condesending MDs?

[bigboi]

While at work the other day, I witnessed a family practice MD grilling an infectious disease PA. They were arguing about continuing or discontinuing some anitbiotics I believe. It got so tense that I felt extremely uncomfortable even being in the vicinity, listening to them. I was so proud of the PA as soon she uttered the words "Why because I'm not a MD?" LOL! Eventually my goal to become a PA and I'm wondering how often PAs deal with situations like that?

[EMEDPA]

depends where you work and how much you sound like you know what you are talking about.

generally this happens more early in ones career and decreases as the local medical community gets to know and respect you.

there are always some pricks out there who refuse to talk to a pa but they are a dying breed and hopefully are retiring and dying off...also when they realize that they get no referrals from your practice after they won't talk to you they sometimes change their tune but likely not their underlying attitude.

[jmj11]

Haven't seen it in years. Partially because I'm older and more experienced, partially because the PA profession has grown in respect, but mostly due to the culture and MDs I'm around. Lived in one small town in northern Michigan where disrespect was the norm because that was the local medical culture. But that was 15 years ago. I just can't imagine it happening here . . . except for my old SP. He never questioned my judgement . . . just my worth.

[Contrarian]

Some Physicians actually believe that just because they are physicians... they AUTOMATICALLY know more/are much more knowledgeable and proficient in EVERY aspect of medicine than any PA they encounter... regardless of the PA's extensive background, training, experience or expertise in a given area of medicine.

 

So you will run into primary care and other physicians who will reflexively discount/argue with say a specialty PA-C who has practiced [insert specialty here] for 30yrs... simply because in their minds... we are minimally trained "Assistants" to physicians.

 

So these outpatient primary care physicians have no qualms calling or coming to the ED to "dress-down" a PA-c who was a Paramedic for 15yrs before becoming a EDRN for 10 yrs before practicing as a Trauma-EMPA-C for the last 10yrs...

 

Some of these physicians will actually flat out refuse to come to the phone if a PA-C calls their practice to discuss a mutual patient the PA is currently caring for... and will have their MA/Nurse tell the PA to have their SP call the physician to discuss patient care.

 

Yep... have heard a few exclaim.. "I don't discuss patient care with "assistants"... get the doc on the phone.

 

Have also heard a couple complain about referring patients to "specialists"... then their patients are being seen/managed by "assistants." The issue there was that the physicians felt that their generalist knowledge was automatically equivlant to that of any PA-C working in ANY field of medicine and therefore they wanted "their" patients to recieve the benefit of a workup by a specially trained "physician"... NOT some generalist "assistant."

 

So yeah... It happens...

 

I usually deal with this by insisting that the conversation remains focused SQUARELY on the patient and their care... stating the FACTS, my rationale and my recommendations in a simple, straight-forward manner.

 

Then I remind the "physician" that they are free to do as they please without my input or assistance.

 

Finally, I clearly document my findings, rationale, recommendations and the conversation with the physician in the medical record.

 

Then I go about my day.

 

I wrote "usually" because sometimes... it does get a bit contentious... and I have to write a few "CYA 1150" emails, including references and detailed accounts of the conversation to Admin.

 

The beauty in this is:

If I'm wrong... to me... it simply means that I need some remediation and I'm actually ok with it because theoretically the physicians around me IS suppose to be a bit more knowledgable than me.

 

Thing is... if/when I'm right... the involved physician and everyone around us (physicians, NPs, RNs, Admin, etc) knows that the PA was correct over and above that particular physician and it causes that physician cognitive dissonance and hopefully "self concept" issues... :heheh:

[Cideous]

The answer depends on who the MD is and what position they hold over you. Are they you're supervising physician? If yes...you have a problem. If they are in a position of authority over you then appeal to them on a human level. Most docs that act this way are angry and bitter at a lot of things, most of which have nothing to do with the PA. Realize this and don't react too quickly saying something you might regret. If the person has no authority over you then I tend to be a little more forceful. Once you react with confidnece and most importantly know what you are talking about, they generally back off. Let me give you one more piece of advice. Most of these situations can be avoided simply by not acting like you have a chip on your shoulder to begin with. A LOT of PA's feel they have something to prove and come off a wee bit overbearing :) Docs are human. They have the same feelings of insecurity, fear and anxiety that everyone has. They have just been conditioned to supress or redirect it. This is usually when the "acting like a jerk to you" pops up. I've been a PA-C for 17 years, so I have seen a good bit :)

[CAdamsPAC]

Yeah it happens at times, usually it's a doc who is an anal orifice at baseline looking to "prove" themselves as "better" than a PA. I do believe this behavior sounds like a former MD poster to this site "Panda bear" who felt it was important to bleat out how much more educated he was than PAs! I say just do good and correct medicine document your findings , plan/recommendations and move on. If you have a good SP who supports you this type of behavior shouldn't be a problem, if not .......find a new job.

[EMEDPA]

I work with a guy who has been a pa for 30+ yrs after being an rn in the military. I have heard him end several conversations with this:

"yes, I'm a PA but I'm not your PA. Goodbye" (hangs up phone on ahole md).

[HopefulPA]

I have run into a few times, mostly from residents or fellows of a speciality, that did not want to take the consult unles it was a doctor to doctor consult. I would say ok I will document that in my note and refer to a different doc in the same speciality.....oh how quickly they changed their tune......

[Contrarian]

Had a Physician attempt to assert herself upon me/her "authority" over me in the nurses station, a few weeks ago, in front of 2 PA students I was lecturing to at the time.

 

The Physician INSISTED that I order a specific set of lab tests to rule out something that I had already decided the patient didn't have... and had already addressed it with my students. She came in on the tail end of our learning/teaching rounds and discussion... then decided that she needed to show them the 'importance of PA deference to the whims of physicians.'

 

I re-wound our discussion and explained why it wasn't necessary... she insisted.

I suggested that as a physician, she could order whatever tests she felt the patient needed... she insisted that this was MY job and within my purview and responsibility as "Internal Medicine" medical staff and this was NOT her job or responsibility as "Psychiatry" medical staff.

 

I resisted the urge to agree with her while telling her to then consider minding her own business and to "bowl in her own lane"...

 

I simply turned to my students with a smile and said, "pay attention."

 

We ordered the tests, then I had them research the problem (5MCC, Harrison's, Pub-Med, Medscape EMedicine).

 

The next day, when we got the results, I had them go into the physician's office with the results in hand and politely and inquisitively show them to the physician, and ask her to explain the process of interpreting those particular labs and what the different permutations of those labs would mean... to include a list of differentials.

 

She couldn't do it... and kinda played them off.

They came back with a huge Azzzz grin and simply said, "Ok... got it."

:heheh:

[whimsygirl]

I see doctors treat other doctors that way too. I don't think there's any getting around it.

[dm123]

I see doctors treat other doctors that way too. I don't think there's any getting around it.

 

10-4 on that!!

 

Seems fresh out of Residency surgeons are the worst.

 

I've had the worst problems in emergency rooms that may not have board certified ER docs and have fill-ins from the 'hood. Example, I'm definitely not a peds person but know what a normal and a hot TM looks like. Examined a kid with nl TMs. Labs nl. Fill-in doc, in order to appease mom, looked and called it otitis media. Mom got her scripts, as well as prophylactic scripts for the brother of the "sick" kid. Pelvics are another area that set you up. Over a period of time, I've learned to avoid the trappings of orifices not easily visible.

[Contrarian]

Over a period of time, I've learned to avoid the trappings of orifices not easily visible.

 

Well...

I Guess YOU are Waaaaaaaaaaay ahead of the rest of the men on this planet...!!!

:wink:

[dm123]

Well...

I Guess YOU are Waaaaaaaaaaay ahead of the rest of the men on this planet...!!!

:wink:

 

You got me on that one:=D:

[andersenpa]

Alright, that was a good one, but keep it clean, there's kids around.....

[physasst]

s

Had a Physician attempt to assert herself upon me/her "authority" over me in the nurses station, a few weeks ago, in front of 2 PA students I was lecturing to at the time.

 

The Physician INSISTED that I order a specific set of lab tests to rule out something that I had already decided the patient didn't have... and had already addressed it with my students. She came in on the tail end of our learning/teaching rounds and discussion... then decided that she needed to show them the 'importance of PA deference to the whims of physicians.'

 

I re-wound our discussion and explained why it wasn't necessary... she insisted.

I suggested that as a physician, she could order whatever tests she felt the patient needed... she insisted that this was MY job and within my purview and responsibility as "Internal Medicine" medical staff and this was NOT her job or responsibility as "Psychiatry" medical staff.

 

I resisted the urge to agree with her while telling her to then consider minding her own business and to "bowl in her own lane"...

 

I simply turned to my students with a smile and said, "pay attention."

 

We ordered the tests, then I had them research the problem (5MCC, Harrison's, Pub-Med, Medscape EMedicine).

 

The next day, when we got the results, I had them go into the physician's office with the results in hand and politely and inquisitively show them to the physician, and ask her to explain the process of interpreting those particular labs and what the different permutations of those labs would mean... to include a list of differentials.

 

She couldn't do it... and kinda played them off.

They came back with a huge Azzzz grin and simply said, "Ok... got it."

:heheh:

 

Perfect.

 

Are there docs like that? Yep. I just try to avoid getting into a verbal altercation as it serves no purpose....There was one a few years ago who was being a particular a hole about a test that she wanted and I didn't order....(You don't need a blood gas to treat anxiety).....so, a week or so later, I was working in critical care, and I was teaching the senior resident an orthopedic trick on reducing hip dislocations. The physician was there, and asked him a question about care of a septic patient. I in turn, said, yeah, that's a good one, and then proceeded to ask a rather esoteric question related to hers, and said, perhaps you could help explain that too.....(very sweetly with a smile).....She got ticked and red, and said "You're not allowed to quiz me".....I said, "I thought we were teaching *******". She got mad and walked off.

 

BUT, and here's the important part, she has always treated me with FAR more respect after that. It won't work on all physicians, but it will on some.

 

Besides, it's not just physicians that can be jerks.....if you spend any time in the research areas......well, I have never seen a more cutthroat group of professionals, except with my work in D.C.....Thick skin is required. It's not about being "nice".

[burnpac]

I worked in a occ med practice some time ago with a physician who suffered from the "my PA is smart and OK, but every other PA is suspect" syndrome.

 

We made quite a few referrals to an ortho practice who employed another PA friend of mine, highly experienced.

 

My SP objected with the argument that he wanted is patients to see the physician consultant, not the PA when we made a referral. The bottom line was that we were very astute with ortho and managed a significant variety of significant work injury. The only thing we needed from our consultants was surgery. If we referred to the physician, 6 weeks out on the appointment. If I called Bob, I could get our patients right in and into the surgery queue in under a week.

 

I played to my SP's ego and told him the only thing we needed the consultant for was a surgical solution to a problem we had already fully worked up. We sent them to ortho with a dotted line on the affected part and the instructions, "fix and send back to us for rehab." Once I pointed out to him that we got our patients the definitive care that they needed six weeks sooner, he never insisted on physician consults again. In fact, he was calling Bob himself with referrals. :-)

[Joseph22541]

This one reason I work nights. I don't deal with a lot of docs cause no one else is up at 4 am!! :;;D:

[EMEDPA]

This one reason I work nights. I don't deal with a lot of docs cause no one else is up at 4 am!! :;;D:

ditto...also no nursing administrators....

[Hemegroup]

had a physician attempt to assert herself upon me/her "authority" over me in the nurses station, a few weeks ago, in front of 2 pa students i was lecturing to at the time.

 

The physician insisted that i order a specific set of lab tests to rule out something that i had already decided the patient didn't have... And had already addressed it with my students. She came in on the tail end of our learning/teaching rounds and discussion... Then decided that she needed to show them the 'importance of pa deference to the whims of physicians.'

 

i re-wound our discussion and explained why it wasn't necessary... She insisted.

I suggested that as a physician, she could order whatever tests she felt the patient needed... She insisted that this was my job and within my purview and responsibility as "internal medicine" medical staff and this was not her job or responsibility as "psychiatry" medical staff.

 

I resisted the urge to agree with her while telling her to then consider minding her own business and to "bowl in her own lane"...

 

I simply turned to my students with a smile and said, "pay attention."

 

we ordered the tests, then i had them research the problem (5mcc, harrison's, pub-med, medscape emedicine).

 

The next day, when we got the results, i had them go into the physician's office with the results in hand and politely and inquisitively show them to the physician, and ask her to explain the process of interpreting those particular labs and what the different permutations of those labs would mean... To include a list of differentials.

 

She couldn't do it... And kinda played them off.

They came back with a huge azzzz grin and simply said, "ok... Got it."

:heheh:

 

 

Love it. Love it. Love it.