Responding to Doctors

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" 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.

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.

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.

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

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!--

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.