I don't want to call you, but you ARE the doctor!

  1. bah, what can you do? I get this guy from another floor, they called a stroke code because he was confused and not himself(nm the guy's 74, amputee, bedrest, a mess). CT and MRI are negative. they write orders to transfer the guy at like 1200. He gets to me at 7 pm! and he gets there, his abdomen's rigid with rebound tenderness, I can't convince the doctors that something is going on and he keeps spiking these 102 degree fevers! give him tylenol, comes down in like a hour. but he's rocking, looking like he's having cramping. NM that the CT of the abdomen showed he had gallstones! but NO GI consult yet! So i'm trying to convince the urologist that something is wrong.
    It takes the guy's bp to bottom out, and not come up after a bolus for the doc to agree to send him to ICU. another bolus, A KUB(which of course is negative cause the radiology guy's like-"oh KUB won't show much acute stuff"), and off he goes.
    Then my admit comes up at 2330, has horrible pain issues. the pain doc had ordered a PCA. ER didn't start it. just kept giving him 1 of dilaudid(although he tells me "i told them it wasn't doing anything"). I spend 3 hours (although with ICU tx guy) bolusing and increasing his dose per protocol. Then he maxes out. Primary won't order pain meds. Pain doctor won't call back. Had to get the house super to call the head of the anathesthia department. He gets me orders, and tells me to write up the primary and the consultant. just busy crazy. Ate at 0430, a half hour before the end of shift. Ran my butt off! I got out of med surg to limit this!
    I'm just so ticked off at docs who won't listen that I'm only calling because I need something! they talk over me, insist that I stop talking(because of course, the reason I'm calling is something they addressed earlier, and the situation couldn't possibly have changed in oh say 12-15 hours since seeing the patient), and berate me because I had the gall to call em. I'm on a write-up roll and don't care. I always get the ok from the super to write em up, cause I'm a professional taking care of your people while you sleep. do your job too, mmmmkkk?
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  2. 11 Comments

  3. by   Reno1978
    I find this phrase helpful when I'm not getting anywhere when I think I should be getting orders: "So, you'd like me to document that I notified you about _____, and your satisfied with letting _____ continue."
  4. by   Esme12
    If I had a penny for every time a MD asked me..."DO YOU KNOW WHAT TIME IT IS?" or ""YOU CALLED ME FOR THAT?"......

    First of all, HERE'S A CLUE.....of course I KNOW WHAT TIME IT IS.... I'm awake and at work babysitting your patient. One MD it became comical, I bought him a Big Bird alarm clock for Christmas so he'd always know what time it was......

    OR when MD's.......DEMAND my name and/or told me they'd have my job......(which by the way we nurses know you can't do because you couldn't possibly know how to multitask as you never seem to know the time or keep reminding my about how many people you care for.....like I can't remember....jeeze) I'd have more money than Warren Buffett who has more money than GOD.......

    I just consider the source and do what I need to do for the BEST interest of the patient AND..... to keep my butt out of court. BUT, At the end of the day I am the only one who has to live with me and when it's all said and done and I go tot he pearly gates I want GOD to look at me and say....."Good Job!".

    All their hot air doesn't phase me in the least.....all I hear is Blah, Blah, Blah...
    Last edit by Esme12 on Sep 29, '11
  5. by   Biffbradford
    We had a surgeon that did his last case on Friday afternoon, and split town for ???

    Pt did not do well, needed to go back to OR. Surgeon is not on call and out of town. On call MD won't take him. We just kept going up the ladder until the chief had to do it!
  6. by   PMFB-RN
    Like others have pointed out I don't think you were using the right words when calling the docs to get the proper reaction from them. Also doesn't your hospital have a rapid response team you could have called? Make things official with a documented rapid response activation and things get done in my experience.
  7. by   Isabelle49
    Quote from Biffbradford
    We had a surgeon that did his last case on Friday afternoon, and split town for ???

    Pt did not do well, needed to go back to OR. Surgeon is not on call and out of town. On call MD won't take him. We just kept going up the ladder until the chief had to do it!
    Way back when I worked PACU I thought surgeons should be completely responsible for the patient for a minimum of 24 hours after the procedure.
  8. by   richardgleaton
    The work of doctor is to protect us with the disease and any other paining things....But what should even we do if fever comes late night or suddenly something happens in night..so its duty of doctor that if possible for them,they will do help us..
  9. by   anotherone
    thank god i work with a teaching hospital where the night floats or covering interns expect to be paged. sometimes i can tell they are annoyed at being paged but not to the extent of some of the reactions you guys have experienced. sometimes a rapid response does seem like the only way a pt will get transfered to higher level of care.
  10. by   Anna Flaxis
    How frustrating. This is why having hospitalists around the clock is really great. They're physically at the facility 24/7. They expect to be paged, and often show up to look at the patient for themselves.

    In the ED, I work with (mostly) a great bunch of docs, and they're physically present in the unit all the time. Not only do they listen to the nurses' input (most of them, there are a couple who don't seem to care what I have to say), but they will actively solicit our thoughts on many patients.

    I think that's really terrible that you had such a hard time getting a doctor to listen to you.
  11. by   leslie :-D
    sometimes i wonder if docs realize how darned dangerous they sound.

    i always advise the new/inexperienced nurse that meticulous documentation and a bite me attitude (towards the ranting docs) will guide you accordingly, through the process of trying to get an order.
    and yes.
    it always works when you inform dr that you intend to note, "dr ________ notified about pt's declining status: t 103 hr 160 bp 88/50 rr 32; pale, diaphoretic, ox1. nno's."
    they do not like to hear that you will document this, and suddenly decide to play nicer and give order(s).

    the most important act, is to totally disregard their blabbering (but still note it), and get what you need to.

    leslie
  12. by   Aurora77
    We have one hospitalist that doesn't like to return pages. It's incredibly frustrating. I understand that we're a small facility and he may be busy in the ER, but amazingly enough all the other night hospitalists DO call back. One of them (gasp) actually rounds on the floors when he's not occupied in the ER. I just want to tell the the problem guy that it's not like I'm bored and calling to chat at 0200. I'm sure his job is difficult, but if he can't handle it, maybe it's time to find another career.
  13. by   PMFB-RN
    Quote from Aurora77
    We have one hospitalist that doesn't like to return pages. It's incredibly frustrating. I understand that we're a small facility and he may be busy in the ER, but amazingly enough all the other night hospitalists DO call back.
    *** His failure to preform the job he was hired and is getting paid to do should be brought to the attention of his supervisor. My pracitce, and what I teach new nurses is to page and document time you paged, wait 15 min and if no call back page again and wait 10 min. If still no call back then I work my way up the ladder. I have, on occasion, woken up the chief of medicin and / or surgery to report that a patient is having difficulty and their underlings refused to answer their pages. I have never had a bad experience going up the chain. Don't get me wrong the attending / chief is usally pretty ****** off but not at me (not that I give a damn who they are ticked off at).
    Those who suggested informing the physician exactly what you are planning on documenting are giving good advice. Sometimes you can shock a doc back into realiety by repeating what they told you and telling them you are documenting it.

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