June 3, 2008, 12:57 pm

Eyes Without A Face

Ha! This doctor won’t get away with poor auscultation skills!

Not if Nurse Sour Expression has her way!

Have you ever seen a doctor auscultate a chest without putting the earpieces in? Raise your hand, don’t be shy!

Now, how many of you have done the same thing?

I have. I thought I had gone deaf from too many rock concerts. Turns out the stethoscope was around my neck.

Speaking of stethoscopes, I have a beautiful “electronic” Littmann stethoscope that amplifies sound. I thought it ran on an AA battery, but it turns out it needs an AAA battery, so I have had to use my regular Cardiology II.

Guess what? I hear just fine. I guess I’m not going deaf after all. One more NASCAR race and I might be, though. The loudest band in the world has got nothin’ on a race car!


Wondering where Grunt Doc has gone? Have no fear, he’s with his family and away from his computer. He’s getting lots of worried emails, and asked me to pass this along!

Whatever it is you are doing, Allen, have fun! Then get back to work, we’re having withdrawls!


I’ve written before on how wrong I think it is for nurses to evaluate doctors (and vice versa), especially when it is anonymous. It isn’t easy, but as professionals I think we are obligated to talk out our differences of opinion regarding patient care.

And the only thing that really matters is the patient.

Well, now this topic has hit close to home. I was given an evaluation tool that had all our doctors listed on it.

I refused to fill it out.


Never mind that I had reservations about why the survey/evaluation was being conducted.

It was what they were asking and the way they were asking it that caused me to raise an eyebrow.

It was touted as a way for the nurses to give anonymous feedback to doctors. It even said “Nursing Evaluation” on the top.

But it was given to non-nursing personnel. Apparently, non-nursing personnel have the insight and education to evaluate physicians on the same level, using the same criteria as professional registered nurses.


If the concern is how well the doctors work with others, wouldn’t you think the non-nursing personnel would have different issues to address other than say, how physicians treat patients?


The questions were geared toward evaluating the doctor’s personality as opposed to medical expertise. One of the questions was actually “Which doctor makes you excited to come to work when you see his name on the schedule?”


How, exactly, is that professional?

I’ve been in ER nursing since 1991. There have been doctors whose very names have made me cringe, let alone work with them. Are they any less competent as physicians because I don’t like their personality or the way they practice medicine?

Or how about the question regarding whether or not a doctor moves a patient efficiently through the system?

Well, some doctors work fast and some work slow. I’m supposed to evaluate their pace? God help the doctor who tells me I’m not working fast enough for his/her taste.

Ah, but I don’t tell the doctor anything. You see, this is an anonymous survey. We give specific grades to specific doctors and they get the “feedback” with no way of addressing any problems with the nurse who has the problem with them.

Hate a doctor? Now is your chance to blow them out of the water with no accountability. For example: say that you are a physician and I don’t like you. You practice safe medicine, and you are relatively efficient. But I think you are one step above an amoeba in terms of your personality and I want you out.

Well, I would have two words for you: Bye-bye! Except I would not have to say those words to you. I could just evaluate you at the bottom of all categories and skew your evaluation so that it looks like you are a detriment to the department.

But I wouldn’t do that.



Because I don’t care if you are Marcus Welby, Hawkeye Pierce or Dr. House. I don’t care if you are Grumpy the Dwarf for as funny as Robin Williams. I may get frustrated with how fast you (don’t) move, but that doesn’t matter.

Every single one of us as have quirks, idiosyncrasies and unique personalities. As professionals we work with (and sometimes around) these qualities so that together we provide decent patient care. A doctor can hate my guts (and some have) or I can think they are the biggest ass on the face of the earth (and I have) but when the focus is the patient, none of that makes any difference.

I may get angry, frustrated or tired of getting screamed at by surgeons some physicians, but my patients are taken care of both by myself and the doctor. Interfere with safe patient care and I’ll be all up in your business, but at least you will know who is accusing you.

It beats having a bunch of eyes watching you without knowing whose faces they belong to.



    June 3, 2008 at 5:17 pm


    Health care is not a popularity contest.

    This survey remnds me of those anonymous slam books that used to circulate in grade school.

  • Ian Furst

    June 3, 2008 at 6:38 pm

    auscultation skills — here’s a good story (sad but true) — I auscultated a pts heart prior to sedation and all was good. Gave him a bit of sedation and as his rate slowed the ST segment was sloped. No big deal in a healthy 25 year old; right? Thank goodness, I thought, let’s take another listen and, bang, III/VI SEM LSB (heart murmur) I previously hadn’t heard. Scratched my head for 5min then just stopped giving sedation cancelled and referred him for CV consult. Turns out he had undiagnosed cardiomyopathy and needed an impl. defib. Make sure the pointy things are in your ears. You never know what you’ll hear.

  • Doctor Anonymous

    June 4, 2008 at 5:08 am

    Wanna know were GruntDoc is? Check out his Twitter feed, and that’ll give you all the info!

  • Pk

    June 4, 2008 at 7:37 pm

    ahh Dr. A I was thinking the exact same thing.

    I rarely am anything but flexible and coorporative with doctors. But I had one that was openly hostile to me. (she even told me, point blank that she thought I was a hypochondriac, used the word too)
    She ‘listened’ to my chest, only the stethoscope never touched my chest and the ear pieces were still around her neck.
    She huffily said “sounds just fine” (I was having shortness of breath)

    I looked at her and a bit huffily said “you can hear through your neck?”

    Yeah, the exam was done shortly after that.
    She then gave me the ‘results’ of the tests she’d done on me, which she said were essentially self induced and attention seeking ..and I asked (ignoring that) if stress and depression were causing me to have the symptoms I was should I see a psychiatrist. She said “no, you need to stop being a baby about being a new mother” (my son was 4 months old)
    Report to PCP went as post partum depression.

    2 years later, dx’d with Myasthenia Gravis … applied for disability, got records from her .. and it included a positive EMG, and positive antibody test.

    Why? Who knows. The saddest part of the story isn’t what she put me through … it’s that when I’m asked the history of how I was diagnosed at the hospital … there have been both doctors and nurses that have said “that wasn’t Dr. So and So was it?”

    So, she’s done that often enough that others can identify her? GREAT!

  • NPs Save Lives

    June 5, 2008 at 8:16 am

    I’ve seen entire exams with no hands on. Interesting.. I don’t agree with anonymous evals for the same reasons you said. There are some doctors I wouldn’t bring my dog to see and some I think are brilliant. Same said for nurses. We all have different personalities, but as long as the patients are being taken care of, it’s all good!

  • NewGradNurse

    June 7, 2008 at 7:16 pm

    well said

  • ernurse

    June 10, 2008 at 2:53 am

    I agree with you 100%. It’s our different personalities and quirks that make life interesting. I like the points you make about accountability. Surveys like these should have as their goal the improvement of patient care. If I can tell a doc that something he’s doing is interfering with patient care, and do so courteously and professionally, no matter his reaction I have accomplished more than I would have if I put it down in some anonymous survey.

    Bravo for the thought provoking post!

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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