Communication with doctors

[luckykitkat]

Hi, i work in a rehab facility wherein we get different patients everyday. Everytime you have a 2-day off, most patients are strangers to you. It's not a long term facility. So when we have no doctors around, and we get results from an ordered lab or diagnostics, we would call the on call doctors. Many would just want me to read what the results say and what meds theyre taking. But I have trouble with communicating to some doctors who want an in-depth information about the patient. It's so difficult to find the right answers.

Id say "Doctor, this pt has this diagnosis, age this, takes these medications, she was ordered these because she had symptoms of this"

then the doctor would be like "be more elaborative with your information. You know her more than me."

But due to poor endorsement, and patients being new to our facility, the area being busy, and me not working at their bedside, it's difficult to know how they were in their baseline. Im the desk nurse and the med nurses are the ones who really spend time with bedside care. Paperworks are my responsibility. So there were times when i would excuse myself and run to the med nurse and have them talk to the doctor, and if they dont know either they would just say "i dont know her doctor, she just came in a couple of hours ago so i dont know how she was in the past." Then the doctors would just kinda sound as if they give up. Any tips on how i can be a better informant to on call doctors? Im a new grad by the way so im still picking up ideas from coworkers. What else do they wanna know when they ask for more elaborative details? It's not common to talk to on call doctors who are super detailed, most of them are really easy going but i want to know what to say to doctors who want more infos

[macawake, MSN]

Hi, i work in a rehab facility wherein we get different patients everyday. Everytime you have a 2-day off, most patients are strangers to you. It's not a long term facility. So when we have no doctors around, and we get results from an ordered lab or diagnostics, we would call the on call doctors. Many would just want me to read what the results say and what meds theyre taking. But I have trouble with communicating to some doctors who want an in-depth information about the patient. It's so difficult to find the right answers.

Id say "Doctor, this pt has this diagnosis, age this, takes these medications, she was ordered these because she had symptoms of this"

then the doctor would be like "be more elaborative with your information. You know her more than me."

Im the desk nurse and the med nurses are the ones who really spend time with bedside care. Paperworks are my responsibility. So there were times when i would excuse myself and run to the med nurse and have them talk to the doctor, and if they dont know either they would just say "i dont know her doctor, she just came in a couple of hours ago so i dont know how she was in the past." Then the doctors would just kinda sound as if they give up. Any tips on how i can be a better informant to on call doctors?

If I understand you correctly you work in a rehab facility and most patients don't even stay two days in your facility? Those are very short stays. I don't really understand which role the stay at your facility fills in the patient's "care path"? When do patients come to you and what criteria have to be met before they are discharged? What kind of decisions does the on-call physician have to make over the phone? I assume the patient is seen by a physician/provider in person before they are discharged? Also, your job from what I understand is purely administrative and the so called med nurses are the ones who meet, assess and chart on the patients? I assume though that you have access to all of the patient's charts? That would mean that you have two possible ways/sources to find out more about the patients, the med nurse (who can of course ask the patient pertinent questions) and patient charts.

If many or most on-call physicians are happy with the the report you give them (the lab results etc), I suggest that you ask the physicians who want more in-depth information specifically what it is they want to know/what kind of information they want included in the report. Perhaps if they ask specific questions instead of just a general/vague request for more "in-depth" information, you might actually already know the answer. Otherwise you'll have to get back to them after finding out (if possible). This way you'll learn what type of information is valuable to them and the next time you'll know to try to find that information before making the call.

Doctors are individuals with individual quirks just like the rest of us and I don't think that those who want more specifics necessarily want the exact same information. In my opinion it's better to ask them directly rather than asking us. If you find out what their expectations are, that will likely reduce friction/improve communication and patient safety going forward. Ideally for safety reasons, I think that the same healthcare professional who actually has eyes on the patient (the med nurse in your situation), should be the one making the report to the physician but if this is how your workplace has organized things, I guess you can only try to make the best of what you have to work with. The fact that your role is something of a "middleman", might contribute to some of the frustration that you and/or the physician might be experiencing when giving/receiving report.

Also, I personally think it's helpful to organize the information I want to convey in a standardized format. SBAR (Situation-Background-Assessment-Recommendation) is great, if you're not familar with it there's information on the internet. I think it's a good way to communicate clearly and minimize the risk that important information is overlooked.

Good luck!

[dishes, BSN, RN]

Before contacting the doctor, is there a discharge report from the referring physician and an admission history from your rehab facility that you can review? At what point in the patient's rehab stay are they assessed by the attending physician?