Why apologize to doctor when calling?

[Florence NightinFAIL]

Hi,

I'm a new graduate. I just wanted your thoughts/opinions on this. When calling doctors at night, I noticed that a lot of the nurses start the call with 'I'm sorry to bother you doctor, but....."

Don't they realize that the doctor is not on call out of the goodness of his heart? He/she is getting paid. That's his/her JOB.

I'm not heartless and can sympathesize with someone being woken up/sleep deprived/etc. but I'm not calling to talk about the weather or chit-chat about a game - so it's definitely not a BOTHER.

I feel like everytime a nurse apologizes for calling the doctor to do his job - they get this entitled feeling and that's why most act so nasty and bothered and start yelling at nurses for calling them. Some nurses just dread calling certain doctors and always make apologizes and it just annoys me.

Why do you think they do that?

And do you do it?

[Elvish, BSN, DNP, RN, NP]

I think someone already said it before me. When I say "I'm sorry I have to wake you up at oh-dark-thirty, but...." it's not like I'm admitting guilt over something. I'm not admitting I've done something wrong. What I'm saying is, "I realize you'd rather be sleeping, I know how it feels to go on 3 hours of sleep out of 24 in the day, and I'm not calling to shoot the breeze...". I don't feel bad for advocating for my patient, and I will never apologize for that. But I seriously don't get what's so terrible about recognizing that you have indeed woken up someone from their slumber and giving them a second to get their bearings. Recently I had to call a doc about a long term antepartum (preterm) patient of his whose water broke at 0345. I wasn't sorry for doing my job, but heck yeah I was sorry that it was crummy timing. I like it when my patients all stay stable just as much as the next nurse but when $#!+ happens I try not to make things any more difficult than they have to be.

For what it's worth: on my floor if the charge nurse puts someone on call and ends up having to call them in in the middle of the night, they almost always say, "Elvish? Hey, it's Susie Charge nurse. I'm sorry to have to call you, but we need you to come in...." even though it is my job to be on call and my job to come in if needed.

[Florence NightinFAIL, BSN, RN]

HarleyPinkno15 and the many others who responded to my questions without making assumptions about things I have never said - thanks very much.

I just have 2 points to make:

1) Please direct me to the rule that states I have to work X number of years as a nurse before I can form an opinion or make an observation. I honestly have not seen it and sincerely apologize for thinking that I could speak before putting in the required years. I'm so embarassed.

2) I thought this was a place to ask questions, vent, and pick each others brains. Obviously, we say things here we would not say to our fellow nurses, doctors, and patients. Just because I said something here does not mean that I go into work with that attitude.

[SE_BSN_RN, BSN]

I don't apologize unless I have to call the same doctor more than once for different things. I don't work nights so I don't worry about calling then. If I have to make a call to get meds verified, that must be done, and they give me attitude, depending on the mood I am in I will give it right back. I am doing my job, it's not like I have all day to sit and make dr calls. And I don't have all day to sit by the phone to get my call returned, either. I also try to offer a solution, in case they say "Well, what do you want ME to do?" And if most dr's knew LTC policies, I wouldn't HAVE to call as often. So, sometimes they make it hard on themselves and their coworkers.....and sometimes corporate won't allow us or them to make things easier.

There is just one dr I dread calling. I called the answering service one day and asked who was on call and the service said "Dr so-and-so," and I muttered "Sh**," and the lady starts laughing. OMG I was so embarrassed. I apologized profusely, and she said "Oh, that's ok, I know what you mean," I also have another dr I can never tell when he is joking or serious. I called to verify meds on his patient one morning and he said "I am not going to do this on the weekend." (If we don't have meds verified, we can't give them) so I asked "then what do you want me to do?" and he said "I guess you'll do nothing...." so I charted that, because I thought he was serious. He called me back withing the hour and ok'd everything. That was not funny!!! Although I laugh about it now.

[gopalan]

I think it should be viewed as a courtesy preface for the subsequent message. No more than that. All of us, Nurses and Doctors must realize that patients are not a bother to us, we chose this profession knowing well that sacrifices of personal comforts and family life are an unavoidable ingredient. The day we feel patients are secondary, time to quit the profession.

Gopalan

[cb_rn]

Nothing wrong with saying sorry to wake you. Being polite is always in style.

I just get ****** when we have to sit around and hem and haw about whether we really have to call the doc in the middle of the night because we know certain docs are gonna be jerks. It really compromises patient care when we tiptoe around certain docs and hate to "bother" them. this doesn't just extend to middle of the night calls. My thoughts -- if you didn't want to take calls about patients, become a medical examiner.

I do apologize for needing to wake someone because its no fun, I don't accept bad behavior from anyone, no matter what credentials are behind their name.

[caroladybelle, BSN, RN]

I hate to tell you but medical examiners get lots of calls at night and often have to proceed immediately to site, unlike most of hours that can merely give an order and go back tomsleep.

[General E. Speaking, RN, RN]

Nothing wrong with saying sorry to wake you. Being polite is always in style.

I just get ****** when we have to sit around and hem and haw about whether we really have to call the doc in the middle of the night because we know certain docs are gonna be jerks. It really compromises patient care when we tiptoe around certain docs and hate to "bother" them. this doesn't just extend to middle of the night calls. My thoughts -- if you didn't want to take calls about patients, become a medical examiner.

I do apologize for needing to wake someone because its no fun, I don't accept bad behavior from anyone, no matter what credentials are behind their name.

Sorry to hijack thread but this is a very good point. Usually, the ones that are jerks when you call will be the ones to throw you under the bus in court when you decide not to call because the last time he screamed at you. His defense? "no one called me".

[Poi Dog]

Common courtesy goes a long way. If the person continues to be a jerk, then it's all on them.

[pedicurn, LPN, RN]

I don't think it's good to say sorry to show sympathy. Well, not really, to show sympathy with the 'sorry' word, I'd phrase it like this: "I'm sorry that you are called in the middle of the night. I want to let you know that your patient blah blah blah .... insert SBAR". Better yet, I would say 'Hi doctor. I know it's late and I thank you for picking up the phone. Insert SBAR." I would not apologize, it's the policy to ask your doc about how to take care of your patient. It's a mutual agreement. Think about the patient, who's in the worse case, me or the doc or the pt? Also, docs are expected to be called. I did not do anything wrong, so why apologize?

Am not sure why there is this issue saying 'sorry' when they are not really saying sorry.

Have came across this lately ....some of the nurses I work with don't get it.

The other day, I said 'I'm so sorry that happened to you' a couple of times to different coworkers - one instance was about a personal financial loss to a nurse, other one was about a case of extreme rudeness directed at a coworker.

I got racked over the coals for saying it by other coworkers listening - 'why are you saying that - YOU didn't do it'

This is all about nuance ... not everyone gets it

[llerkl, ADN]

My standard line about calling docs in the middle of the night....." If he/she wanted to be a plumber, they should have been a plumber!". However they ARE a doctor and patients DO have issues 24/7 and sometimes they need to be notified. I have no shame calling docs in the middle of the night....IF IT NEEDS TO BE DONE. I do try to wait till a reasonable hour if the patient condition/situation allows.

A pet peeve of mine is when you finally do call the doc about something important....and they say " I'm just cross covering". Then I LOVE saying, " So are you telling me you are not medically responsible for this patient right now?".

[cb_rn]

I hate to tell you but medical examiners get lots of calls at night and often have to proceed immediately to site, unlike most of hours that can merely give an order and go back tomsleep.

So I picked the wrong specialty to illustrate my point.

The focus of my point was that no doc should be shocked about getting calls at crap hours. Its not like you wake up one day after you're practicing independently and say "WTH? I have to get calls!?!" Its part of the job. One they were exposed to before making final decisions in picking a specialty. If you have such a problem with taking a call about a legitimate issue at an inopportune time, pick another specialty. Don't expect I'm going to listen to you rant. I'm going to tell you point blank, "Ok I'll document that I called you and received no orders. Thank you for your time." Then I'm going to hang up and talk to my charge nurse to see if we need to pursue another avenue for the patient to get proper care. If you don't call me back after I page you three times, it will be reflected in my notes. Nobody is saying we don't all get testy or snappy. I empathize with having precious sleep interrupted. Maybe a little sarcasm is even slightly justified if you get woken up at 3 am because of a mistake on the part of the nurse. I get that. We are human. However, when I see there is a worried nurse and a group of sympathetic nurses around her clucking their tongues because there is something she's got to call about at 2am and we know she's going to get reamed --- that's a big, huge, hulking red flag.

Being "afraid" or "dreading" to call a particular doc because of his/her reputation for being a jerk is a sad testament to that physician. It compromises patient care because of the time spent debating on whether the issue really deserves a call.

So be polite. Be proactive. Call only about the issues you must call about. Say you're sorry to wake them just the same way you'd say excuse me, but please don't do it because you are exposing your belly to the alpha dog.

[talaxandra]

I had no idea there could be so many different opinions about this aspect of our practice, particularly as I've given a lot of thought to, and discussed nurse/doctor communication with less experienced staff many times - fascinating :)

We have 24-hour resident coverage and an on-site med reg at all times; the only time I have to call a doctor out of hours is if a patient has a unit-specific issue. The examples tha come most readily to mind are renal transplant patients dropping urine output or CVP, or unstable T1DM's. In both cases I know the reg wants to be notified then rather than having the covering resident's best guess implemented.

I open with "Hi, W, it's talaxandra of ward X. I'm sorry to wake you - Y's BSL is Z..." for three reasons. As other members have posted, part of it is to give the reg a minute to wake up, particularly if I know they've been short-changed with sleep already. The second reason is that I'm genuinely sorry they have to be woken.

This isn't to say that I think I'm wrong to call, or that I don't recognise that being on call is part of their job. It's because being woken sucks, particularly if it happens over and over. One of our reg's was called at least once a night, every night for over a month - and I think I function poorly with one interrupted nights' sleep, without even being expected to make decisions at o'dark o'clock!

And the third reason? Perhaps I'm impossibly old school, but I found Stein's classic article on nurse/doctor communication fascinating when I first read it and, though much has changed since its publication, think it's still relevant. I want the doctors to do what I think is in the best interests of my patients. My input and suggestions are more likely to be heard if the doctor feels comfortable and collegiate with me. Acknowledging that being woken in the middle of the night, even if it is part of the job, sucks, is part of that.

I have a great relationship with almost all the physicians I work with, even the ones I've never met, only spoken with overnight. I haven't had any of them yell at me or give an indication that they think they're better than I am. On occasion some of them are a little short, but I tell them to stop being a tool and everything's fine again :)