Doctor Management 101:

Watch an experienced nurse.

One of the reasons I chose EMS as a career was the perception I held that nurses had to beg the doctor for permission to do pretty much anything.

Give oxygen? Ask the doctor for orders, and then only at two liters per minute, lest the Hypoxic Drive Fairy come steal your poor COPDer’s breath away.

Defibrillate someone? Check with the doctor first. He may just have some weird-assed joule setting that they only teach proctologists in medical school.

Wipe an ass? Only if the doctor has confidence in your ass-wiping skills.

As a young EMT working for the Little Ambulance Service That Could, I had a great deal of autonomy in the way I practiced. As a young paramedic, I had the luxury of being able to write my own protocols. We had an excellent medical director who trusted his medics to use their brains. Such a system is a real luxury for a new paramedic eager to learn his profession.

Now, over the years, my perception of nurses changed somewhat. Partly it was being married to one for so long. The first thing I noticed about Ex Missus when we first met was “Hey, she thinks like a good medic!”

But as my skills and knowledge grew, so did my perception of the nurses I encountered. I began to notice a lot of them like my wife. They were capable of thinking for themselves, and they did. The doctors didn’t seem to get all huffy about it, either.

I also began to notice a lot of medics who weren’t deserving of the trust I and my colleagues at TLASTC had been afforded by our medical director. Quite frankly, a lot of them were poorly educated Protocol Monkeys who had no idea why they were doing things to patients.

And then came the epiphany: Competence rises to its own level of trust.

The docs recognized good nurses and medics when they saw them, and granted them a higher degree of trust and respect. They also held them to a higher standard than their colleagues. Rather than be offended by the nurse or medic thinking for themselves and practicing a little initiative, they expected it.

Rarely have I had a doctor deny me orders. On the frequent occasions I found it necessary to treat first and ask permission later, rarely was I chastised, even when they disagreed with my treatment.

Some of my colleagues used to ask me, “How is it that you get orders from Dr. X, when he turns down everyone else?”

I simply answered, “Because I know exactly what I’m asking for, and why. And I only call when it’s necessary.”

What I didn’t say was, “Maybe it’s because I don’t sound like an effin’ idiot when I pick up the phone.”

But if you’d really like to see a master manipulator, watch an experienced ER or ICU nurse, one of those trained in the days when nurses were required to all but genuflect in the doctor’s presence. Masters of subtlety, they are. They know how to get what they want, without ruffling physician feathers.

The old battleaxes who have worked for years in teaching hospitals? They can intimidate a first-year resident with just a look. If the look doesn’t suffice, a growl usually will. Rarely do they need to show their claws, but woe betide the arrogant resident who pisses off the nursing staff. The good doctors usually figure that out pretty quick.

Now the new nurses and medics, however…

They’re scared of their own shadow. They have just enough education to know that they don’t have enough education, and they’re rightfully intimidated.

Most of ’em, that is.

Occasionally, you find a new nurse who displays a confidence and subtlety beyond her years. One that knows how to manipulate a doctor into doing her bidding.

One that knows how to con an Ambulance Driver into sending her some linky love, by playing to his capacious ego.

Y’all go by and say hello to Dixie Laurel at Nautical Dawn, and see for yourselves if she isn’t a worthy addition to your blogroll.

I feel the force is strong with this one.