Many times I have called a physician in the middle of the night to propose an idea or a concern I have, and many times the physician has listened to me knowing I wouldn't call in the middle of the night just to chit chat. Sometimes the physician agrees with me, and others he or she acknowledges disagreement and chooses to do things his or her way. Yet through all our discussions the benefit of the patient has always been at heart.
Many times I have had a question about the course of a patient's disease, perhaps a question about what the physician thinks, or what is on an x-ray, and almost every time the physician has taken the time to share his knowledge and expertise. Many times a physician has come to me with a question about equipment. In this way I have formed a good relationship with most doctors I've worked with. Many times our discussions have evolved further than the patient to discussions about politics, family, and even personal matters.
Many of these physicians rely on us to analyze labs, blood gases and even EKGs and make decisions on our own without calling them, and to the benefit of everyone (patient, physician, RT). They rely on us to determine who needs breathing treatments, and to recommend who should and shouldn't continue on such a regime. They rely on us to increase and decrease oxygen in the middle of the night as appropriate without always calling them. Yet they trust that we will call if the patient's condition deteriorates, or we suspect such is occurring. Thus, the bond between physician and RT is strong.
Yet there still exist a few physicians who believe they know everything and have no reason to communicate with a respiratory therapist other than to direct orders. They do not trust us to know what a normal EKG is, and insist we hunt them down with all EKGs. They do not trust RTs to know when oxygen is needed, and insist we call them instead. They do not trust our scope of knowledge, and question our skills and abilities when things don't go as planned.
Such is what happened to me recently. The BiPAP was set up and the patient got worse not better. His CO2 rose from 60 to 100. I informed this doctor on several occasions that the patient was bucking the BiPAP and if sedated I think the BiPAP would work better. Yet she chose to ignore me. She even questioned that I set the BiPAP up correctly. She even questioned that I listened to the patient. She said, "You are a tech, it's your job to listen to your patient."
I've had many run ins with this doctor in the past, and so have my coworkers. On the first day I met her she pulled me aside and said, "Look! I'm the doctor and you're the tech. You do EKGs and I read them. You're not trained or qualified as I am in reading EKGs and even ABGS. So when you do them I want you to bring them to me no matter where I am. Understand?"
In the days since there have been many times I have approached her and said things like, "So, what do you think?" Many times I've asked this of a physician and it's lead to a discussion of the patient. Many ideas have come forward, and many patients have benefited with shared wisdom. Yet this bad doctor simply looks at me like I'm an ignorant cuss and she rolls her eyes and says, "So, do you have any bright ideas?" In other words, I'm wasting her time.
So what do you do when you have an arrogant and condescending doctor? In most cases I would recommend what I normally do, and simply walk away. Yet this physician has had many such run-ins with what she calls "here respiratory therapists." Or, rather, "her techs." She thinks of us as ancillary staff meant to do a job, as opposed to professional members of the team. I decided it was time to step up and face this doctor -- mano-a-mano.
I calmly said: "I am not a tech, I'm a respiratory therapist. I have two years of school in respiratory therapy, and I am registered and licensed. I know what I'm doing. I think it's time you start respecting my skills and knowledge as other doctors do, and I think it's time you start respecting my fellow RTs who work here too. I respect you. You respect me. The patient benefits."
I turned and walked away. It was at this time the adrenaline started flowing, and I was shaking like a leaf in a hurricane. I could no longer function. I wanted to call my boss, but my voice was so shaky I decided better of it. I completed my other tasks, yet not without difficulty. As soon as my boss arrived I told her what happened to make sure I stayed a step ahead of this doctor, and kept this doctor on defense.
My boss and all my coworkers were actually impressed at what I said to her. Some didn't believe I did it, considering this was totally out of character for me. Yet I had witnesses. Yet something had to be done. I did not question this doctor's skills, because she is an excellent doctor. What I did was question her respect for a respectable group of professionals. What I did was deflate her big, fat, bloated, egotistical head.
I discussed this with another physician of whom I have a good bond with, and I asked, "Was I wrong? Should I have just walked away yet again and said nothing? Should I stop sharing ideas with her?" He said, "Rick, you did the right thing. I would recommend you not change anything."
So I won't change a thing. I also doubt I'll be confronting any more egotistical and condescending doctors in the near future either. I also wonder what my relationship with this doctor will be from here on out. Imagine nothing will change, because ignorant people rarely learn.
I will leave you today with a quote from Donald F. Egan, MD, et al, "Egans Fundamentals of Respiratory Care," 1982, 4th ed., page 678:
"The techniques that have evolved for the treatment of these patients required the supervision of highly educated and skilled professionals whose degree of specialization is beyond the scope of the average attending physician or nurse."