Rude physicians

[amzyRN]

I started another job at a new facility and have noticed that two of their docs are very rude in interactions that I have had. I don't appreciate being grilled when I make a phone call or ask for clarification. My last facility set a standard that no one was to be antagonistic with each other. I am uncertain if this facility has the same standard. Many of the nurses seem reluctant to talk with the physicians. I was wondering if there was a general consensus on how to deal with this effectively. I think I'm much too new to be talking to supervisors and what not. I also prefer to talk with a person directly. What I usually do is explain why I am asking for clarification and inform them that it is my job to update them and that I will continue to do what is necessary for the patient, including calling them with questions.

Most of the time this does the trick. I explain that I am a patient advocate and that is what is motivating my action. And I don't call MDs for things that are not pertinent. But, I had one doctor that was very argumentative with me today and I didn't appreciate it. I feel like I'm getting to old to be belittled by someone and that I don't have to tolerate it. At the same time, I don't want be just as rude an inappropriate as the physician. Plus, the physicians have more "worth" at this facility, especially considering I am new. Any suggestions?

[TheCommuter, BSN, RN]

What I usually do is explain why I am asking for clarification and inform them that it is my job to update them and that I will continue to do what is necessary for the patient, including calling them with questions.

Do you consult with your charge nurse or house supervisor before making these phone calls to see if they can clarify or answer any questions you have? As a house supervisor, I'm often able to clarify what some of the floor nurses did not understand, and as a result, the multiple extraneous physician phone calls are minimized.

I'm cognizant that physicians entered the profession with the full understanding that calls are part of the territory, but after a while I imagine that certain inconsequential phone calls and pages can grate on their last nerves. Examples include the following:

1. The nurse who calls at 2:00am to report a critical creatinine level of 4.5 on a patient with ESRD who has been on hemodialysis for seven years.

2. The nurse who calls to request orders for pain medication without first looking at the standing orders for Norco, Tramadol and Morphine if not allergic.

3. The nurse who calls to report a blood pressure of 170/100 without first administering the PRN blood pressure medications and awaiting the response.

Some physicians are less open to answering questions than others. Some physicians have such a wide protocol and list of standing orders that eliminate the need for certain calls. Some physicians do not want phone updates on their patients unless a significant change in condition is transpiring.

Whenever possible, we combine phone calls. This essentially means that one phone call is placed to each physician at a certain time for all non-urgent issues, and at that time, all the nurses talk to the doctor and make their notifications, suggestions and requests.

[amzyRN]

Yeah I do ask for clarification. This new job is really old school, still paper charting, no vocera to let nurses know that I am paging a doctor to see if calls can be combined. I had to call for clarification about medications that weren't added to the med recon for discharge. Another patient had asked for a note for work. I do understand that physicians are busy and have enough clinical judgment to minimize unnecessary calls, such as the creatinine of 4 in a patient with ESRD and the like.

[classicdame, MSN, EdD]

you really need to consult with your supervisor on how this should be handled. Ask if there is a policy regarding bullying or intimidation. Ask how they handle these situations. If it every interferes with patient care, or is carried on in public, make a complaint to the CEO.

[firstinfamily, RN]

We did the same at the last facility I worked where a time was agreed upon to call the attending MD by the house supervisor and the call was placed and then transferred throughout the facility so that everyone got their questions answered. It took the MD to agree to this but it did eliminate multiple phone calls to him. It worked for us and we got what the patient needed most of the time. We have to remember the MDs are usually attending at more than one facility, having their own private practice and most likely on call somewhere. They have had to step up the game also, so are spread rather thin. If I feel I have a reasonable question/clarification I will continue to call the MD to get the answer I need. Sometimes they don't like this, but I just tell them it was not clear and I needed it to be clarified period. I don't go into a lot of detail, they usually want the down and dirty version, streamline what you are telling them, get to the point right away. The case manager should have taken care of the work excuse for the patient being discharged. There were times when our case manager drove to the MDs office to get anything signed that was needed on discharge. It takes a whole team, not just the nurse. As nurses we should never, never feel we cannot call a MD. However, utilize your supervisor or charge nurse if you are not sure.