If you think you need to call the MD, CALL THE MD!!!! - page 7

by wooh 14,338 Views | 67 Comments

Decisions to call the MD need to be made on the basis of, "Does the MD need to be aware at this time. Does the patient need interventions that are not ordered? Tests that are not ordered?" And that decision needs to be made by... Read More


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    As charge on a Med-Surg floor, I'm usually the one doing the calling. The nurses like that the responsibility is off them and it frees them to do something else, but then I can know if there's anything else that needs to be addressed at the same time. I can imagine the MD does get frustruated getting 3 calls, 5 minutes apart, on 3 different pts instead of one call with ALL the complaints. Most of the time it works, but if not----oh well, I'm already dialing! lol

    I did have a butthole surgeon to deal with one early morning---post-op, wooky vitals, did not look so good at all. All I wanted were some simple lab tests, antibiotics, and a promise that the MD would see him ASAP on morning rounds. Got those orders an hour later...lo and behold, white count's sky high. It's a critical value, so I gotta call it to report. Dr. Congeniality asked why I called and I told him to report the lab. Before I could finish speaking, he clearly said, "Do not call me for anything for him tonight!" Gotcha Doc---noted that I reported critical lab value. Telephone order written exactly as he gave it---'Do not call me again about this patient tonight'./ telephone order verified/ TX RN Shannon.

    Comes in all blustery and ***** the next morning, but became livid when he saw the order I wrote. At the nurses' station during shift change, with many other practitioners around, and hallways filled with ancillary staff and visitors, he stood up til he was facing me and BELLOWED "why in the h*ll did you write that sh*t on my chart?" I had already notified my nurse manager so she was on the unit and aware. He's getting keyed up, trying to get nurses and doctors to support him (but many know of his antics), going on and on...and I HAD IT! I got in his face, finger pointed, and said, "Look, Dr. Grumpy---do you think I actually enjoy waking you up and wondering what kind of mood you'll be in? Do you think I enjoy getting hollered at or called an incompetent dumb*** when I am busting my butt to make sure your patients are being taking care of in an excellent way? I do not call you with trivial matters at 3 am; if I call you, its YOUR patient and its important! Do you think I really want to end my shift with you b*tching me out in front of all the other nurses, doctors, and families around the desk? No! I do what I am supposed to do and I do a damn good job at it. I do not think there is ANYTHING I could do to please you at all! Uugghhh!!!!"
    It was deathly quite, until I hear some claps coming from my coworkers, some ancillary staff that had been at the nurses's station, and even support and applause from FELLOW MD'S!!!
    CrazyGoonRN and nrsang97 like this.
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    Tonight was a horrible night on my floor. At least each of us had to page the hospitalist a minimum of twice. One of my patients had a fall and later in the shift needed a restraint order. Anyways, she calls back and proceeds to rip into me about the amount that we've called her tonight.
    . What did I want to say? I'm so sorry that everybody on this floor is nutting up at different times, or that they're BPs can't all spike or drop at once. Or that the lady with a sat in the 70s and horrible ABGs won't keep her bipap on. How rude of all of us!? Would you prefer that we write our own orders as we see appropriate? Oh that's right because I have RN after my name, not MD.
    What did I really say? Ok thanks, have a good night!
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    In other words listen to your gut even if it's hanging over your pants.

    If you don't, it's a sure thing that you will be there two hours past the end of your shift.
    PatchycatRN and nrsang97 like this.
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    Always call, no matter whether the doc is "nice" or not (by the way, sometimes the tetchiest docs are also the best surgeons). But only call for truly important issues, and always make sure you have all the pertinent information ready to hand.
    At my hospital we were lucky -- we had hospitalists we could text-page, and a very good NP who made rounds at night. It was relatively seldom that we had to wake up the surgeons.
    Besides, for some reason I have a soft voice that sounds very young and frightened on the phone. Maybe that's why I never got yelled at, even when calling docs who had a nasty reputation. I guess I just sounded too scared to be hollered at!
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    By the way, a sincere "I am very sorry to bother you, doctor, but..." goes a long way too.
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    If this has been covered- please excuse me- (didn't read through all the posts). If you decide you do or do not need to call the doctor- It's YOUR decision. If you ask me if you should, and I say yes/no or I don't know- I don't expect to be quoted when the doctor starts growling about being called. Dealing with grumpy docs is part of the job- do it. Don't point the finger at me just because you asked for my input before making YOUR decision and don't like the way you are being treated when you made it. I'm not the one treating you that way- the doc is. If you decide not to call on my advice, and the doc throws a hissy- YOU ARE STILL THE ONE WHO DIDN'T CALL. I can tell you what I would do and why, but you know the patient best and are in the position to make this decision. Don't drag me into it or the only answer you will ever get from my is "I don't know, I guess you'll have to call" or "ask the supervisor if it isn't covered in the policy book". Sometimes you are going to get grumped at if you call AND/OR if you don't-there is no answer that isn't going to end up getting your head bit off. It is just a matter of when you want to put up with it and what the patients needs are.
    Altra likes this.
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    I get the whole "have your ducks in a row before you call" thing, I REALLY do. But one thing that needs to be understood is that when you're a med/surg nurse with a 5 or 6 (or more) patient load, it's not always possible.

    For instance: the phone rings and it's the doc, you have to grab it no matter whose room you're in or what you're doing because you might miss them, and you're calling to report, say, a fever and coarse lungs on a neutropenic patient, you might have looked to see if they've had blood cultures drawn, but you might not know if they were swabbed for flu and strep this admission. And furthermore, you AREN'T always in a good place to look at the chart or computer quickly. Believe me, I would love to have the chart open in front of me with zero distractions when the doctor calls me back, but unfortunately I have to keep moving.
    CrazyGoonRN and wooh like this.
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    Quote from weirdscience
    I get the whole "have your ducks in a row before you call" thing, I REALLY do. But one thing that needs to be understood is that when you're a med/surg nurse with a 5 or 6 (or more) patient load, it's not always possible. For instance: the phone rings and it's the doc, you have to grab it no matter whose room you're in or what you're doing because you might miss them, and you're calling to report, say, a fever and coarse lungs on a neutropenic patient, you might have looked to see if they've had blood cultures drawn, but you might not know if they were swabbed for flu and strep this admission. And furthermore, you AREN'T always in a good place to look at the chart or computer quickly. Believe me, I would love to have the chart open in front of me with zero distractions when the doctor calls me back, but unfortunately I have to keep moving.
    But part of having your ducks in a row would be to print out the SBAR and jot down the pertinent tests BEFORE calling the doc. That way when they call back you have that paper in hand to use till you can get to the computer.

    Sent from my iPhone using allnurses.com
    Ruby Vee likes this.


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