Complicated theories as to motives, political philosophies, and the subconscious aside, I agree with Prudie that the young Dr. needs to assert some managerial authority before things go from bad to worse. And, while I agree that firm corrective instruction is a good initial approach to the talking back, and possibly even the breach of etiquette ("Mrs." vs. "Dr."), I disagree in that the assistant who contradicted the Dr.'s advice in front of the patient, should be fired immediately. The Dr. has the professional responsibility of giving proper medical care, and carries all the legal liability. It is absolutely unworkable for an assistant to be second guessing the Dr.'s medical opinion, disfunctional, inefficient, and, without wanting to get too carried away, potentially dangerous.

My mother would agree with Prudie's advice too. She was a "nice" person and did not like confrontation, but as a resident in New York she had to learn to be assertive so that the nurses would know who was boss and the older doctors would show her a modicum of courtesy and respect.

Having been in a similar situation before, as a now-30 year old female physician, it is definitely true that in certain situations groups of other women can be hideous to other women who they feel have some "unearned" position.

My best advice to this young female physician is what I have learned. It is just to calmly and nicely assert herself (letting them know the proper address is expected, etc.) and realizing that these women are NOT YOUR FRIENDS. It is not your job to make them happy or make them like you, although you do need to be polite and professional. I suffered and suffered from the above issues until I realized that. I'm guessing from her age that she is still a resident. Things do get better somewhat when you are out from residency and are a "real doctor," mostly because it is then really your own decisions and you have to take full responsibility for them, the buck stops with you. There gets to be a certain point where it's your name on the chart and it is much easier to be calmly assertive when it is your reputation, your conscience, and your livelihood on the line.

On the other hand, I understand it can be hard in residency, however, not having the power to back up yourself. I had a horrible time during part of residency, even getting physically bullied (hands slapped, hair pulled) and gossipped about and reported (I was "unkempt," my physical appearance was unacceptable, etc) by some of the nursing staff as retaliation for reporting a nurse to her supervisor for almost killing a patient through negligence. Frankly nothing was done about these because the older (all male) physicians did not believe that such things could ever happen because they had never happened to them. However, things like this were all too common among the female (never male) residents I spoke with. Hopefully her male boss is more understanding and empathetic and will not think it doesn't happen because it doesn't happen to him. At this point I've gotten over it (and moved to another hospital where such behavior, fortunately, is unthinkable and would not be tolerated for a second) but it still is a horrible experience.

Of note, however, the generation that comes of age now still has difficulties with female physicians as well. I always introduce myself as "Doctor so-and-so," it says MD 2 places on my white coat and badge, and I still have patients refer to me as "Mrs. so- and so," mention that "the other nurse" (the actual nurse) said something to them, and ask when the physician is coming to see them as I'm leaving. I am a pediatrician, so my patients and families are generally quite young. SIGH.

dad3mass:

My best advice to this young female physician is what I have learned. It is just to calmly and nicely assert herself (letting them know the proper address is expected, etc.) and realizing that these women are NOT YOUR FRIENDS. It is not your job to make them happy or make them like you, although you do need to be polite and professional. I suffered and suffered from the above issues until I realized that.

I think that's one of the hardest things for people to deal with when they go from being a worker bee to management. When managing personnel, one of the hardest things for me to deal with is coming to terms that my coworkers are colleagues, associates, subordinates, etc. but not friends. This was my experience when I became an NCO in the Army and when I got my first supervisory job after grad school.

It's especially hard when you're thrust into a leadership position at a young age and are all of the sudden the same age or younger than all of your subordinates. We all want to be friends with our employees, especially when in high stress or isolating jobs but that really only works until you have to actually be the boss and do something that's unpopular or controversial. Then, all of the sudden you're not getting invitations for beers after work.

It's been my observation too, that people generally treat women in authority with even less respect than men. This goes for both women and men who are subordinates. Young women probably get the most flak and least respect from subordinates. I've witnessed it time and time again; a woman is put in charge and acts just like any other supervisor, yet gets zero respect. Then she begins to be more assertive and then is labeled a "bitch".

After reading the letter, I'm not so sure I'd say that she's definitely a resident, despite her age. Usually these outpatient experiences in residency are temporary affairs--"shadowing" in an office rotation for a few months for example. The resident wouldn't be considered a "permanent addition", but just there to learn until she moved on to something else. Alternatively she might be talking about a resident-staffed clinic, but somehow I wouldn't expect a nurse working in a resident-run clinic to behave this way--you'd expect a nurse in that situation to be used to have young doctors of various stripes running around.

I got the impression that this was LW's first "real" job following residency, which probably makes the situation more difficult to bear. I'm a female physician myself and was on the receiving end of crappy treatment by nurses as a resident (and even more as a med student--sh*t does roll downhill, after all), but sometimes knowing that I'd be able to move on after a month or two made it bearable. On the other hand, one would usually want a practice of their own to be a lifetime arrangement--making it all that more important that the whole environment is a "good fit". She sounds like she needs to assert herself more, but if that doesn't work she may be left with a "she goes or I go" situation.

How often does this kind of doctor/nurse dysfunction actually happen? As a patient, I've really never noticed it. What's at the root of it, is more of "I've been doing this for 20 years and all of the sudden some 25 year old doctor is telling me what to do" kind of syndrome? I'm actually surprised this sort of things crops up in medicine since there are very specific tasks that only a doctor can do and are just out of the scope of an RN.

I agreed with Prudie's advice to the young doc. I also suggested that she enlist the older, male doctor in the office in her campaign to raise her profile of authority in the office. Not in the sense of 'running to Daddy' to have him 'fix' her problem, but just to make him aware that this issue has cropped up, she's dealing with it, but she would appreciate him doing what he can to underscore her authority with his staff. Ie., when appropriate to the conversation, being complimentary of her abilities within earshot of the office staff; reminding them of her rightful title if he has occasion to witness them being too familiar and/or insubodinate, and the like. She will have to take the horns of this issue herself, but if a doctor they do respect also displays a belief in her abilities and authority, that will go a long way toward helping them see her in a more favorable light. He is obviously, whether her direct boss or not, being treated more courteously by the staff--not only because he's more experienced, but also because he's a man. Pointing this out doesn't make me an antifeminist . . .it's an observation about what I think is happening, not what I think should be happening as the natural order.

I am not a medical professional, and I don't lump all nurses in with this particular group in this office, but when I expressed the opinion that oftentimes nurses give young female doctors a hard time simply because they are young and female, I was accused (presumably by someone who is a nurse and took umbrage at my assessment) of antifeminism and a host of other sins. Like I said, I haven't experienced such gender harassment directly. But I have read about, and heard firsthand myriad stories from other female physicians of precisely this kind of treatment themselves from nursing staff. Many doctors can be arrogant, and just as many tend to be dismissive of their nurses, who are doing the bulk of the patient care. But it seems in the eyes of many in the nursing profession (though I hasten to say, not all. Never all.) what is permissible or at least expected arrogance on the part of male doctors is magnified and resented tenfold if it's a female practictioner issuing the directives. Particularly a female practitioner who's a lot younger than they are. Regardless of whether or not the lady doctor IS arrogant, a nursing staff can easily undermine her, as this group is trying to do.

Why, we ask? I think that's complicated, but at bottom it boils down to the lady doctor on some level presenting a threat to these nurses. Because she is young and female, and has attained a level of education and professional skill that they either wanted for themselves, or, even if they are happy being nurses, there is an element of hierarchy and hidden, or not-so-hidden resentment about having to answer to an uppity young snippet of a doctor even as experienced professionals. I was also accused by this same disgruntled person as somehow rating doctors 'better' than 'lowly' nurses--which is not true, either. Nurses are highly skilled and I know I couldn't do what they do. In our system of care they are subordinate to physicians, though, so someone who has issues with her appropriate place in hospital/office hierarchy might be the type to resent a newly-minted doctor. Perhaps someone who is a Mean Girl in high school goes to nursing school . . .that doesn't eradicate the Mean Girl . .she now just has an LPN or an RN after her name. Sounds like young doc here has blundered into an office rife with post-High School Mean Girls.

She needs to hang tough and remember that she's still honing her skills and still mastering all the facets that go along with being a physician, including projecting a requisite air of authority. It will come with practice, and without being a Bitch--persistence is the key to hammering home her new role not just to others, but also in her own mind. After she gains more experience, she can always nurture the dream of opening her own practice and hiring the nursing and office staff of her selection--those employees will unquestioningly accept her as The Doctor.

hikari:

but when I expressed the opinion that oftentimes nurses give young female doctors a hard time simply because they are young and female,

No. You did not do this. You stated that the nurses were treating her poorly because they had wanted to be doctors, but couldn't be and so as "failed" doctors they were bitter towards one of their gender who succeeded. For someone who claims to have a degree in english, you have a hard time writing clearly and succinctly.

hikari:

Because she is young and female, and has attained a level of education and professional skill that they either wanted for themselves, or, even if they are happy being nurses, there is an element of hierarchy and hidden, or not-so-hidden resentment about having to answer to an uppity young snippet of a doctor even as experienced professionals.

Backing off, are we? Realized that you stuck your foot in it? If the doctor is uppity, people will resent her. It's HER fault, not theirs. And if she's uppity, getting the other doctor to "back her up" won't do anything at all.

hikari:

. Perhaps someone who is a Mean Girl in high school goes to nursing school . . .that doesn't eradicate the Mean Girl . .she now just has an LPN or an RN after her name.

Because, of course, a person who is mean is going to go into a field where she works hard, is paid little merely to take care of other people. Bullshit.

I think Tarquin Machismo is right. 727 words. Seriously. An entire essay to repeat your belief that nurses are failed doctors with a few weasel words thrown in so you appear less foolish.

What hikari said this time around:

hikari:

She needs to hang tough and remember that she's still honing her skills and still mastering all the facets that go along with being a physician, including projecting a requisite air of authority. It will come with practice, and without being a Bitch--

And the original advice she gave:

"She must marshal her Inner Bitch and give some right back to these office bitches."

hikari, instead of back-pedaling and whining on this thread and trying to get sympathy for yourself by talking about PhysicsGirl behind her internet back (and you'd know if you weren't so rudely dismissive not to read her post that she's a physicist (duh) and not a nurse - that would be PG's mom) why don't you have the guts to address this issue back on your original post where it started?

We're all still waiting.

Physics Girl, Hikari: My question has less to do with the argument, or lack thereof, regarding sexism/respect for a position of care whatever it may be, etc. It has to do more with your responses and how articulate you are. I am nearly 40, professional (male if it matters), but don't think that I would ever be able to speak with the efficiency that Prudie suggests, for example (I loosely quote): "I welcome questions after we're done with a patient, but it is unacceptable for patients to hear your questioning my treatment; it undermines my authority as a doctor", and other well stated defenses she's presented. How Physics Girl interpreted Hikari as "backing off" by a simple (if I'm correct) "even if they are happy being nurses..." and Hikari, saying, "there is an element of hierarchy and hidden, or not-so-hidden resentment"...first of all, I thought I was of at least average intelligence, and even have a Masters Degree, but you blow me away with your abilities to produce these highly intelligent, articulate replies "on the fly" during your busy workday. I hardly can think of words like "satirical" in everyday conversation, but of course understand them. Why do I feel so smart when I read you, but so dumb regarding my abilities to write/speak in a way consistent with your litanies? Are there books that can help me think of such words and synthesize such eye-opening phrases that summarize multiple thoughts into fewer, more concise words...or am I just going to be at the other end of the spectrum forever? And, finally, should I be writing this to Prudie instead of to you on this thread? After all, she's a good book-recommender. Thanks for any replies/suggestions at all.

I've got these little bumps behind my left elbow, which at first I thought were poison oak, but they don't itch and aren't going away...

Kidding, no, my question is, does this letter sound fake to you? I mean, if she's a in her mid-20s, shouldn't she either still be in medical school, or interning in a hospital? I mean, if she is some sort of prodogy, like she claims, why is she only working in a small practice, not in hospital or more prestigious local?

My take is that she is still in medical school, and maybe doing volunteer work, or intern work in a small practice.

KA

In answer to your first question, I just tell everyone to take some Keflex and walk it off : )

I guess it didn't sound THAT fake to me, from what I can tell. I did the traditional 4 years undergrad/4 years med school/3 years internal med residency and finished several months before my 29th birthday. So, I guess if I had gone into practice right away and was kind of vague about my age, I could theoretically say I was in my "mid 20's" at the time.

Alternatively, if this gal did one of those "combined" programs (undergrad plus med school combined into one) which usually take 6 years, she could be finishing a couple years early, making her roughly 26 when she finished. Incidentally, you don't have to be much of a prodigy to do that, just prove yourself motivated enough to get accepted. (I went to med school with a couple of people who did that and they were as smart as the average med student, but certainly not freaky geniuses.)

The other possibility is that she's a foreign medical grad, since many countries also do the 6 years of med school/skip undergrad route. (The LW doesn't mention this being the case, but I have seen nurses clash with FMGs for a variety of reasons. Although, if racism was an element here she probably would've said so.)

Even if she was a total prodigy, there'd be plenty of logical reasons for not practicing in a big academic center--her family might want to live in a small town, private practice generally pays better than academic positions, not everyone can keep up with the rigor of having to publish all the time, she might've entered med school as a prodigy but got knocked down a few pegs by the whole experience...

If she was still in medical school, she wouldn't expect to be introduced as "Dr." (at least she shouldn't--no one can call you that until you graduate.)

It might be feasible that she's still a resident, but, at least when I was a resident, my office experience consisted of either a half-day of clinic a week (where the office staff was used to taking orders from residents and even if there were difficult people you saw them so rarely that it was no big deal) or following around a local internist in their office for a month or two (in which case you're really treated like more of a visitor, so the jockeying for authority stuff wouldn't really come up.) As a resident, I just wasn't in an office for a really extended period of time--it was always broken up by being in the hospital. It might work differently for different specialties, I suppose.

From the way she worded things, I thought this sounded more like her first "real" job.

That's my take on it, anyway.

sr2007:

Physics Girl, Hikari: My question has less to do with the argument, or lack thereof, regarding sexism/respect for a position of care whatever it may be, etc. It has to do more with your responses and how articulate you are. I am nearly 40, professional (male if it matters), but don't think that I would ever be able to speak with the efficiency that Prudie suggests, for example (I loosely quote): "I welcome questions after we're done with a patient, but it is unacceptable for patients to hear your questioning my treatment; it undermines my authority as a doctor", and other well stated defenses she's presented. How Physics Girl interpreted Hikari as "backing off" by a simple (if I'm correct) "even if they are happy being nurses..." and Hikari, saying, "there is an element of hierarchy and hidden, or not-so-hidden resentment"...first of all, I thought I was of at least average intelligence, and even have a Masters Degree, but you blow me away with your abilities to produce these highly intelligent, articulate replies "on the fly" during your busy workday. I hardly can think of words like "satirical" in everyday conversation, but of course understand them. Why do I feel so smart when I read you, but so dumb regarding my abilities to write/speak in a way consistent with your litanies? Are there books that can help me think of such words and synthesize such eye-opening phrases that summarize multiple thoughts into fewer, more concise words...or am I just going to be at the other end of the spectrum forever? And, finally, should I be writing this to Prudie instead of to you on this thread? After all, she's a good book-recommender. Thanks for any replies/suggestions at all.

Um, thank you . . .I guess? I'm not sure whether this was intended as a compliment or a jibe at my (admittedly) wordy 'litanies', as you call them. I will thank the universe and accept the former as the truth.

That's a good description. I do tend to write very lengthy posts, which have been misinterpreted as sermonizing . .. but I write so much simply because it's my favorite hobby--not because I'm trying to compose my own personal Koran. The Fray substitutes for spirited conversation in my life, which is sadder than I care to admit . . .but I come here because I love debate and ideas and well-turned phrases. For me, this is fun, so I have a hard time knowing when to quit. Plus my job sucks, so my 'busy workday' is not so captivating and I spend way more time than I should in the Fray when I am on the clock.

I have angered some nurses or relatives of nurses on this board, which was not my intention. But every profession has examples of bad apples (or at least, unprofessional ones) floating around, making everyone else look bad. I'm not sure why anyone who respected nurses and the nursing profession (as I do) would want to rush to defend the behavior of these particular ones. They sound like bitches to me . .. and probably would be so, whether they were working in a doctor's office or for the phone company. In these letters to Pru, we always only ever have one person's perpective on any given story . . . but even if this young doctor is far from perfect herself, that doesn't excuse unprofessional behavior from the nursing staff . .. who are supposedly the more experienced and seasoned in this environment. I thought that was perfectly obvious to everyone, but I guess not.