Responding to Doctors

  1. I am going to be a new graduate in May, and I have a few questions about responding to doctors. When the doctor is on the phone, what should you have in front of you to be prepared, besides the patients chart? Also, what kind of information should you know when they are making their rounds. I just don't want to be caught off guard, looking like I am so unprepared. Another thing, what kind of things should you call the doctor for, and what should you not call them about. If you have any advise or answers to my questions please spill it. I could really use some great advise from those of you who are experience, and know the right way to handle phycisians without being walked all over.
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  2. 19 Comments

  3. by   shay
    Just know everything and you'll be safe.... lol! Just kidding...

    The "big three" that are a must:
    I&O (they'll want numbers)
    Vital signs (make 'em recent...like within the last hour)
    Diagnosis for current hospital stay

    Other stuff they usually want is type of IV fluid, meds, if there's a surgical wound what does it look like....

    A lot of it depends where you work and why you're calling the doc. I work labor and delivery, so for me, before I call the doc I need to know:
    Gravida/para
    Gestational age
    cervix check
    membrane status (ruptured or not)
    and any pertinent risk factors.

    I think that as long as you have the 'big three,' that's a good jumping off point. You'll learn on your orientation what's important and what's not. If you're ever unsure, just remember to sound confident and calm on the phone (docs get annoyed with a flustered nurse), and just stick to the facts. Don't include a lot of anecdotal info that isn't vital to the situation at hand. And yes, it's usually a goooooooood idea to have the pt's chart in front of you because without fail the doc will ask something you haven't committed to memory. Lol! Don't worry.........you'll be fine.

    Docs may bark, but if they bite, hey, you can sue 'em till the cows come home and get that nasty mortgage paid off.
    :chuckle
  4. by   micro
    the reason for your call, pt. name(quick history if physician is covering for another physician)
    what nursing interventions you have already done and the effect of such
    current medications, current acute changes succinctly,
    and then if specifics or on specialized unit--- if on telemetry current rhythm. current vent settings and the patient's responses per vent,
    what nursing intervention you have already done and effect of such.........(gave IV lasix PRN at this time and pt. has diuresed _____cc and lung fields remain with congestion throughout, vs are _______)

    and never be afraid to repeat to the dr. the order that they gave to you to ensure accuracy.........or have them repeat to you as well.........

    it will be okay, your preceptors and charge nurse will help you to develop how to call and when it appropriate to call and etc.
    some doc's may bite, some may bark, and some may just have to be truly woken up literally.......

    it comes with time and then you will still get the grumpy doc and you will still forget to have the chart in front of you.........
    AND OF COURSE LIKE SAID ABOVE SO WELL.........hehehe Know everything!!!!!!!!!!!!!!!!!
    YOU WILL DO GREAT AND TO ALL STUDENTS GETTING READY TO JOIN OUR RANKS...........WE NEED YOU.....COME IN THE WATER IS FINE..........:kiss :stone
    Last edit by micro on Apr 21, '02
  5. by   moonrose2u
    in kentucky when we take a verbal, its like this"

    v.o. dr smith/(my name) r/v

    r/v is for "repeat and verified"

    it really saves our butt..

    not to mention it is now law in kentucky.
  6. by   momrn50
    Make sure you have the chart in front of you along with any important information, like vital signs, allergies, etc....they like it when you call them Doctor...don't get flustered!!!! Don't be afraid to ask them to repeat an order.
  7. by   Agnus
    Before you pick up the phone I ask myself a few questions:

    1. Is this something that can waite until the doctor makes rounds. Or does it require immediate attention of the physician?

    2. Did he specifically ask me to call with this info.?

    3. Is the patient stable?

    I have discovered that in a stable patient most things that I need to talk to him about can wait until he rounds. So, I write notes to myself and to him about this.
    I often place a sticky note on the cover of the chart for him in case I miss him (or forget when I see him). I also check my notes to myself, when I see him so that I ask/say everything I need to.

    4. Is the information that I need from him obtainable from any other source? (other nurses, pharmasist, other professionals, polocies, proceedures, algorythms, protochols etc. )

    Once I descide I need to call I ask myself some questions depending on my reason to call and the patient.
    This is especially important if I am calling an MD who is covering for another doctor. But is important for the primary as well. Know all the diagnosis of the patient and history, what led me to call, That is, it is usually not just one fact that is behind this call. For example pt has a fever > 100.1 so I look at what might be causeing this, I look at other VS, I and O, LOC, other signs of infection and where they are comming from, look at labs to see if I can tell where It is comming from. and so on.

    SO I play a little detective work with myself before calling. I look at the big picture and try to figure out what is going on with the patient. This is what doc will do. That way I am ready when he asks. I have pertenent labs, x-ray and immage reports and other test reports in front of me.
    I know when a procedure was done (ex. surgery) I
    I know quantities where applicable (example, 300 cc of serous sangunious drainage in one hour, from J P number 1 and 200 cc in 8 hours from JP # 2. previously he had put out 5 cc over 8 hours in each JP)
    Know other S/S the patient is having, how long, when they started, what percipitate them, what I think is the problem or what I think the pt needs. I may not know but if I do have an idea or feeling about this it can help. Have as much info that I think will be useful to the doc available as I can.

    Don't just have the chart but have my notes from report and any other informal notes that I have been writing available.

    Not every call will require all of this info obviously. But making a point of having this info and asking these questions before will simplyfy the call make it easier on me and the doc.
    Imagine having the doc ask (and he will) what I want him to do, or what I want for the patient, or asking me what my opinion is, or saying, "I don't know. What should I do?" There will be times nurese have to direct the doc.

    If I don't have all the info I need and he ask for something that I did not anticipate then I tell him and if he wants I'll get it and call back.

    Oh yea, know what meds he's on and amount and what he has had today. So have the current MAR.

    I try to keep in mind that he takes calls from many nurses and from many hospitals, I do not bother him with routine thnigs by phone, or to call at 10 pm tell him a gram stain came back postive for a patient whom we already know the organiam.

    By all means talk to to the doctors when there are doing rounds, this is the best time. When it can't wait call but try to already know the info he will require from you. Look at the whole patient and be a detective yourself (pretend you are the one going to provide the answer to your question. )
    It is OK to consult with other nurses or pharmacy before you call.

    Play a game with yourself pretend you are back in school and this is an exam or quize and you must provide the answers as to how to treat this patient. This means you must know what information the test should provide about this situation. If you don't have all the info you need then ask the test proctor for this info and be sepeific about what you need. If the info can be quantified it should. Example a lot of blood tell no one anything. 50 cc does. Crying a lot is not quantified, crying 1 hour is, patient c/o pain is not quantified, Pain of 9 when it was previously 3, tell a lot.

    In other words just use your head.
    Put youself in the doc's place who has taken 40 calls in the last 24 hours most which could have waited or had such incomplete info that you could not make a decision, or they were valid and emergent and now you are about to pass out or cry.. And coudl not put up with a caller who did not have her act together.

    The fact that you are asking this question know tell me you will do just fine. You have already started to do just what has been said here. Not every call will go smoothly but if you respect their time and give them the info they need as much as possible you will develop a great rapport. Every Doc gets mad and frustrated with us at times. They are only human. Some are spoiled arrogant children. You can help raise then to the level of adult, by being a competent adult yourself. Some, well they are hopeless but there are goods ones that make up for them.
  8. by   RN-PA
    Excellent response and advice, Agnus! I can't think of anything to add-- you said it all so well!
  9. by   aimeee
    The only thing I would add is that I like to have the MAR at hand too. I make notes of all the information I feel the Dr. should know and make a list of everything I want to ask the Dr. for before I call.
  10. by   VAC
    In our hospital as part of the physician satisfaction campaign; they have created an acronym to help us remember what to have while initiating a phoncall to a doctor..

    C.L.A.S.S.
    Chart (includes mars) Labs, Assessments, Signs and Symptoms (including most recent vitals)

    They also request us to make sure our co-workers know which nurse is calling which doctor, and on the med surg units they keep a call log so the docs aren't kept waiting.

    Hope this helps. When you get used to a unit and the docs it gets easier. Through experience you'll get to know the kinds of questions docs ask when they call you back.
  11. by   KRVRN
    If you go into anything peds or infant related, know the pt's weight.
  12. by   Goofball
    Also, before you call: Look in the chart in the physician progress notes section, and read what the last couple of entries say, because sometimes your answers are in there. Like if you are wondering if the dr. is aware of certain lab results or conditions. Also make sure to look at sigs to check who saw the patient last.
    The stamper plate may say Dr. Smith, but maybe he just admitted the pt. and it is actually Dr. Jones who has been seeing him every day.
    Another idea is to be sure and announce around to your co-workers who you are calling, and did they need to speak with that Dr. as well? That way your unit can make fewer calls/fewer interruptions to the dr., which will also make the Dr. less impatient with you for putting out 5 calls in a row instead of 1.
  13. by   OBNURSEHEATHER
    WOW! Excellent advice from all! I don't think there is anything else to add!

    Just make sure you are paging the right doc.

    Heather
  14. by   Sleepyeyes
    Memorize the following phrases, spoken in a smooth, emotionless voice (I call it my Secretary voice ) Don't smile, don't smirk, and above all, don't lose your cool. If he says something that pizzes you off, repeat the order slowly, like you're writing it verbatim.
    It'll give him time to think about what he just said, or time to fume (in which case he deserves it).

    1. "Yes, Dr, I called you about your pt. X. I really didn't want to wake you but I knew you'd want this information before you started your early-morning rounds. It seems that his troponin level is positive for an MI and we're concerned because although he denies pain, he is becoming more confused and is insisting on walking the halls looking for his clothes so he can get a cab and go home...." (Let him interrupt you with orders...)

    2. "Yes, Dr, so sorry to wake you; let me just turn up the volume on this phone so I can hear you better...." (Let him surmise that he sounds like poo on 2 hours of sleep)

    3. "Ok, Dr, so those are your orders for the patient? --[Repeat order and establish parameters] "Ok, you basically just want us to watch her until her pauses are how long? Since they're at 20 seconds now, did you want us to wait til they're what? 30
    seconds? 40 secs? OK, let me just write that down as an order, one second please..."
    Or,
    "Did you want a followup K level after the pt's bolus runs?"

    4. Follow with "OK, so these are your instructions: 'Give IVP of Lasix 40 stat, then Lasix IVP in one hour. Titrate O2 to >91%. CXR flat & upright, and call with results asap." Confirm. Document, do.

    I very rarely get yelled at using this technique.

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Responding to Doctors