. The truly great people, docs and others, do not have to put down others as their excellence speaks for itself and people recognize that. I had a recent experience with a doc who out and out lied to cover his own hide. He also put down every other clinician he worked with, including me. Everyone was incompetent except him, apparently. But he was working in a podunk town with little to no competition. My question, if he is so great, why is he not at some more esteemed bastion of care? Because he is unlikeable and not so great as he thinks he is. Thankfully, as I said, I have only encountered this a few times in a long career. I just look at doctors like these as human failures.

[physasst]

Wow. What a fantastic example. Go Mayo Clinic!

 

Yes we do use 360 evals. They work well. I've even had to evaluate my chair. That being said, this does occur, even at Mayo....although to a far lesser degree than elsewhere.

 

I've had this happen a few times during my career. The few times it has, I've usually just resorted to making them look like a fool. It's not particularly hard if you are skilled at debate techniques. Physicians often think of themselves as good at everything, but many of them are not very good at debate tactics, and it's pretty easy to make them look foolish if you really want to.

 

It's not something I would do on a routine basis, but there are those few occasions where it's time to just let them know that they aren't as smart as they think they are. Usually because of some insulting comment. They usually get frustrated and walk away. That's fine. I don't pick verbal battles, as I am a grown up, but I also know how to end them when needed.

[rev ronin]

I'm sorry, but the first surgeon who throws an instrument AT anyone in my presence will be placed under citizens arrest (well, in Washington it's actually more like 'detained by a citizen pending arrival of law enforcement') for assault. Throwing a piece of steel in someone's general direction is bad enough, but once we presume bodily fluid contamination...

[d2305]

I've dealt with the insurance doctors before, what a pain in the butt. Most neurologist are strange anyhow.

[Friction]

Was it Mark Twain who said something to the effect: "Don't argue with a fool. They will drag you down to their level and beat you with experience."

 

Sorry to laugh, but I think you mixed up two different quotes. It works though ;)

 

[h=1]“Never argue with a fool, onlookers may not be able to tell the difference.” (Mark Twain)[/h][h=1]“Never argue with an idiot. They will only bring you down to their level and beat you with experience.” (George Carlin)[/h]

[jsfelder0417]

Those quotes were awesome, hahaha.

[burnpac]

There is a reason that this physician is reviewing disability claims and not practicing medicine. Those that can, do. Those that can't.... I guarantee you that a long history of bad behavior follows this jerk.

[JFarnsworth]

I'm sorry to hear this is still happening after all your experience. In one of the ERs where I worked, none of the consulting physicians would condescend to talk to a PA, they only wanted to talk to the SPs. I disregarded this and called 'em any way, presenting my patient in a clear manner, giving my impression, and what I thought should be done. I played humble and it usually worked (as in, "you know so much more than I do about this"). As for the neuron who called you, the words "insecure", "frustrated with his life and career" and "looking for someone to kick around because possibly that's what happened to him" come to mind. It probably could have been anyone that he treated this way, I highly doubt that it was any thing to do with you. Hope this helps.

[browndog]

There is an MD at one of my PRN gigs that has a great deal of disdain for all NP/PAs and he lets the entire ED know his feelings about non MD providers. My solution is simple. I will not sign up for any shift that he is working. Ever.

[EMEDPA]

there is an md at one of my prn gigs that has a great deal of disdain for all np/pas and he lets the entire ed know his feelings about non md providers. My solution is simple. I will not sign up for any shift that he is working. Ever.

most excellent!

[haeriphos]

he started a very condescending rant lecture about me (and PAs in general) . . . being a just a PA and caring for this, what he considered a complicated patient. Actually, this patient has a very simple migraine disorder and represents the easiest 10% of my patients.

 

You, in most surprised phone voice possible: "Really, Sir? You consider this a complicated patient? Can I speak to someone who's been practicing a little longer? Feel free to place me on hold."