Physicians have tremendous responsibilities for the well being of their patients. Time constraints and financial issues contribute to these responsibilities as well. For far too long, the general public has viewed doctors as being god-like or having powers to perform miracles. Physicians fostered this by allowing their egos to expand to enormous levels. This created a monster that has grown to be a malpractice nightmare.

For the most part, this has been a somewhat humbling experience for physicians. In the past, physicians had an attitude of superiority unequaled by almost any other profession. The physician's bedside manner was atrocious, and his treatment of other health care professionals was unacceptable.

Health care is more of a consumer-driven field these days with all the managed care efforts, and physicians have had to learn to play the game. Patients have been forced to change physicians because of insurance coverage changes, so a new feeling of empowerment has emerged that if they don't like their doctor, they can change. People used to be afraid of hurting the doctor's feelings. Others never knew that doctors could be caring souls. Now if they don't like their doctor's attitude, they move on.

As nurses demand respect and refuse to be doormats, physicians have had to evolve as well. The Good Old Boys have learned to behave for the most part. There still are and will continue to be, some who have the “God complex” and demand that everyone kiss their feet. The number of these types of M.D.s will be fewer and fewer as time goes on. In general, nurses avoid these doctors as much as possible; they learn how to stay out of their way, and word spreads throughout the ranks. Just do your job and lay low.

Facilities have found that they have the right to make choices, and, for instance, some home health agencies refuse to take patients from physicians who are abusive. In all honesty, they don't have a staff member willing and able to take on that case. The agencies are standing behind their staff and not exposing them to this abuse any more than they will to any other unsafe situation.

Nurses do need to advocate for their patients, but they also need to be professional and careful not to influence them. If you have a patient whose physician is a jerk, you need to follow his orders and care for his patient the same as any other. You can't express your opinion to the patient or family members. You need to be professional and keep it to yourself. If they bring it up, the only comment you could make is to remind them that they have choices and leave it at that. On the other hand, if it's an ethical issue or the care is substandard, you need to consult with your supervisor and your facility to advocate for the patient's well being.

Patients may ask you to recommend a physician and you should not do that. You can provide them with the names of several to choose from, but you need to remain unbiased. Your facility may have rules that even forbid this, and in that case you must tell the patients to call a physician referral service or other resource.

With some of these obnoxious physicians, if you just stroke their egos a little bit, you can have them eating out of your hand and have control over the situation. As long as they get their attention and feel superior, they'll be nice (and you can make faces at them behind their backs the whole time). Anticipate what they want from you. Get their patients' needs attended to and send them off to their office as soon as possible.