Can you identify the physician personality type you’re working with? In this second part of this series, I share more tips that you should be aware of and how to respond. Some physicians are easier to work with than others.
This post points out a variety of physician personalities and examples of dealing with them. Knowing how to react to them makes your job easier.
Physician Personality Type: Sadistic
Undoubtedly, the sadistic doctor is the worst personality to encounter. These doctors usually ask questions they’re not supposed to during the history portion of the exam.
During the physical exam, they are also the kind of doctors who make the client do a test three or four times.
When measuring the clients, they do those three or four times, even though they’re supposed to only do it once on each body part.
They also like to force the measurement to ensure it goes with whatever measures they hope to put on the report.
This physician personality type of examiner watches to see if the client is having pain. If the client does any test, such as range of motion of the cervical or lumbar spine, and the doctor notices that the client has a lot of pain. Then the doctor tells the client to do that same test three or four times.
The sadistic doctor seems to enjoy the pain that the client exhibits when they’re doing the test.
The sadistic doctor will tell the client, “Lean forward,” and the client leans forward and gets to a certain point, saying, “Oh, that hurts bad when I do this.” And the doctor says, “Do it again.”
Even though the client is not exhibiting any signs of over-dramatization, you can see this is hurting this client.
The non-sadistic doctor who examines the client will ask the client to perform the maneuver, and when the client expresses pain, the doctor will look at the client. Depending on the level of grimacing or pain they notice from the client, they will tell them to stop.
The sadistic doctor will ignore the client’s expressions of pain or tears.
LNC Response to the Physician Personality Type: Sadistic
How and when the LNC intervenes involves making a judgment call. Some of the tests will cause a reasonable amount of pain if the client has pain in those areas. At times, the pain the doctor produces is necessary for the doctor to know exactly where the pain originates from.
In the situation of the sadistic doctor, the nurse should be trained to use critical thinking to know the difference between a regular exam versus the actions that result in unnecessarily hurting the client where the doctor is doing their exam.
The first thing I consider is if this client is the kind of person who can’t tolerate any pain whatsoever. I consider what usually happens with most people in this examination phase. A client with a lot of back pain will experience increased pain when leaning back too far.
Suppose the client starts saying, “It hurts,” before leaning back very far when they haven’t done anything yet. That’s the difference. The doctor says, “Can you lean forward and let me see how far you can go?”
“Oh, no, I can’t do that. No, that hurts.”
This type of response occurs when the client is faking pain, exaggerating the pain, or has a low threshold for pain.
When I decide that the client’s expressions of pain or tears are consistent with pain, I stop them. “Doctor, I believe in your code of ethics, and the paperwork that I gave you states that you should not knowingly hurt the client.” I describe exactly what is occurring for the attorneys’ sake so they can hear everything on the recording. I say, “You are visibly hurting this client. You keep telling them to do it over and over again. Excuse me, sir, can’t you see that the client is crying?”
If the doctor ignores me and tells the client to do it again, whatever the test is, depending on how bad it is, I stop the examination. I’ve done it twice: put the doctor on hold and called the plaintiff’s attorney right before the doctor. I put the attorney on speaker and told the attorney what the doctor was doing. The attorney fights with the doctor and then may instruct the doctor to continue the exam or get so upset they tell me and the client to leave.
Physician Personality Type: Violent
The violent doctor acts to hurt the client or the nurse. For example, I met a violent doctor who took almost two hours for the history portion. I told him he had only two hours to do the exam, both the history portion and the physical examination portion. This doctor was distraught that I was intervening when he asked questions regarding personal medical history, any work-related injuries, and prior injuries and surgeries. He had the medical records and the response.
He refused to look at the response. When I was interrupting him, at some point, the doctor said to me, “You are interrupting my exam. You are blocking my exam. You have no right to block my exam. You’re a stupid bitch.” After that, I ignored him and figured I would keep acting professionally.
At that point, this doctor picked up the client’s chart and threw it at me. After he threw the chart, I watched to see where the chart landed. The chart landed just inches away from me; it didn’t hit me. I made sure to state for the recording when he threw the chart at me. I said he was lucky that the chart did not hit me because if it had, I would have been filing assault charges against him.
Violence is Never OK
The doctor, at that point, hurriedly finished the exam. When I got outside, I called the attorney who sent me there and told him what the doctor did. The attorney didn’t believe me. “No, you’re just telling a story.”
“No, I’m not. I’m not telling you a story.”
“How could he do that? That was violent.”
“He did it. I will take time to write the report to ensure I write everything down.” I handled this report diligently to ensure I recorded everything that happened there. The attorney asked, “Can you forward me the audio recording of the exam and let me just listen to it?”
The Power of an Audio Recording
I sent him the audio recording before I sent him the report. The next day, he called me and said, “I can’t believe it.”
“I told you the doctor did that.”
The attorney filed a motion to disqualify the DME on the grounds of assault on the nurse. The judge disqualified the DME. The defense was not allowed to locate another DME physician because this doctor had messed up the one DME that they were supposed to do for that specialty. (They should only do one DME in each specialty if needed. In this case, it was neurology.)
The Court said that the defense was not allowed to request another neurological exam because this doctor was supposed to do the exam, but he chose to become violent. The doctor eventually got citations on his license for assaulting nurses.
He behaved this way more than once and was chauvinistic. I could tell he didn’t think very much of women in general. Everything that he did was affected by what he thought about women. The client was a woman, and I was a woman, and he did not appreciate that at all. He did not hide his chauvinism, but he took it a step further. I made sure I took care of it. He was lucky he didn’t lose his license. I suspect he was taken off the list of doctors to perform DMEs, as I have not seen his name in the last ten years as a person doing DMEs.
Sings of The Violent DME Doctor
The violent DME doctor may direct their anger at the client when physically examining them. The doctor holds the body part and keeps pushing it in different directions. When the client says, “Doctor, that hurts when you push my arm in that direction,” usually if a client says that the doctor is supposed to stop and make notations indicating, “Oh, the client had pain when I move the arm or the leg that way.” But what these doctors do (they also border on sadistic) is they keep moving the same body part. They keep moving the same body part repeatedly until the client has tears in their eyes or almost cries.
When the LNC observer objects to the pain they’re inflicting on the client, the doctor says, “I just have to make sure he or she is injured.”
LNC Response to Physician Personality Type: Sadistic
In response to this behavior, the LNC may say, “Doctor, you’ve done this test before. The client will not do this test three or four times to satisfy your curiosity.”
Part of this behavior may derive from a narcissistic or sociopathic personality. They enjoy seeing people in pain and use their authority as doctors to carry this out. And they think they can go as far as they want to, no matter what happens. That’s why the role of the LNC as a client advocate is vital. The LNC observer must not get intimidated by this type of physician. Some of the doctors try to intimidate the nurse.
Physician Personality Type: Passive Aggressive
The passive-aggressive physician tries to hide their aggression by being friendly with the client, but then they inflict some pain on the client by repeatedly performing the same exam.
The difference between the utterly aggressive doctor and the passive-aggressive is that the passive-aggressive physician is initially friendly with the client.
When it gets to the physical exam, the doctor keeps moving the body part, whatever body part is involved, while smiling at the client and asking, “Does this hurt?” After the client states it hurts, the doctor continues the painful exam.
That’s the difference between this type of doctor and the ones who are aggressive. The ones who are aggressive and violent are the ones who will perform the painful exam repeatedly.
In contrast, the passive-aggressive doctor will inflict pain and then try to be nice, and then do it again, and try to be nice again to the client. Most clients are not knowledgeable about the laws and their rights, so the doctors try to take advantage of that. The clients’ vulnerability worsens if they do not know how to speak English and bring interpreters.
LNC Response Physician Personality Type: Passive Aggressive
The LNC may note by listening to the dialogue that the client may not have the capacity to understand the doctor. When the doctor spots this vulnerability, they ask the questions anyway, although they know that the client doesn’t have the educational capacity to understand what the doctor is talking about.
The doctor may take advantage of the situation by using complex medical terminology, knowing that these clients do not understand that terminology. The doctor does not bring it down to their level, to the level the client would understand, and they don’t care.
The LNC observer would note in the report that the doctor used complicated medical terminology with the client even though the client didn’t understand what the doctor was saying.
While most DME physicians are friendly and professional, the LNC needs to be alert for signs that the physician is sneaky, aggressive, or violent. Even in states where LNCs cannot object to questions the DME physician asks, the LNC is at the exam to protect the client from an aggressive or violent physician.
Intimidating
The aggressive and intimidating doctors adopt the same behavior pattern by advising the client not to lie. “Look, you’re supposed to do what I tell you. If you lie, that goes back to the courts.” The intimidating doctor doesn’t indicate they have medical records; they concentrate on intimidating the client.
The exam’s history part allows the intimidating doctor to ask questions regarding injuries. After the client identifies their injuries, the doctor is intimidating by asking the client, “Are you sure that’s what happened? Because there might be a possibility that’s not what happened.” The client looks at the doctor, puzzled.
LNC Response to Physician Personality Type: Intimidating
In a state where the LNC is permitted to object, the LNC may say, “Doctor, you can’t do that. You can’t intimidate my client. You should directly ask your questions. If you are asking the questions you’re supposed to ask, we will let those questions go through. But you are not here to determine whether this client is lying or whether this client is putting on a show. All you’re here for is to do the exam, provide a report on doing the exam, and let whatever medical records, deposition, and other information you have decide on what the client is doing and is not doing. You’re not here to determine who is lying or telling the truth.”
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Pat Iyer is president of The Pat Iyer Group, which develops resources to assist LNCs in obtaining more clients, making more money, and achieving their business goals and dreams.
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