Calling MD's per patient request!!

Tweety, BSN, RN · Jul 3, 2003

Sometimes I tell a little fib and say their doctor isn't on call, so it's not worth the effort calling anyway and on-call docs don't deal with nonemergent things.

Usually, I firmly, but gently say it's policy only to call MDs off hours for emergencies.

Then I make a promise to call when the MD comes back on call if they are insistent. Then I make the call after 7:00AM.

Edward,IL · Jul 3, 2003

Each of us is responsible for our actions. As a nurse, I'll call any Dr. at anytime to report a change in condition or clarify anything that I deem needs to be done right now. If, however, there is a doc on call that can help me to my satisfaction, then that settles it.

I then explain to the insistent family member what MY perception of the situation is and why I have taken the action I have. It is up to them to call the doc, and they can be responsible for THEIR actions.

Edward, IL

sbic56, BSN, RN · Jul 4, 2003

Really interesting responses. I have never worked where you would expect the patient to call the doc. I like that. Alot of the docs don't have answering service, though, so I can't blame them for not wanting their own numbers out.

jlsand · Jul 4, 2003

I not only will call the doctor, I will be on the phone when he answers, tell him that a family member or the patient is insistent on talking with him/her and I don't care if he/she gets mad or not. You will have a lot less grief if you just let these people run everything anyway. Nurses are becoming more and more powerless when it comes to things like this. :confused:

In all my years of nursing, I've discovered you have to take care of the family first, anymore, because they will be the ones who will report you to the management, state board, or whatever. It's kind of come to this order, 1. Take care of the family demands, no matter what they are, because they run everything now. 2. Take care of the patient. 3. Be sure to be a team player and help all your coworkers, too. 4. Never complain about anything and always smile!! ha ha...

Please don't take this post seriously, I'm joking, (or, as Homer Simpson would say) or am I???

My blog

stella123 rn · Jul 4, 2003

Thanks you for your replys everyone. I have learned some good responses. I do think that I would get in big trouble if I gave them the docs phone number though. We are a smaller hospital and do not have a resident on call. The on call MD is often sleeping at home too.

The patient and family do come first however I think they are irrational sometimes.

In talking with some of the longtime nurses in my hospital many of them feel that the whole media thing of taking control of your health has gone over board. They have noticed a trend that patients and families have become more and more demanding. One friend of a patient even marched over to the clinic and walked right back in his office and started to yell at the doc about the patient's NPO status and that she needed to eat. She was there for a GI bleed and had tests scheduled for early in the morning.

Nurse Ratched, RN · Jul 4, 2003

Stella, I always just say (politely) that we don't make a practice of calling the doctor in the dead of night for issues that don't need to be addressed before morning. However, if he calls for some reason or we have to call for something more urgent, I will certainly add their request while I'm on the line.

As far as the visiting hours, I would be inclined to indicate that while late night may be the most convenient time for them to visit, it is not when most doctors are in the hospital and you would be happy to relay any messages to them in the morning. (Smile sweetly.)

Anyone who gets too rowdy, demanding, or disruptive to other patients can always be invited to leave by security .

passing thru · Jul 4, 2003

Good advice here. Another thing I encourage all patients and

family members to do is: "write every question you have on a sheet of paper." When the doctor comes in, if you have the questions written, he will stay until he has answered ALL your questions. If they are not written, he will not hang around

while you are trying to remember what you wanted to ask. He will answer every one of your questions."

This is true in my hospital. The doctors will do that.

I encourage the patient and family members to keep the conver-

sation on a question and answer basis. (Not to go into what happened to Uncle Ted or a friend who had a similar

situation.)

This information is always appreciated and usually takes

care of the problem.

I rarely call any doctor after 10 p.m.

It would have to be an emergency. Patient coding....etc.

I explain the docs are up at 6 a.m and see patients as late

as midnight on their rounds. Most people understand that

doctors need some uninterrupted sleep also.

If they are insistent, I usually ask a few questions to find

out WHAT THEY ARE REALLY UPSET ABOUT.

Often it is something else that is on their minds.

And, I can usually help them get past it , until morning anyway.

flashpoint · Jul 4, 2003

LOL...We only have three doctors in town. They each have two PAs. We would get hung if we called in the middle of the night for something non-emergent. They don't have answering services that can get ahold of them...it's up to us. Most of the time, our patient's families understand why we are not calling in the middle of the night. We also have a great list of standing orders that we can implement for almost any patient.

If a family insists on the doctor being called, we'll certainly do it. I would NEVER expect a patient's family to do my job...it's rude and unprofessional. If they want to call the doctor at home, all three of them (and all 6 PAs) have listed phone numbers...silly people. I'm working on my PA right now and I will have an unlisted number when I am done...LOL.

passing thru · Jul 5, 2003

Cotjockey, you might be in for a rude awakening...,

a friend of mine was just interviewed for a PA position.

Actually had 3 different interviews with 3 different doctors in the last month. All offerred her a position.

All three docs stressed upon her the FACT that SHE

would be the "on-call" person, Not themselves.

She finally accepted one of their offers.

Hellllllo Nurse, BSN, RN · Jul 5, 2003

Suggesting to a family to call the doctor themselves is "rude and unprofessional"?

Well, not nearly as rude and unprofessional as the docs are when you call them in the middle of the noc.

Also, I've called a doc at noc before and a nurse returned my call saying she was on call for the doc.

I asked her if she was an NP. She said that she was an RN.

Well, jeez. Me too, what a coincidence!

I told her I'm an RN, too. I need to speak to the doctor. She said "He doesn't want to be bothered and told me to be on call for him. He told me to give telephone orders for him."

What the?!

Now the docs have gone from rude and unprofessional all the way to illegal.

And...what's the matter with this nurse agreeing to this?

I told her I could not take doc orders from another nurse. She kind of stammered and didn't know what to say.

Thank goodness it wasn't an emergency. I did chart the etire thing.

This was in LTC, btw, where I was the only licensed staff on duty.

Flynurse · Jul 5, 2003

I tend to say its not something that I can just call the doctor for RIGHT NOW. I tell them, "I'll leave a note", if its something that can wait for the next time the doctor makes rounds. Then, though its annoying for me, I'll write the note in front of the family (usually on half of a 3x5 card with a hole punched in it - I keep tons of these in my geeky pen holder) and slip it on one of the chart's rings.

Ta! Da! They don't bother me anymore. If that's not good enough I direct them to the Unit Clerk who can give out the Doctor's number or the Nurse Manager who will tell them to go stuff it! J/K!

flashpoint · Jul 5, 2003

I fully expect to be on call...I will, however have an unlisted phone number. Our job as nurses is to be there for the PATIENT (and the family). I am not there to make the doctors happy... If the family wants the doctor called, then it is my job to do it. The doctor cannot give orders etc to the family, they have to give them to me. If the family wants to speak to the doctor, I like to call the doctor and give them heads up about what is going on, so they have time to think about their answers or run to their office to pull a record if they need to. I feel that as a nurse, it is part of my job to be the patient (and the family) advocate and if calling a doctor in the middle of the night is part of that, I will do it. We need to remember that even though it may seem unimportant to us, it is important to the patient. If we can fix it without involving the doctor at 0200, we should, but if we cannot, the doctor needs to get involved.