When's the doctor coming in??

klone, MSN, RN · Jun 7, 2014

Because they only see the doc once or twice a day, and want to know what the plan is, or they have questions. Try to think of it from the patient's perspective and understand what they might be going through. I know you probably have heard it 5 times each day from 5 different patients, but the individual patients don't know that, and they are just concerned about what's going on with THEMSELVES.

Here.I.Stand, BSN, RN · Jun 7, 2014

I give a general response about what time they typically start rounds. Of course, what time they will see THIS particular pt is anyone's guess. Then I'll ask if they have a particular concern that they want to address w/ the team.

I used to work in this LTACH where the docs would come in around 0730, and frequently they'd still be there when I left at 1930-2000-2030. They'd see the ICU pts first (small ICU--8 beds) and then the floor pts. In that case I'd be honest and say that I'm not able to give them an answer right now, but ask if there was a concern they'd like me to pass on to the MD. And then if it wasn't anything I could help w/ or if they really just wanted to be there for rounds, I would ask the dr. if s/he knew roughly when s/he'd be seeing this pt. Morning, early afternoon, etc. Then I'd give the family the approximate timeframe.

RainMom · Jun 7, 2014

Asking when the doc rounds doesn't irritate me since I can usually give them a ballpark time for most of our MDs. What irks me more is when my new admission/family on nights wants to know what time surgery is. Um, the surgeon hasn't even seen you yet, we have no orders for consent/surgery & the attending has to clear you first!

martymoose, BSN, RN · Jun 8, 2014

I will say that 80 percent of the time it's because the pt wants to go home. like at 8 am.

We are a teaching hospital, so there are residents and hospitalists . They change often. We have no clue of their schedule because 1/2 the time we don't even know who they are( they haven't been at the hospital that long, I mean)

Or, as in the case of one of our known medical-hospitalists, he sometimes has 20 pts to round on throughout the whole hospital. There's no way he's going to see someone jonesing to go home for fill in the blank, over someone who is critically ill and needs to be seen before them.

But of course the customer care model dictates me me me first.

I do usually call the doctor if patient is persistant and has not been seen by noon.

Karou · Jun 8, 2014

Ugh. Why do so many family members/patients ask us this question?I don't know the answer- he didn't give me his schedule!
Or he could be with a critical pt. I don't know- he doesn't tell me these things.
Anyone else get this all the time? Why does anyone think we know the doctor's schedule?

My initial reaction is to get annoyed with this question. I work night shift and I have NO idea when the doctors round, I probably wouldn't recognize 75% of them if they saw them!

Then I try to think it from the point of view of the patient. Being in the hospital is unpleasant, sometimes the patient is waiting on specific tests/results before they can go home or decide on the next step in care. They probably have family members to care for, a job to worry about, and they are sick and feel physically and emotionally exhausted. If they think the nurse might have an idea of when the doctor will round then that's one less thing that is unknown/uncertain. Some doctors do round generally the same time each day, so it's not a totally unreasonable question.

I always tell the patient that I can't give them a certain answer. I explain that the doctor has many patients in different areas of the hospital and has to prioritize who they see first. Sometimes they run late, sometimes they come early. If I know a particular doc is almost always here at 0700, I tell them so. We have one who almost always comes after 1900 and I tell them that. If they are waiting on a surgeon I explain that rounding is even more unpredictable. I then ask if there is anything specific that I can answer for them. Sometimes they want to know the plan of care, ask about discharge, specific meds, ect... Often I can answer their questions for them. They usually appreciate my attempt at an answer, instead of getting shut down with only getting told that we don't know.

MrChicagoRN, RN · Jun 8, 2014

Excellent post, Karou.

if they don't ask us...what's the alternative? Sit passively and hope they are seen sometime in the next 24 hours?

mama.RN · Jun 8, 2014

I work in a specialty office. I will sometimes have a patient call me directly from their hospital room to ask when the physician will be seeing them. I understand that the patient may be anxious to find out what is going on or perhaps wants a family member to be present when he arrives. I'll gladly give them an approximately four-hour window of time when they might expect to see the physician and if they are upset about not having an exact appointment, will educate them (as they may not actually be aware) about how things work. That is, that they are on a list of approximately 20 patients to be seen that day, at multiple hospitals and that the sicker patients will generally need to be seen first.

SeattleJess · Jun 8, 2014

I always ask is if there is any particular reason they need to speak with the MD, it's almost always something the nurse is there to help them with (what's the plan, etc).

Excellent! I appreciate the skillfulness of your approach. Sounds like you're listening for feelings and needs that underlie the words. I often get tangled up in the words; connection is easier and outcomes are better when I can listen for what's behind them. Thanks for the great example. (Tho' I won't even be a student until fall, some communication principles are universal, no?)

TeeKay12 · Jun 9, 2014

I get this question every day. I work nights on a surgical unit. We have more than 100 docs with privileges, and since I'm nights I have not clue.

I tell all my patients and their family members just that - I don't really know their surgeon, and I am almost always gone before they round, so they must show up after 0800. I then offer a piece of paper and pen to write questions down on.

Nimishi · Jun 9, 2014

We have SIBR (structured interdisciplinary bed rounds) in one of our wards- this allows family to be present at the rounds as the 'round' times are set - I.e. Between say 1000- 1200 hours. The pharmacist, physio, nurse, patient, doctors, nurse and family are present to discuss the plan for the patient and thus are all 'on the same page'. Questions can be asked then and any questions on the whiteboard answered. Surely our patients and families deserve to be fully informed of what is occurring and planned

puricandy · Jun 9, 2014

All the time, and I get to deal with people that get angry because I don't know their schedules. Most of them are not satisfied with being referred to the on call or the resident. I have occasionally given the office phone number of the doctor in question and suggested that maybe they would get an answer that may be more satisfactory if they spoke directly to him. And as a side note. I have to agree with some of the nurses. This is supposed to be a form of PROFESSIONALS and some of the comments are judgemental and hurtful. I don't agree with a lot of what is said, but we all have opinions and different methods of doing the same thing, not all right or all wrong. Take what is useful and agree to disagree with the rest.