People who ask for medical information

RN1982 · May 31, 2008

I was hoping for some advice from my fellow ED nurses...
In my ER the policy is that nurses do not give out medical advice over the phone.
However, we get a lot of calls from people who claim to be asking for medical information, not advice. Sometimes instead of calling on the phone people actually just come in and ask questions of the triage nurse.
For example,
"What are the symptoms of . . . ?"(fill in the blank with the disease du jour)
or
"Does this medication interact with this medication?" or "What are the side effects of this medication?" (we do not have a 24-hour pharmacy in my community, and I'm not talking about meds we prescribed them)
Do any of you have a good way of handling these types of questions? Some people are very manipulative and persistent.

Tell them that you are unable to give out information over the phone and that they need to discuss any medical concerns with their doctor and if they need medical attention, tell them to go to their nearest clinic or ER. If they persist, politely repeat what you have said.

If they say something to the effect of "Well, you discharged me and gave me my instructions so if anything happens to me, it's your fault", I personally heard this before, I didn't even discharge this patient, they were calling the wrong unit. Anyhow, tell them to contact their doctor.

TraumaNurseRN · May 31, 2008

Our policy is to not give medical information over the phone. We advise them if they are concerned that they can come to the ED and be examined by an EMD. Some come in, some don't. :nurse:

gonzo1, ASN, RN · May 31, 2008

Our policy is no info over the phone. If there is a concern I tell the caller they need to come in. If someone were asking what the symptoms of something were I might suggest they look it up on the internet.

The nurses in our ER follow these quidelines very well, but I hear the CNAs giving out medical advice over the phone all the time. When I hear this I write it up as an incidence report.

They just don't get it although they have been re-educated many times

MikeyJ, RN · May 31, 2008

I was actually suprised that people called a hospital unit for medical advice. One of my first days on the unit at a nurse apprentice (pediatrics), I answered the phone and this lady started asking me what should she do about a possible reaction her child had to an immunization. It took me a minute to realize it was a stranger calling, thus I answered by saying "if you think your child is having a bad reaction to their recent immunization, you need to bring them to the urgent care or ER".

mom2michael, MSN, RN, NP · May 31, 2008

We do not give advice over the phone either. We tell them (sometimes 10 or 11 times) that if they have a question they need to direct it to their PCP or Rx of their choice if it's a medication question. If they feel they need to be seen by a doctor there is an urgent care in town that is open until X time and of course we are available in the ER if they feel it's something that needs immediate attention. I almost always give the ER has the final option and I try very hard to give them many viable options first. Sometimes people just need gentle reminders of who they can call with a problem.

You would be amazed at how many times people have said...WOW I never thought of calling THAT person or place.

Sometimes people don't get it though and you are left :banghead:

webbiedebbie · May 31, 2008

You might suggest that they call their "Nurse Advise" line if they have this benefit with their insurance. They should be able to find the number on their insurance card. Giving them an alternative might help keep them from calling all the time.

sfsn · May 31, 2008

Thanks so much for your replies. They are helpful.

Sometimes people don't get it though and you are left

Those are the ones I'm asking about. I have no trouble telling people that we can't give advice, I just lately have gotten stuck in some conversations that last way too long w/ people badgering me with "I don't understand why you can't answer my question, I'm not asking for advice" etc.

That's when I don't really know what to say.

Sometimes I feel like a broken record and end up basically telling them (after explaining multiple times that they can call their MD, come in and be seen, etc.) that I've answered their question in the best way that I can but that I am taking care of patients in the ER and am going to have to get off the phone.

The last time this happened the lady actually said, "Well can you look up the information for me when you have time and I'll call you back later?"

I guess some people just don't get it. Part of the problem is probably caused by the fact that I have heard some of my fellow nurses give phone advice, so we are inconsistent. Sometimes they say, "Well, I am not able to give you medical advice, but if I were you I would..." Talk about :banghead:

sfsn · May 31, 2008

I just realized something based on your helpful replies - something small and obvious but might make a difference:

We are told to tell callers that we can't give medical advice over the phone.

But if I change it and say that we can't give medical information then that might work better.

**canoehead, BSN, RN** · May 31, 2008

Can't answer questions over the phone, but they can call their doc, the nurse advice line, their pharmacist, and the poison control center. They also have access to computer information, or maybe a friend or family member does that would be willing to help.

Rarely I've looked up CDC guidelines and quoted them verbatim, saying "I don't know but this website says...." or I've pulled the old chart (less than 24h ago) to clarify simple DC instructions.

A warning...I discharged a woman and her family called me back within 30min saying she got a bruise getting out of the truck, and they were concerned. I gave them the standard ice/pressure response, wondering why all this fuss for a bruise. The second time they called I told them the same thing and added to come back if they were concerned. They DID come back on the next shift. She died 2 days later because she had a new coagulopathy diagnosis, and bled out under the skin, starting with that new bruise (it was down her entire leg apparently). Now I know why they were so concerned. I will never, ever, ever, ever mentally minimize a problem without seeing it. Assume the worst, and tell them to come back if they have a problem.

Yes, my experience was a zebra, but trust me, it will only take one and you'll never do it again. Start now before you kill or maim someone with the best intentions.

northshore08 · Jun 1, 2008

Tell them that you are unable to give out information over the phone and that they need to discuss any medical concerns with their doctor and if they need medical attention, tell them to go to their nearest clinic or ER. If they persist, politely repeat what you have said.

:up: :up: That's it. I know they sometimes will get manipulative or ugly; those folks get the hold button and the charge nurse. If you are the charge nurse, they get the number for the customer relations department, along with the reminder that the ED is not the place to call to get answers to medical questions unless you are willing to come in to be seen.

At one ED, we had policies that allowed us to clarify doses of Tylenol or Motrin or to clarify our ED's discharge instructions over the phone. :rolleyes:

LoveMyBugs, BSN, CNA, RN · Jun 1, 2008

Just keep repeating that you can not give advice. Thankfully where I work, the main line for the ED is the front desk where a CNA is and we are able to say that we are not a medical proffessional and therefore are unable to provide you with any medical adivce, that we do not have a nurse availible to speak with them as the nurses are caring for patients presently here, if they feel that it is an emergency they are more than welcome to come in, or call their PCP. And when they go on and act like they dont hear you, just repeat word for word. I have said that if they like it is an emergent situation and want to be treated they need to come in, the nurse will not be able to asses you over the phone, if you need medical treatment you need to be seen as there is nothing that they will be able to do for you over the phone.