Knowledge puffs up

I learned an important lesson at work yesterday.
I was working at the detox center and I had a few sick patients. The doctor was scheduled to come at around 8 but she called me at 9 to say she would be in after lunch. I don't normally give the doctors too much trouble- I get everything organized for them and try not to call them on their cells, especially at night, unless it's an emergency. If I need a lot of orders, I try to group them all together in one phone call so I don't bother them too much. Suffice to say that by the time Dr. Michaels* showed up at 2:30, I had a lot of stuff to talk to her about. (*Names changed, of course, since I'm about to criticize her).
One of my patients, a young man withdrawing from morphine, had been in a car accident and sustained serious nerve damage to his left leg. He was barely handling the excrutiating pain when a buddy gave him a couple of dilaudid pills (similar to morphine) and he quickly became addicted. Now his life was falling apart and he was willing to do anything to get off the drugs. We talked about the pain together and I gave him regular tylenol and ibuprofen but none of it was really cutting it. There is a drug called Gabapentin that I told him about- it is very good for nerve-type pain and it is especially good in the withdrawal pain associated with opiate use. I told him about it and he said he'd be willing to try it. In detox it is one of the more commonly prescribed drugs by the doctors- it is non-addictive and fairly safe and I've had patients tell me that nothing helped their pain until they tried the wonder-drug Gabapentin.
Dr. Michaels came in and I was down the hall and I heard someone calling for me.
"Where's the nurse?" She demanded as I came into the office.
"I'm here." I said, and quickly pulled out all the charts for her to sign. I asked my nursing student (who was shadowing me) to go and get the first patient to see the doctor. Dr. Michael's scanned the orders sheet.
Stephanie had been on a regular dose of dilantin (a seizure-controlling medication) but the doctor the day before had forgotten to order it and I needed her to write it out for me. Kyle needed a physician's signature on his admissions form for a treatment program. James had a bad cough and was asking for his puffers and I needed an order to get new ones from the pharmacy. One of my patients came into the office just then, doubled over in pain and looking like he was about to throw up. While Dr. Michaels was signing charts I whisked him into the examining room and quickly gave him some gravol.
He kept the gravol down without vomiting so I took his blood pressure and opened the med drawer to get him some clonidine (a medication used for opiate withdrawal that takes away a lot of the pain and nausea). The poor guy hadn't had his dose yet that day, as he had been sleeping, and he was in rough shape.
Suddenly Dr. Michaels stalked into the room and stood there, in my way.
"I'm just giving him some clonidine." I explained, checking the dose of the drug.
"Can't you do this later?" She demanded, waving me out of the room.
"Okay?..." I shrugged at my patient and went out of the room. She closed the door after me.
I busied myself copying orders and then went to get another patient lined up to see her. As I was coming back into the room she was sitting with her back to me, and she called out, "Nurse!"
Now, I don't mind being called nurse by my patients, because most of them are sick and there are so many nurses they can't keep it straight anyway, and we're all wearing uniforms.... But when a doctor calls me 'nurse!', especially a female doctor, there is something very disrespectful about it. I felt my blood begin to rise, but I held my tongue and came over to help her.
"What else do you need me to sign?" She asked.
I sat down next to her and went over some of the orders, finishing with asking about the Gabapentin.
"Paul has had nerve damage in his left leg from a car accident and it's excrutiating. I was wondering about getting him some gabapentin for it."
She shrugged, ignored me, wrote something else on Paul's chart about sleep medication and shuffled the papers together.
"I'll leave this form for today, I don't have time to fill it out." I held out the clipboard with her msp forms that required her signature to be paid, and she signed it and went out of the office, putting on her coat.
She had been there for an hour but it took me two to process her orders and clean up the mess. I explained to Paul that the doctor hadn't ordered Gabapentin for him, so we'd try to manage with tylenol and hot water bottles, and the poor guy looked like he was going to cry.
Later that night, after a busy day, I was doing shift report with the night staff. The nurse coming on shift was a veteran- she is a kind older lady with an ever-present smile and a sense of humor. She took one look at Paul's chart and said,
"Why isn't he on gabapentin?
"I asked Dr. Michaels for it today" I said, "but she wouldn't order it."
"What?! We use it all the time for this type of thing! Why on earth wouldn't she order it?"
Suddenly the old nurse smiled knowingly.
"Heather, you have to learn how to talk to doctors." she said to me. "I've learned over the years, you have to treat them like a husband."
I wondered what the heck she meant.
"I know Dr. Michaels," she continued; "she's a type A personality, and from what I know of you, you are too. What happened today had nothing to do with the Gabapentin. It was a power struggle, pure and simple."
Suddenly everything began to clear.
"The way you treat a doctor and a husband," she said, "Is you never tell them what they should do or ask them for something directly. You always make it seem as if it was their idea first. I'll bet anything you said to Dr. Michaels, 'Would you please order gabapentin for Paul?'"
I laughed. "Of course."
"Well, what you should've said was 'I don't quite remember, but is gabapentin the drug you normally order for this type of thing?', or something like that, to make it seem like it was her idea first. If she thinks that you know more than her, or know what she should do, she'll do the opposite."
We all laughed together.
I thought about it all night, though. It shouldn't be that way, but it is. Dr. Michaels (and some other very talented doctors I've met) treat me like a dumb LPN. Part of me wants to look her in the eye and say, "I know what I'm talking about, I've been in college for 8 years and I was in medical school." But part of me also believes that you shouldn't have to get respect by showing off how much you know. If Dr. Michaels can only respect me for my societal rank in the healthcare field (or lack thereof as an LPN!), then it's not true respect. True respect has to do with listening to a person and considering their opinions simply because you believe they matter as a person, not because they have the initials LPN or RN or MD or PhD behind their name.
I remember in nursing school, a very wise teacher told me, "If you want to know something about a patient, whether or not their behavior is normal or how long the strange rash has been there, then ask the care aides. If you want to know where things are or you need somewhere quiet to nap during your break or you have a machine break down or the cafeteria is out of food, ask the janitor. Never underestimate what the people 'lower' than you know and are capable of. They will make or break your career.
I have the same issue going on with my nursing student. She's annoying and not super smart, but I learned something from Dr. Michaels that I can pass on to her in the way I treat her.
"We know that we all possess knowledge. Knowledge puffs up, but love builds up. The man who thinks he knows something does not yet know as he ought to know." I Cor. 8:1-2
There is no substitute for loving and respecting people. And if I truly care about my patients I'll have nothing to do with the hierarchy that demands I treat the people 'lower' than me as if they don't know as much as me. Instead, I'll seek to build them up however I can.... In doing that, people like Paul won't have to suffer needless pain.