I am the boss (well sorta?)

Sometimes it's really frustrating to deal with people who are below you inrank but think they know more than you.

Like even if they DO know more than you, in the end it's your job on the line, not theirs.

So I got pretty peeved on Saturday when on my overtime I kept getting bugged by this nurse who was convinced she knew better than everyone else.

There was a patient who had a fall and had been a bit off since then. No signs of visual disturbance or headache and her GCS was 15/15 throughout. We discussed the patient with both the night and day med registrar and both of them agreed that CT was not needed.

However when I went to see the patient the nurse was like "Why isn't this patient getting a CT?" I nicely explained that we had discussed the patient with 2 senior doctors who also both agreed no CT was indicated.

But this wasn't good enough. Of course the nurse knew much more than 4 doctors with medical degrees and began to rant and rave about how the patient was unsteady on her feet. I explained gently that this patient had been like that for the past week as documented in her notes due to her hepatic encephalopathy.

But that just made her more ticked off. So I started to attend to the other patients and try to ignore her.

But she came to ask me to review a pt's CT scan. I looked up the system and found the patient had never HAD a CT Scan so didn't review something that didnt exist. I was promptyl called back to say she had changed her mind and now wanted an EEG reviewed for this patient. Now EEG's are never really that urgent and interns on call are NOT expected to review EEG's as part of their on call work.

But this nurse wouldn't give up. And I wasn't gonna budge. I told her "If you want this EEG so much, you go find it for me!"

30 minutes later I got paged again. "We got that EEG urgentyl faxed over for you to review"

Grrr!!!

So I reviewed the report which was essentially normal. "There.. you happy?" I thought to myself.

Obviosuly not happy enough for the nurse. She then pointed to the notes written in haste during the week that said that if the patient's EEG was normal he could be discharged. Now this was a note for the regular team to be reminded... not for the oncall intern to be sorting out.

However, 30 minutes later I found myself filling in a discharge summary for this man and doing something just to please the nurse (never good practice)...

Sometimes I wish they woudl just let us be the leader in patient management and stop bullying us into doing things they think are best... I'm happy for them to express a disagreement, but after I've listened if I still say "no" then that means "no!"

To quote the immortal words of O-Ren Ishi:

"As your leader, I encourage you from time to time, and always in a respectful manner, to question my logic.
If you're unconvinced that a particular plan of action I've decided is the wisest, tell me so, but allow me to convince you and I promise you right here and now, no subject will ever be taboo.

Except, of course, the subject that was just under discussion.
The price you pay for bringing up either my Chinese or American heritage as a negative is... I collect your f!#$ing head.
Just like this f!#$er here.
Now, if any of you sons of b!#$%es got anything else to say, now's the f!#$ing time!

[pause]
I didn't think so.
[calmly, in Japanese]
Gentlemen, this meeting is adjourned."