When communicating with physicians who are negative or intimidating, remember the classic scene in the movie The Wizard of Oz when Dorothy finally meets the wizard. Dorothy shivers in fear as the wizard’s voice booms in stereo sound while lights flash dramatically from every direction. Suddenly, Dorothy’s dog, Toto, runs over to the curtain and pulls it to one side, exposing the wizard as an imposter. Why, the big, booming wizard is just a man!

Never tolerate any behavior that leaves you feeling like Dorothy did at first–small, insignificant, frightened, or intimidated. How can you “pull the curtain back” on these behaviors? Simply say, “May I speak to you in private for a moment?” Then, state clearly that the behavior is not acceptable. Here are four other helpful examples:

1. A physician enters the unit and is clearly annoyed and in a hurry–you can tell by her tone of voice and her mannerisms. You need to discuss a concern you have about one of her patients, but she does not acknowledge your presence, and so you hesitate to “bother” her.
The physician will perceive your vulnerability. Don’t hesitate or let her behavior change your approach. Be professional and direct. Role model the collegial relationship you expect to have with the physician. Don’t hesitate! If you need to speak to the physician urgently, do so immediately by stating your clinical assessment of the situation. If it is a non-urgent matter, wait until she rounds on that particular patient.

2. The physician has given you a verbal order–but you do not understand his reasoning.
Ask for clarification. What you are asking for is reasonable: knowledge. There is a six-to-eight year difference in your educational levels. Our nursing practice requires that we know and understand the reasoning behind the plan of care. Say “Doctor, can you share with me your rationale for this order? I’d like to apply it in the future as well.”

3. What if the doctor says, “Just follow my orders. You don’t need to know”?
You have several options. The first is to say, “I disagree” and then wait for the answer. You could say, “Today’s patient safety practices mandate that every member of the team understand the plan of care” or “If I don’t understand it, I am not doing it. I am legally liable,” or “My goal is to give the best nursing care possible, and I can’t do that without using my mind.” Or you could use the chain of command: “If you like, I can get you the charge nurse.” Tone of voice is everything here-remember your intent and disengage from the power struggle.

4. “But what if I can’t resolve the issue? What if I have tried and the disruptive behavior continues.”

• Speak to your manager
• Fill out an incident report
• Give the chief medical director a copy of the incident report

Editor’s note: This except was adapted from Stressed Out About Communication Skills, HCPro, Inc., 2007. For more information on this title, click the book cover on the left side of this page.