Communicating with Doctors

I know it's really basic, but I always make sure to identify myself at the beginning of the phone call. "Hi, this is Jane. I'm the nurse for Mr. Smith, your patient in room 2022. I'm calling because..."

Honestly, the communication will be bad unless the administration from the unit director on up promotes a culture where physician dismissiveness and other shenanigans are not tolerated.

do you refer to face-to-face comm or over the phone or both? I noticed that the doc-to-nurse interaction was a world of difference in the ER compared to the floor. A lot of them are called by first name, we joke around, keep things really light like "hey man, that dude in 6 with hernia is requesting pain med" and etc. On the floor, I felt a wall between nurses and docs. Probably because they kind of review/write orders then move on, but at least we see lots of residents and hospitalists in ER, and they are easy to get to know because we see them constantly. I don't have much suggestions, I don't know why but every time I had to talk to doc on floor, he/she were douches, to the best apathetic, but down in the dungeon, it's a lot better, so... ya move to the dungeon :)

We co-ordinate our calls. If I am paging the doc in call, I let all the other nurses know so that if they need something they can be available. This saves the doc being called 6 times in one hour.

On weekends we have a page to write things we need that are needed but not urgent. When the doc rounds, they know to look at the list and work their way through it. Again, saves a lot of calls. And when we do call, they know it's urgent and respond appropriaely

The hosptialist system really changed how we interacted with doctors. Rather than call/page doctors from different services, a critical care resident in charge of the unit handles all issues that come up. They write all the orders. If the resident in charge needs to check with the surgical service the patient is a part of (ortho, ENT etc) before putting in an order, the resident handles that communication so a nurse is never caught in the middle. Unless there is an emergency, the resident in charge is on the unit all the time, so communication is easy.

The nurse is part of rounds when the attending and residents see our patients so we are aware of the plan and the docs are aware of who is taking care of which patient. Communication is easier if the nurses are in the loop. In the past, doctors would see the patient and leave. The nurses had no communication about what the plan of the day was or what the doctors told the patients.

Finally, the attendings set the tone of how the rest of the staff (nurses and RT) are treated.

Why is the assumption that the onus is on nursing to fix this systematic problem? As with any marriage, both parties share equal responsibility for communication and partnership. (Lack of understanding this critical point is responsible for a lot of unhappy marriages involving nurses-- we take responsibility for the relationship and fixing all its problems, and the other party skates).

Your nursing management (or a senior, well-respected clinical nurse as designate) should approach the medical chief of staff and ask him/her to be an equal partner in this process. This nurse should be ready to recognize and totally resist the inevitable suggestions that will ensue and sound something like this, "It would be fine if only the nurses would ..."

If the nurse leader brings the results of a survey that enumerates the problems the nurses have, and asks for the physicians to think about the problems they perceive, then the next step could be collaborative problem-solving.

We have an oncologist with a serious chip on his shoulder. In a nutshell, management wrote him up (nursing kept meticulous notes) and he showed up to this 'meeting' with a lawyer. Our management handled it fantastically and literally taught this dodo from scratch how to be nice.

On his end, he had legitimate issues, poorly organized information from nurses, referring to patients by their room numbers, etc. He was told by our great management that he was 'scary' to talk to, which was news to him. That's an example of a positive, supportive management who have their nurses' backs :)

Nurses need to have an organized 'picture' to present to the doc, not just throw a bunch of stuff at them and demand Lasix (one doc's assessment). He had a point. The DON gave out little cards with an acronym to help us get organized prior to making the call to the doc.

If the issue is very important, the nurse should fill in the charge about the issue so two people know and the charge can talk to the doc if the nurse is with the patient. Also we had issues where a nurse would page a doc to the front desk and NOT tell the unit clerk so the doc would return the call and everyone sat there with their face hanging out DUH.

Little things can make important communications, such as with the doc, work well or bomb out, and since I'm a nurse, I focus on what *I* can do to communicate better. I can blame the docs or management but in the end it's my patient's butt on the line and I'm responsible.

When the doc is chronically difficult, management needs to move in and deal with it. Until that happens, each nurse has to get it together in his/her own head, get priorities straight (the patient!), and plow through.

We had a doc that would answer his phone (once in a while) and NOT SAY HELLO or identify himself. Good lord. So as soon as I heard the line come open (if I could) I'd say my name, patients name and brief blip and a very concise description of the problem. Whatever the doc responded was what I got. I documented every word exchanged with this doc in charting, in case something bad happened. He was an as* but not a terrible doctor, his patients survived.

Encourage the new hires to 'own' their professional license and capacity, and encourage a 'team' relationship with docs, RTs, CNAs, housekeepers. We all serve vital functions, without housekeeping we'd be hip deep in filth, so they are respected team members. Nurses often feel oppressed (and are) but some of this is on us as individuals, it's easy to get hooked into a victim mentality because we are worked to within an inch of our sanity and strength. Ask me how I know. Playing the blame game is such a black hole. The docs NEED US and we need them, so mutual respect and keeping the patients need first (instead of my pride) has since made even excruciatingly hard jobs doable.

Honestly, sometimes to improve communication, you have to stand up for yourself. I had a doc that was very rude to me on the phone and I politely told him that if he was going to yell like a child, I was going to hang up on him. There was dead silence for about 10 seconds, then he spoke calmly and concisely with me. When I sat down beside him to ask him for something a few months later, he looked at my name tag, looked at me, and said "not all what I expected for someone who put me in my place" with a big smile.

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Systemically, I think it has to be elevated above the general floor nurses to the Managers to get anywhere. If we have a problem with a doc being a "pain" multiple shifts to several people, we just let the house nursing supervisor know so it can be documented. If it's one doc, one shift, I say let it ride - everyone has a bad day.

I've been charged to present info to our new hires about communicating with doctors. We've had communication problems, (misunderstandings, dismissive attitudes, lack of responsivness, putting things off to the next shift etc) with our docs for a long time. What things have you done to improve communication and collaboration with the docs? How have you dealt with uncooperative or patronizing docs? Suggestions on how to approach them, key phrases etc would also be helpful! Thanks!

It's easy to blame the physicians for being uncooperative, patronizing, etc. but first we have to look at our own part of the interaction. Are we calling them incessently with little bits of information, or are we putting together a concise a precise summary of the issue so that they can make informed decisions? Are we calling them at 2AM to report normal lab values? When we call them at 2AM are we immediately identifying ourselves, apologizing for waking them and completely identifying the patient and the problem? (Apologizing for waking them is just "social grease," and allows them a second to wake up and switch gears from that nice dream they were having to "oh yes, I'm on call.")

Once we've identified the issues we own, then we can collaborate with the physicians. Talk to them, ask them how they percieve the interaction and how they think it could improve. Share with them your perceptions, and see if you can't work something out together.

I've dealt with some world famous donkey posteriors, but they all put their pants on one foot at a time, and if you find some common ground, you can probably work things out. Treat them like PEOPLE, not like uncooperative or patronizing superiors. There was a pulmonologist who was famous for blistering the skin off new nurses. I found out he loved fishing, so I read a bit about it and every morning when he came to work I'd say hello and ask him if he'd been out to the creek lately, if he tied his own flies, if he had a successful trip, how he cooked his trout . .. something. He was shocked at first, but after awhile started looking for me when he came on the unit. We'd chat about fishing for a moment or two, and then he was willing to address patient care issues. He just wanted to be recognized as a person.

Another doc used to throw tantrums on the phone, in person, whatever. He was throwing a tantrum in my patient's room one morning when my foot in mouth disease took over, and I said (with an eyeroll) "I'm SURE Dr. Systole ordered this renal consult just to ruin both of our days."

He stopped what he was doing, stared at me for a moment as if I'd grown an extra head or two. And then he started to laugh. I never had another problem with him, ever. Once he was subjecting a new nurse to a tantrum when I walked into the room. He looked at me, then apologized to her.

Teach your new hires to have their ducks in a row before calling, greet the docs with a line or two of social grease and then tell the full story including pertinent labs, vital signs and meds.

Well I'm certainly in the minority since we have exemplary physicians, nurse practitioners, and physician assistants on staff. Of course, I work in a hospital so we have 24/7 coverage and there is no fear of waking someone up since hospitals obviously never close for business. I agree with the above posters, it's a 2 sided issue and both sides need to be involved (including management and perhaps upper management) in order to improve communication between nursing and physicians. The suggestions given above are great; treat the physicians like people. Give them the respect they deserve and you should expect to receive it in return. At the end of the day, we're all just people (albeit with different levels of education and experience) trying to do the best we can for the patients that put their trust in us as healthcare professionals.

We are encouraged to use the ISBAR tool.

Seems to work well