Nasty M.D phone manners

deespoohbear · Jan 16, 2002

I love P RN's solution!!

I am glad that I work at a small facility! We have about a dozen different doctors with work with and they are pretty decent about clarifiying orders that we can't read. We kind of have a running joke with our internist. He knows he can't leave the floor until a nurse or the unit secretary can read his orders! If I ever did encounter a situation like the one mention before, I would let the supervisor deal with it and figure out the mess. That what he/she gets paid for.

**canoehead, BSN, RN** · Jan 16, 2002

Anytime I get a nasty reply like that I say "may I quote you on that" or "is that your order?" and if they say yes write it in the chart as a verbal order in quotes, then notify the sup, make the incident report, go further up the food chain medically etc. But always get that order down, or at least chart "no new orders" each time I call. Seems to humble them a little when they realize that all this is documented, and they are accountable for their rudeness.

CATHYW · Jan 16, 2002

Your answer was absolutely on target! This is the kind of advice and sharing that is invaluable-you will never find it in a book or a course-anywhere! This is the voice of experience.

Canoe, you are right too, about documenting "no new orders." Darned if that shouldn't bring some of the lazy docs up short! You are trying to be a patient advocate, and the MDs are trying to stifle you! :eek:

Nursechris1, when I was a floor nurse on telemetry, I received a very nice late 50's country gentleman as a direct admit from his MD's office because of EKG changes. His MD was one of our terrors-a young, good-looking, flirty smart-a** that would smile to your face and then turn around and report you for not dotting your i's and crossing your t's. He gave pages and pages of orders over the phone, anytime he was called, effectively tying a nurse up for nearly an hour. He always ended with "Hemoccult X3," no matter what their admitting dx was.

Anyway, this nice gentleman arrived with scant orders-just serial EKGS, and lab work. No pain med, no meds of any kind. As I was doing the admission assessment, the gentleman began to c/o CP. I stayed with him, and asked the asst. head if she would call the MD. She did, he said put O2 on him, and that he would be in to see him when his office hrs. ended. We did, and it helped, briefly. He was brady, with occ-to freq PVC's, mostly unifocal. He denied any prior medical problems, except that he was a type II diabetic. It is approximately 4 p.m., and there is no order for Accu checks or meals. I went ahead and did an Accucheck-to high to register! About that time, we got a call from the lab about a critical BS->800! The patient was continuing to c/o CP. I got the asst. head to sit with him while I went to take on the monster. When I got the MD on the phone, I called him by his first name (we were the same age), and said, Ralph, the patient that I got from your office is still complaining of chest pain and has a BS >800. Shouldn't he be in ICU?" Dr. bigbutt says, "I already told ..... (the asst' head) that I would be in when I finished at the office. If you don't quit bothering me, I'll never get there!" I ignored this crack, and asked what to do about the CP and BS. He gave orders for NS and an insulin gtt! I told him hospital policy did not allow insulin gtts on regular floors, and he basically told me to take it or leve it, and hung up. I was livid. I told the asst. head what happened, and told her that this man needed to be in ICU. By now his LOC was changing. He was very drowsy, and his speech, while appropriate, was slurred. He was also very frightened. I stayed with the pt., monitoring vitals and his rhythm. The asst. head, bless her, and the ICU head started making bed arrangements, and got the insulin drip on a pump while I started the NS. An ICU nurse came out to the floor to administer the insulin gtt, and do an assessment. When she saw the man, she looked at me like, what the he-- is he doing out here? She hooked up the insulin, and we decided, right then and there, that the two of us were going to take him to ICU-orders or no orders, and that is exactly what we did. I reassured the gentleman that he would get excellent care there, and that the Dr. would be in soon. The man begged me not to leave him-he said he was afraid he would die. :eek: Again I reassured him told him that his wife would be in to see him soon, and left, after giving him a hug. 10 minutes later he was crashing, and was dead within the hour. Apparently he had been having CP for a couple of days before he finally went to the MD's office, and extended his MI while we were caring for him. I was told later that necrotizing cardiac tissue can cause an elevated BS, not to mention the stress response! :eek:

That MD dodged me for weeks, and I could barely be civil to him when I saw him. Several months later, several 3-11 nurses and some of the younger Drs. got together after work at a local lounge. I finally got my opportunity, walked right up to this MD and told him that I felt that he had killed the gentleman. His first response was that "he was going to die anyway. It wouldn't have mattered if you'd had orders or not." I wanted to throw my drink at him, but didn't. I told him that if he had been half the Dr. he pretended to be, and had not abused the trust that patient had in him, and done what he was ethically bound to, the gentleman MIGHT have died anyway, but not before we had done everything possible to prevent it! He had nothing more to say to me. :rolleyes:

Suffice it to say, all of this was documented in spades (except the personal conversation we had). As far as I know, the hospital did nothing about it!

thisnurse · Jan 16, 2002

that makes me sick.

**canoehead, BSN, RN** · Jan 17, 2002

Happens all the time.

In a situation where the doc isn't responsive I have found an excuse to call the family, and they come in and then you have the added weight of their concern and involvement. The physician seems to weigh their opinions more carefully when they know the family will want to know what is happening and why they are making the decisions they do.

A couple of times now I've felt a patient was going down the tubes and called family. They got there before the doc and I can explain what is going on, the doc is on the way, and probably they will want to move your family member to the ICU. With that prep and the concern and flurry of activity from the nurses the family will expect something major to be done, so when the doc arrives he/she will find that the best choice is usually to go along with the nurses.

Luckily I haven't pulled out the big guns yet and been wrong. I think that an experienced nurse is usually right when they have that "feeling" and we are usually way ahead of the game when the docs come in.

sharann, BSN, RN · Jan 17, 2002

That guy ssounds like quite a gem Cathy.

Amazing, the gall of these people.

Genista, BSN, RN · Jan 17, 2002

Prn- Loved your advice, too! It was flawless! ;-) Will keep in mind for next time. Another idea: inform MD that you want to confirm orders w/ another nurse & place on speakerphone :-)

I don't call docs unless it's important. They are on call for a reason, so I don't appreciate a negative attitude when we alert them to problems. I had a pt wanting to sign AMA once, and when I called MD to notify, he ranted and raved about how I "interrupted a VERY important meeting." He was scolding me as if I were a gradeschool kid! Well, guess what, he was ON CALL and it was his patient! I told him," Well, I was told by your service that you were ON CALL. This is YOUR patient & per hospital policy I am OBLIGATED to notify you when YOUR patient wants to sign out AMA. I had NO IDEA you were at a meeting. Would you like to give an order NOT to be notified if pt signs out AMA?"

Silence on the line. "No," he says calmly,"uh, I am just tired of this patient's complaints, uh, thank you for the call."

Some docs expect us to do it all, and they don't even want to come up w/ dx & tx...expecting us to spoon feed orders to them for their pts. Other docs are fantastic, and nearly always cordial, so I know the nasty ones have no excuse.

Katana · Jan 20, 2002

I've had so many different experiences with Dr's over the phone... one was giving orders so fast, I had to keep stopping him and sking him to slow down... he got mad at my constant inturruptions and I just told him that I was a nurse and a secretary versed in shorthand and that if he wanted his orders transcribed correctly, he would have to slow down and not bombard me with orders faster than I could write them down. Once I had all the orders, I told him that I would now read them back to him to make absolutely sure that no mistake was made... needless to say, he wan't happy but didn't hang up on me.

Another instance when I wanted to do drastic things to a Dr was when I had a LOL admitted because her colostomy wasn't working.... she hadn't been seen by the Dr. The family had just called him and he told them to go to the hospital and he would admit her.

During her intial assessment, I noticed that the tumor that had caused her to need an AP resection was now growing out where her rectum used to be. :eek:

Got her IV started and gave her her first does of IV pain medication.... 25 mg of Demerol. After that, I took a closer look at the orders and the pain med was ordered PRN Q 4 hours!!!

Needless to say, the pain medication didn't hold her for the 4 hours so I got back on the phone and gave the Dr my assessment and the information that the pain medication wasn't taking care of the patient's pain.

He asked, "What did I order?"

I read off his pain med order for Demerol 25mg IV q 4h prn.

He then said, "That's what I ordered and that's what she can have."

Then slammed the phone down.

Now I had the pleasure of going in and informing the family that I had talked to her Dr and that he did not want to change her pain medication order.

The patient's daughter is almost in tears and the husband looks at me with these big CockerSpaniel eyes and asks, "What can we do? She's in pain!?"

I then asked the hubby if he saw that little bird sitting out on the windowsill... he looked at the window and didn't see a bird so looked back at me as if I had lost my mind. I just smiled and said, well, you see, that bird is special, it talks and is asking you if your wife's Oncologist knows that she was in the hospital and in a lot of pain.

hehehehehe

Lightbulb turns on over his head and he smiles and said, "That's an awfully smart bird. I think I'll call the Oncologist right now."

I head off and take care of other patients.... get called to the nurses' station to take a call.

The first words I hear are, "What the HE** is going on with my patient?"

It was the Oncologist. I informed him of everything, patient's condition, pain level and lack of pain control and reply of the other Dr to my request for a change in orders.

His reply, "That G**D**** )(*)*$%^#@ S*N of a B*tch!!!! You give MY patient 100 MG of Demerol q 1 hour till she is comfortable or her resp is 14/min. I'll handle this."

It was such a nice feeling to go in and adequately medicate a patient.

Unfortunately, the original Dr had a horrible reputation for yelling and throwing things as well.

He threw a chart at me once (can't even remember what that rant was about)... one of the old metal flip top ones that would have hurt like the dickens if I hadn't ducked. He got written up for that one and pulled in front of the medical director of the hospital and suspended for 4 weeks.

Kat

P_RN, ADN, RN · Jan 20, 2002

That "Little Bird" deserves a round of applause!!!

The Blue Bird of Happiness!!

Bless him (you).

P (been there-ducked that chart too)

kats · Jan 20, 2002

Hi, I am not a nurse yet. I am applying for nursing school starting Fall 2003. I have done a lot of volunteer work and am reading whatever I can get my hands on in addition to the classes I am taking to learn as much as possible. I hope you all don't mind, but I have a question about receiving orders from the doctor on the phone. I was just wondering if it would be allowable to have a small tape recorder and put it next to the phone when you know you have to receive orders this way from a doctor that speaks very fast. Then after the call, you could copy them from the tape. I was just curious.

Kimberly

Trauma Columnist · Jan 21, 2002

You guys all have great ideas to deal with these scum of people that pass for very poor MDs. You are great pt advocates.

But...I guess I just don't understand why its necessary. There's a problem, you call MD. If you don't get it resolved satisfactorily, you go over his head. Incident report, calls to nursing supervisor, on-call administrator and just keep on pushing.

P_RN, ADN, RN · Jan 21, 2002

Kats, not all doctors are jackasses. In fact most aren't. Many places do use the tape recorders for just that reason. It's always better to have a face to face with the doctor, have them write legible orders and then wait to see if they are all understood. Many doctors will do that for you.

Others....well see all the above.

:)