This doc has caught you on the Labor and Delivery Unit and is screaming at you right in front of everybody! Since you don't have a can of Mace handy, what's to be done?		Lord, I hope this hasn't happened to you! But, there you are, the Chief Nursing Officer walking through the Labor and Delivery Unit making rounds. Suddenly a normally-congenial physician who's known to be going through a nasty divorce comes exploding out of the nurses' station -- where everyone's face is a glazed-over tone of grey, eyes red and downcast. He sees you, Administration, and lock his gaze onto you with an icy, penetrating grip, teeth clenched, every hair on the back of the neck fully erect, hands knotted into dangerous-looking fists. Then it begins. Screaming so loudly that patients, all staff, patient families, and the guy working up on the chimney next door can't help but hear, he begins lambasting you for a nurse's refusal to accept "orders" sent in by fax. He's threatening to move all his business to St. Overthere, six blocks to the west. You reasonably attempt to explain that faxed orders are prohibited by law in your state.... Ker-blam! And, you thought this guy was loud before! Choices: Keep trying to reason with him... Scream back (probably landing you in the CEO's office for costing your teetering medical center much-needed businss). Call Security (see "CEO's office," previous paragraph.) Burst into tears, once again "proving" that "women are too emotional for high-level positions." As we noticed above, the stress in this person's life has gotten the better of him, he's screaming in a public place, and an attempt to reason with him ("can't legally do that in this state") only exacerbated the tirade. Frankly, this guy is at least temporarily out of touch with reality -- ergo: temporarily insane! And, you can not reason with an insane person! But, if you resist him, talk back, or smack him a good one, that's insubordination. Not a good idea, either! Try this: I warn you in advance that he won't like it...this guy is mad now and wants a piece of somebody's hide now. But, give this a try, anyway... Tell this normally-decent-but-currently-severely-troubled doc that you "absolutely agree" that he's identified a completely valid problem. You totally agree that his med and treatment Orders are for the patient's own good and that it would be best to implement them -- even if they do come in by the prohibited fax. "Heck, Doc, we can follow verbal orders, so why not faxed ones!?" (At this point, he's liable to return to screaming that your #*!x&+#* nurse should be shot for not doing that! Ignore this! Remember, he's temporarily insane and can not hear your reasonable responses, if you're still calm enough to even be reasonable! The goal is to postpone this, to get him quiet, and to eventually get him into your office, where you have the "home court advantage." Say: "I agree with you so completely that I'm going to cancel my meeting with the medical standards committee this afternoon to go to the library and research this...gonna see if we'd can't find a loophole in this dumb law. In fact, I'm even going to call the State Health Department...even the FEDS...and see what we can do. Can we get together tomorrow afternoon? I'll try to have an answer by then!" Maybe you'll get lucky and he'll wander off at that point, but he's more likely to continue blustering that he wants the "errant" nurse who failed to follow his orders fired. By now, you've got the hang of this, and reply: "Hmmmm...well he certainly should be discliplined if he's guilty of serious practice violations. Let me talk with Human Resources and the CEO and see what we can do about that." (You already know the nurse followed the rules by refusing to implement faxed Orders, but there's also a ring of truth to your statement that he should be discliplined if he did wrong. The fact that he probably committed no transgressions in this case is immaterial for the moment.) The idea is to postpone the battle royale until a quieter, saner moment in more appropriate surroundings. If you'll give this technique a try, you'll find that it actually works in more cases than not. Good luck! After giving this idea a test-drive or two, why not email Tom, telling him how this works for you? Click here: tomkelly@southern-healthcare.com

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