Navigating Doctors Idiosyncrasies

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  1. This is a discussion on Navigating Doctors Idiosyncrasies in Nurse Colleague / Patient Relations, part of General Nursing ... So back story. . . I had a 32 yr old female patient that was a direct admit around 2300 for...

    by Mar 21
    So back story. . . I had a 32 yr old female patient that was a direct admit around 2300 for hematuria. We call the doctor and get orders for a CT abd/pelvis w + w/o contrast, insert three-way and irrigate PRN, and CBC.

    So CT calls and says they need a pregnancy test and a CMP to check renal function. I am about to call the doctor when the nurse I'm working with says, "Oh don't call that doctor for things like that at midnight. Just put it in, he would order it anyways."

    Of course I don't, but she puts it in anyways (which I don't care to be honest because it has her name all over it, and the patient needed it anyways). The patient gets the CT done and the doctor comes in at 0530. The doctor said, "Thank you for just ordering those and not calling me. I hate to be woken up for stupid things."

    So ignoring everything else wrong with this scenario (and there's a lot), how do you all manage to figure out these idiosyncrasies?

    For instance, I have a doctor that if you do call him after 2200 for Cepacol he yells, and another one that will yell if you don't call him.

    I can't figure it out. But since prescribing is outside my scope, I just call always, get yelled at (or don't), get my orders and go about my business.
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    by whitecat5000 Mar 21 6:17 pm
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  3. 12 Comments so far...

  4. Mar 21 by
    I call them all or try to get an order for standard things, like cepachol and stool softners during the day. As far as a new admit I would have called him for every order. Not my problem.
    KarenfRN, nrsang97, and AWanderingMinstral like this.
  5. Mar 21 by
    At my hospital, I've gotten to know the doctors over the past 9 months. Most of them WANT to be notified of even the smallest change, and there is no "nursing judgement" needed. Others, we don't necessarily call them right away, but will give them a heads up when they arrive on the floor (things like BP meds held per parameters, low blood sugar, etc). I work in a small hospital so I only deal with 8 or 9 doctors, so it didn't take too long to figure them all out.
  6. Mar 21 by
    A pregnancy test is usually a protocol order that goes along with any imaging order, so if an MD orders a CT then they've also ordered a pregnancy test, performing a pregnancy test on a patient who has a CT ordered is not prescribing. Even if you called the MD and he said do the CT without a pregnancy test it wouldn't matter, imaging would likely refuse to do it. Our protocol also includes a creatinine level as a protocol order for imaging with contrast, I'm not sure why your imaging department wanted one done for a CT without contrast.
    Spidey's mom, nrsang97, GrnTea, and 3 others like this.
  7. Mar 21 by
    Quote from MunoRN
    I'm not sure why your imaging department wanted one done for a CT without contrast.
    The CT was done with and without.
    KarenfRN and psu_213 like this.
  8. Mar 21 by
    Quote from klone
    The CT was done with and without.
    I missed the "w +", my bad.
  9. Mar 21 by
    I consider those things as having been ordered when he ordered the CT since she won't be getting the CT without them.
    nrsang97 and GrnTea like this.
  10. Mar 21 by
    Quote from whitecat5000

    So ignoring everything else wrong with this scenario (and there's a lot), how do you all manage to figure out these idiosyncrasies?
    There was nothing wrong with the scenario.

    Believe me, if you really do want to navigate a good functional path with MDs, you will develop a reputation of not calling them for stupid things.

    I have coworkers who pride themselves on playing "gotcha games" with MDs and coworkers; they are universally reviled and it is their patients who really suffer for it.
    GrnTea, psu_213, and Aurora77 like this.
  11. Guide
    Mar 22 by
    I don't see this as a physician's "idiosyncrasy" ... I just see it as learning to recognize protocols and requirements for diagnostic testing and so forth.

    OT but ... admission for this? Unless there was intractable pain / nausea, this sounds like an outpatient workup.
    psu_213 likes this.
  12. Mar 22 by
    When my late husband had some abnormal outpt stuff, the fastest way to get the CT was admission; the waiting list for OP CT's was huge. Turned out to be the big C; so admit totally justified. Sometimes the admit orders are deceptively simple, especially late night, and the doc intends to order a lot more stuff in the morning.

    Our ED docs fully expect us to put in the stuff we need for protocols; all the policies are in place for doing so.
    GrnTea likes this.