Responding to Doctors

Sleepyeyes · Jul 9, 2002

Memorize the following phrases, spoken in a smooth, emotionless voice (I call it my Secretary voice :) ) Don't smile, don't smirk, and above all, don't lose your cool. If he says something that pizzes you off, repeat the order slowly, like you're writing it verbatim.

It'll give him time to think about what he just said, or time to fume (in which case he deserves it).

1. "Yes, Dr, I called you about your pt. X. I really didn't want to wake you but I knew you'd want this information before you started your early-morning rounds. It seems that his troponin level is positive for an MI and we're concerned because although he denies pain, he is becoming more confused and is insisting on walking the halls looking for his clothes so he can get a cab and go home...." (Let him interrupt you with orders...)

2. "Yes, Dr, so sorry to wake you; let me just turn up the volume on this phone so I can hear you better...." (Let him surmise that he sounds like poo on 2 hours of sleep)

3. "Ok, Dr, so those are your orders for the patient? --[Repeat order and establish parameters] "Ok, you basically just want us to watch her until her pauses are how long? Since they're at 20 seconds now, did you want us to wait til they're what? 30

seconds? 40 secs? OK, let me just write that down as an order, one second please..."

Or,

"Did you want a followup K level after the pt's bolus runs?"

4. Follow with "OK, so these are your instructions: 'Give IVP of Lasix 40 stat, then Lasix IVP in one hour. Titrate O2 to >91%. CXR flat & upright, and call with results asap." Confirm. Document, do.

I very rarely get yelled at using this technique.

skibum · Jul 9, 2002

You also have to learn to sometimes tell a patient that you won't wake a doctor up for some ridiculous request in the middle of the night (such as a sleeping pill at 4 a.m. or for a laxative). Also, if you work nights, get used to docs sounding grumpy, annoyed or sleepy. I've had docs who gave me orders in their sleep and didn't even remember it the next day! One time one mumbled "Check me on that dose - I'm not awake" :eek: If you aren't sure if it's something you should be calling about, run it by a coworker and see if s/he'd do the same thing. And try to stay calm - I know it's hard when you're new and having to talk to some notoriously mean doctor. Good luck! There's soooooooooo much they didn't teach you in school that just comes with experience.

indeed · Jul 9, 2002

All excellent advice. It also helps to run these things by your coworkers when you are first starting out on a unit. They know these docs better than you at this point, and can give you a heads up if the doc is going to be whiny/b1tchy/mean and what specifics you might need. The first time I called a doc, one of my coworkers practiced with me what I would say and I got the best piece of advice from him I have heard so far...NEVER APOLOGIZE. You are doing your job, and they should be too and sometimes, that means getting woken up.

Indeed.

Nurse Ratched, RN · Jul 9, 2002

All of the above is great advice. I might add if they are calling you back in response to a page, I also thank the doctor for calling. I know it's their job, but I think it's common courtesy, especially if you're calling them at 3am. It may not work for everyone, but I have found it seems to soften them up a little.

Sleepyeyes' script is right on the money. And Heather brings up a very important point about making sure you are paging the right doctor. Can't tell you how many times we get calls from the ED (desperate to get a psych pt admitted) wanting to know if we can page Dr. so-and-so because they've been trying for eternity with no luck. Turns out it is in fact Dr. such-and-such covering that night.

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Jul 9, 2002

The only thing that I would have to add is that if the doctor on call is not the primary, to say, "Hey Dr. J I have so and so who is a patient of Dr. S".

Look through the chart and try to anticipate all the information that the doctor is going to want to know about before he asks.

If you are asking for medications, make sure you know the patient allergies, before meds are prescribed. Saves an extra call.

When I first had to call the docs, especially in the night, I always said "Just letting you know". It gave them the opportunity to address the issue, you know the whole power thing.

(then when I got to know them, I knew which ones I could push and those I couldn't for the things that I want)

If something can wait until the morning, don't call in the middle of the night. It always helps to have standing orders for pain, sleep and constipation, diarrhea.

andrewsgranny, ASN, RN · Jul 9, 2002

Wow! y'all are excellent! What more could be said?

Tephra · Jul 10, 2002

Nice work above y'all.

My script goes approx as follows:

"Hey, this is Tephra... thanks for calling back so quick. I'm calling on Mr. Johnson, GI bleeder of Dr. Allgood.. are you familiar with him? Good. His crit's down to 23 from 29, 6 hours ago, heart rate up to 120 from 80, BP down to 90 from 120, 300 cc maroon to bright red now, from his NGT. Did you want to address this? I've got two units down in blood bank if we need."

--Repeat orders, thanks!--

adrienurse, LPN · Jul 10, 2002

Hopefully the MD you're talking to is a human being and will pay you the courtesy of treating you like one as well. Don't take any attitude, stick to the facts, it's okay to push for what you want if you know its in the best interest of your patient. That will come later once you feel more confident.

Remember that it is your job to represent the patient, don't allow the MD to make you feel like a pest -- it is not your job to be his/her buddy. Make sure that you understand the orders that are being given. Ask for clarification PRN. Read the orders over to the doc to make sure you've got them right. If you're not sure, it's okay to ask the MD to spell.

I'm not asking you to diagnose the patient, but have a good idea of what's going on and what you want the doctor to order. This helps you know what data to report on the phone. It's okay to have a cheat sheet in front of you with data on it. Have things like meds being taken, allergies, med hx on hand, in case the MD asks for them. Never be so bold as to say, I want an order for such and such. Doctors seem to get pi$$ed off if you do that.