When to call the doctor...

  1. I know this question is so broad, but how do you really know when to call the doctor? Like when you look at labs for the day, what really prompts you to call? I realize you call for criticals, and lows or highs that are out of the norm, but for instance, say you have a patient with a Hb of 11.9 (female). Would seeing that prompt you to call the doc? I mean, it's almost normal. It didn't prompt me to call, yet when the doc came in, he looked at the previous day's lab and it was 14, so he questioned why we didn't call with the "significant" drop in Hb.

    At times, when I do call the docs for something, 8 times out of 10, he just says "OK" and doesn't change any orders. I just say "well, I wanted to bring it to your attention".

    Up until now, I had just asked my preceptor to see if I should call. I went by what she said. I don't feel I have confidence to make that decision. I am off orient. this week.

    I know the obvious things to call for, but how do you really determine the need to call??
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  2. 11 Comments

  3. by   dauschundlover
    I call the doctor whenever I feel he needs to be made aware of any issue involving his patient. It's up to him to decide what and if anything should be done. That way I can chart Dr.__________, is aware. That way it can't come back to haunt me. Sometimes you'll get yelled out which usually translates to I'm on the golf course.lol but if information is always past on in the best interest of the patient then you should sleep well at night.
  4. by   RNLisa
    I guess what I need to develop is a backbone and just call when I feel it necessary, huh? I need to learn to be more assertive and "take it" when they yell or act annoyed that I called them. Thanks.
  5. by   cardiacRN2006
    I'm really lucky because I have a hospitalist who comes by the ICU many times throughout the shift. So I will have a list of things that I want them to address.

    If they are really critical, then I will call right away (K of 2.2). If it's the Hgb, and the pts VS are stable, her color is good, her assessment isn't indicitive of bleeding, then I think I would wait to call. When the Dr came around and said what he said to you, "why didn't you call?" I would say what I just said, assessment, stable vitals, hemodilution, etc. And from then on out, I would call for every little thing. I guess it helps if you are familiar with your Drs. Even though I'm new, I already have a feel for what some Dr want and what some don't. Again, I know that I will see the whites of a Drs eyes several times during my shift, so I am only waiting a hour or two.
  6. by   Marie_LPN, RN
    One of the most common things we call for is about the standard pre-op IV antibiotic that a doc prescribes for his pt. happens to be one that the pt. is allergic to.

    Docs don't always look at the allergy list before writing an order, and if it's a elephone order, and one of their partner's pts., they might give an order for something the pt. can't have.
  7. by   All_Smiles_RN
    I'm wondering the same thing... when do you call the Dr. during night shift? It seems the experienced nurses think I should wait until my pt is crashing before calling a dr. overnight. For instance, I had a pt with a moderate pleural effusion. CT scan two days later called it a "very large" pleural effusion and picked up a small pericardial effusion. Since it was 1 am when the results came up and my pt was relatively stable (a little short of breath, satting 92% on 2L, cardizem gtt to keep her rate controlled) the nsg supervisor said to wait until the morning. I'm a tele nurse, not in the unit. So I go against my gut and wait it out. Then the day shift nurse nearly has a cow when I tell her I just paged the Dr. this AM, not last night. I feel like I can't win...
  8. by   muffie
    ask your coworkers for advice
    if the pt was your mom, what would you do?
    if you need a med, call
    sooner or later you will feel more comfortable in your decisions
  9. by   RNLisa
    If it were my "mom", I would be calling for EVERYTHING, so I can't use that as an example. I do hope it comes to me because I am on my own this week!! LOL
  10. by   gentle
    Quote from jenniferhelene
    I'm wondering the same thing... when do you call the Dr. during night shift? It seems the experienced nurses think I should wait until my pt is crashing before calling a dr. overnight. For instance, I had a pt with a moderate pleural effusion. CT scan two days later called it a "very large" pleural effusion and picked up a small pericardial effusion. Since it was 1 am when the results came up and my pt was relatively stable (a little short of breath, satting 92% on 2L, cardizem gtt to keep her rate controlled) the nsg supervisor said to wait until the morning. I'm a tele nurse, not in the unit. So I go against my gut and wait it out. Then the day shift nurse nearly has a cow when I tell her I just paged the Dr. this AM, not last night. I feel like I can't win...
    Wow,

    This is why I stopped working tele years ago. I found myself in that position far too many times, and tele patients can become icu patients very easily. It isn't just tele or your hospital though, that type of attitude "don't call the doctor at 1am exists in a lot of different places.

    Okay, so what to do. First I commend you on a lesson learned--you have a great gut:spin: .

    Second, I wish someone would have told me to take as many continuing ed classes as possible. The reason is because, you can learn tons of great information for everyday use in the CEU classes. Since you are working on tele, by all means attend the Critical care certification classes. Oh my goodness, did I love that class.

    I am a med-surg nurse. I love med-surg. I walked up to the teacher explained these 2 facts to her and boy did she gear that class to help me too.

    Third, please don't be like some of your colleagues. Perhaps they may not have sensed the urgency with the patient or understood all the symptoms to know this would turn into a problem--like cardiac tamponade with a "small pericardial effusion." At the aforementioned class, I learned that increases in intrathoracic or intraperitoneal pressure can cause heart arrhythmias.

    Fourth, continue onward with your growth and learning. Sometimes the mds may be grumpy at 1-2am calls but, know that you did the right thing.

    Finally, is there a way that disrespectful behavior by physicians is handled. We actually complete forms for this type of behavior and things are dealt with during their medical meetings.

    I hope this is helpful
  11. by   bigmona
    I work nights and no longer have much hesitation about calling the MD... your judgment gets better over time with when you do need to call. I do my job in assessing pts and maintaining treatments, and they need to do their job in responding to changes in pt status. I don't care if they are sleeping or whatever.. if they're on call then I'll be calling. Pt was SOB, BP 191/66 and audibly wheezing. I had to page a doc three times before he answered my page and by shift change patient was about to head to MICU. It really bothers me when doctors get upset when you call or page them about a patient because that's their JOB and what they are there for. We shouldn't have to "take it" or feel intimidated by them.
  12. by   NotReady4PrimeTime
    Something you can do that might diffuse some of the wrath of the Great MD when you call is to collect up all the issues that might exist for that particular doc's patients and call about them all at once. That's what we do. Of course, being part of a huge teaching hospital, our doc is a resident on call, who is just down the hall, and s/he's responsible for all the patients for the night. But even our residents will try to gather as much of an issue list as they can before they call the intensivist at home in the middle of the night. After all, who knows how many times Dr. Jones has been called already tonight?
  13. by   jjjoy
    Better judgement WILL come with experience... but what's a nurse to do meanwhile? I guess just try to judge the negative feedback as to whether they need to accept it, let it roll by, or put it on a back mental shelf to review later. Nurses are constantly learning and part of that learning is feedback from others. But it's often not clear if the feedback is valid or not or applicable in that specific case or not. Some people will criticize just about any action. Other times, the feedback is valid but not applicable at that point. So someone might tell a new nurse he/she should already know this or that but that's just not true so the new nurse needn't take that kind of negative criticism to heart. Easier said than done.

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