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..."
"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.