I do not like the way you talk to me!

One night I was on call, an IV drug abuser was admitted. She was so restless and keep complained about pain. She is already on Methadone for drug addiction and long term pain control. It does not seem to work, she was twisting in bed. The primary team signed out to me no more pain meds for her. I gave her a small dose of Tramadol at 10pm, it seems worked a little bit. I was called again at 4am and the nurse was requesting to give pt more pain meds. The pt probably kept her busy all night, and she sounds very agitated. I told her no, the reasoning behind it is the pt is drug abuser, probably had built  very high tolerance on narcotics. The nurse was not very happy, "wonderful!" and hung up the phone.

It is not over yet, at 6am, I was paged by the same nurse again, "pt is in pain and please come to bedside to assess patient ASAP". Hehe, pretty aggressive. I returned a few other pages, I got to bedside at 6:30am. Pt is the same as before, restless in bed. The nurse showed up at the door, "why can't you give her more pain meds?" She sounds very angry and frustrated.

I am agitated too, what do I need to do? I took a deep breath, looked at her straightforward, I said to her calmly, "I do not like the way you talk to me, are you angry?" She probably never expected an intern can talk like this. She is in a little bit shock, looked down, mumbled something in her mouth and left.

I thought it is over. When you work in a high stress setting, confliction happens all the time, but it is not personal.

A few days later, I was called to chief's office and said a nurse reported me for not giving pain meds. Haha, I know exactly who she is. She wrote a page long, basically blaming I raised my voice so she raised her voice. I explained the whole situation to the chief, the chief categorized this as miscommunication. I joked to the chief that I should have filed behavior issue against that nurse. Just like I said before, I never took this personal, but that nurse apparently did. 

The chief told me as a female physician, you probably is going to be under higher scrutiny and held up to a higher standard. If it happens to a male physician under the same situation, the outcome probably is different. This is not surprising, I was told the same thing on the day of orientation, and it did happen to me.

Long story short, when someone talk to you in an angry tone, what do you do? Take a deep breath, instead of yelling back, just say it calmly, "I do not like the way you talk to me, are you angry?" You will notice a different effect. If you yell back, and that is exactly what the other person wanted, then you are trapped and that person can use it to against you.