Doctor's attitudes

SwansonRN · Oct 31, 2013

My only suggestions are to be prepared when you call the MD, cluster your issues for one call whenever possible, and make sure you're using SBAR format. I wouldn't confront them about it unless they're compromising the care of the patient or are being abusive to you.

It hasn't been my experience, 99% of the providers I come across have been dreams to work with. The only time I come across crankiness is when I have to wake someone up in the middle of the night.

Trauma Columnist · Oct 31, 2013

I'm a provider who fields many calls a day in between seeing my pts. Some hints

1. Prepare a succinct report. Use SBAR.

2 know the pts meds and most importantly their allergies

3. Weight which is up important for peds as well as adults

4. Why are they admitted?

5. Code status

6. Anything out of the ordinary

Ruby Vee, BSN · Oct 31, 2013

So as a new nurse, I've had a few run ins with doctors who've had really horrible attitudes towards us as nurses.
Is this typical? I don't get the attitude when i call them with a question or about a patient because or an order because it's not like I'm calling them for the whole point of calling them. I'm calling for the patient and so I can provide the most effective care. So what's the point of the attitude?
And would I be wrong if I stood up to them about it?

Calling doctors is an art, and if you're new you probably aren't very good at it yet. If you've had more than one run-in with a doctor you've had to call, chances are you need to improve your game. It's been my experience that most doctors "attitude" is a direct result of the nurse calling them being unprepared.

First, know what you're calling them about and have some idea what you want the result to be. If you're calling for low urine output, why do you think the output is low? Did the creatnine take a big jump? Has there been bloody/clotty urine coming out of that Foley and if so have you irrigated it? What was the result of that? Did you just take out the Foley and now that patient cannot void? Has the bladder been scanned? Or maybe the urine output is low because the BP is 82/40 and the kidneys aren't being perfused? Is it a post-op patient with a CVP of 2? Have the patient's chart in front of you -- vital signs, I & O, lab values and meds. You should know the most recent vital signs and pertinent lab values before you call, but be ready to answer any question the doctor could ask.

Second, make sure you're not calling too often. cluster your calls if possible. Don't call to report a normal lab value unless you are specifically asked to do so. If you're going through your charts at the start of the shift, don't call every time you find an issue; make a list and then call and get all of your questions answered at once. I'll often ask the nurses around me if anyone else needs to talk to that same doctor at the same time so we can consolidate our calls.

Third, doctors are people, too. When you have to wake someone in the middle of the night, it's polite to apologize for waking them. Yes, it's their job. But when you begin your call by saying "I'm sorry to have to wake you doctor," it gives them an extra second to pull themselves together and it makes you seem more sympathetic. Both are good things.

Yes, you'd be wrong if you stood up to them about their attitudes unless you're absolutely certain that you've done everything right, it's not a one time episode of crankiness and that you're not part of the problem. I'm willing to bet that if you work on your calling skills, the "attitude" problems will melt away.

Soliloquy, MSN, APRN, NP · Oct 31, 2013

Calling doctors is an art, and if you're new you probably aren't very good at it yet. If you've had more than one run-in with a doctor you've had to call, chances are you need to improve your game. It's been my experience that most doctors "attitude" is a direct result of the nurse calling them being unprepared.
First, know what you're calling them about and have some idea what you want the result to be. If you're calling for low urine output, why do you think the output is low? Did the creatnine take a big jump? Has there been bloody/clotty urine coming out of that Foley and if so have you irrigated it? What was the result of that? Did you just take out the Foley and now that patient cannot void? Has the bladder been scanned? Or maybe the urine output is low because the BP is 82/40 and the kidneys aren't being perfused? Is it a post-op patient with a CVP of 2? Have the patient's chart in front of you -- vital signs, I & O, lab values and meds. You should know the most recent vital signs and pertinent lab values before you call, but be ready to answer any question the doctor could ask.
Second, make sure you're not calling too often. cluster your calls if possible. Don't call to report a normal lab value unless you are specifically asked to do so. If you're going through your charts at the start of the shift, don't call every time you find an issue; make a list and then call and get all of your questions answered at once. I'll often ask the nurses around me if anyone else needs to talk to that same doctor at the same time so we can consolidate our calls.
Third, doctors are people, too. When you have to wake someone in the middle of the night, it's polite to apologize for waking them. Yes, it's their job. But when you begin your call by saying "I'm sorry to have to wake you doctor," it gives them an extra second to pull themselves together and it makes you seem more sympathetic. Both are good things.
Yes, you'd be wrong if you stood up to them about their attitudes unless you're absolutely certain that you've done everything right, it's not a one time episode of crankiness and that you're not part of the problem. I'm willing to bet that if you work on your calling skills, the "attitude" problems will melt away.

That's the thing, Ruby. I worked with my preceptor and took the class I always make sure that if I'm calling the doctor, I'm using SBAR. I don't want to just call the doctor because I know they have other patients to see, other things to do, and so I only call if it's something that's critical, or something I can't do myself and requires them. It's the same doctors everytime and I've asked other nurses if it's my method but they're having the same issue with the same doctors. :/

Biffbradford · Oct 31, 2013

Unless, of course you've found out that they love Shakespeare (or the Doors, whatever) and you've used that to become their best bud on the unit.

Billy_Ruben · Oct 31, 2013

I called a doctor just the other night regarding out heparin drip protocol. Protocol states call the MD before starting the drip if baseline PTT is less then 50 (it was 25) or if INR is less then 2 (it was 1.1). I got yelled at and hung up on. Sometimes I feel like we're going to get chewed out either way. It wasn't late at night either. It was 8:30 pm.

CrossCountryRN2008 · Oct 31, 2013

I called a doctor just the other night regarding out heparin drip protocol. Protocol states call the MD before starting the drip if baseline PTT is less then 50 (it was 25) or if INR is less then 2 (it was 1.1). I got yelled at and hung up on. Sometimes I feel like we're going to get chewed out either way. It wasn't late at night either. It was 8:30 pm.

Perhaps you interupted their dinner or "private time". They are people too. But also doctors are on call all the time and need a reality check on their attitudes.

Trauma Columnist · Oct 31, 2013

Hostile providers are not to be tolerated. Need to use your chain if command to complain.

Biffbradford · Oct 31, 2013

I've talked to them while on the treadmill at 3am (go figure!), brushing their teeth, and flushing the toilet. Don't take it personally. You're just doing your job and they get paid plenty to answer the phone.

krisiepoo · Oct 31, 2013

Perhaps you interupted their dinner or "private time". They are people too. But also doctors are on call all the time and need a reality check on their attitudes.

still not a reason to be an a$$

chrisrn24 · Oct 31, 2013

Perhaps you interupted their dinner or "private time". They are people too. But also doctors are on call all the time and need a reality check on their attitudes.

They know they are on call. It's not like you're invading their privacy or looking up his private phone number.