Talking to MD

could you add the link to the SBAR site please?

Thanks, that was amazingly quick.

i work as a new rn in ltc. i am worring how to talk to md during phone call. english is my second language. actually i speak well but when i am under stress i just don't know what to say. can anybody tell me what you are saying when md calls to ask some questions regarding pt or to give you a new order?

thanks in advance!

english is also my second language. i was the same way when i was a new nurse. make sure you get the recent vs just in case the md asks you. if you are calling in abnormal labs, have the previous lab results so you can compare if it's going up or down and also have the mar (and chart) in front of you because many of the meds affect the lab values. in time, you will learn to be confident when talking to the mds. you might get yelled at once in a while but just have all your ducks in a row before calling the md to minimize this.

good luck!

English is my first and only language and I still sometimes go blank when talking to the doctor.

Have everything ready when you call, especially if the doctor doesn't know the patient. Fresh vitals and quick assessment pertaining to the reason why you are calling, chart and MARs in front of you and organized. I usually write all the info I know the doctor will ask for on a piece of paper. Keep your surroundings quiet. I have a hard time hearing on the phone when theres people talking near me or the call bell board is going off. I've actually told two PTs to take their conversation elsewhere because I have to hear what the doctor is saying. I keep my conversation short, sweet and to the point. Be polite and thank the doctor for their time.

Commuter beat me to posting SBAR.

SBAR is the way to go! Always have your patient's chart and MAR in front of you, though. There have been times where an MD asked me something about a patient and it caught me off guard, so I had to fumble through the chart to find the answer (and it didn't help that I was still trying to get used to our computer charting system!) - it happens, though! Have the most recent set of vitals and also know the patient's labs. And as far as the "Recommendation" aspect of SBAR, I have met two kinds of doctors - either doctors will know exactly what they want and tell you "I want this, this and this" (YOU can still make recommendations, sometimes the doc will forget to order something) or you will have to suggest everything. Be prepared for both.

Talking to doctors can be scary...I was TERRIFIED when I first started and I didn't want to talk to them at all lol. During my first few days my preceptor asked if I wanted to talk to them, and I told her "not really, but I need to start getting used to it so I'll call them" lol. I work nights and at times I still dread calling the doc, especially if it's at say, 0200, but if it needs to be done, it needs to be done! If it is something that can wait until morning then I will wait, unless another coworker has to call, then I will ask to speak to the doc when they are done. My unit (at least on nights!) is really good about pooling together when calling the docs. We just pass the phone around, and I think the docs appreciate this more because then they're not receiving 20397609276097236 calls at night - at least not from my unit!

in addition to information regarding "sbar", the following publication also contains information regarding the "5p" and "i pass the baton" handoff tools as well.

dod patient safety program healthcare communications toolkit (pdf file)

SBAR is the way to go! Always have your patient's chart and MAR in front of you, though. There have been times where an MD asked me something about a patient and it caught me off guard, so I had to fumble through the chart to find the answer (and it didn't help that I was still trying to get used to our computer charting system!) - it happens, though! Have the most recent set of vitals and also know the patient's labs. And as far as the "Recommendation" aspect of SBAR, I have met two kinds of doctors - either doctors will know exactly what they want and tell you "I want this, this and this" (YOU can still make recommendations, sometimes the doc will forget to order something) or you will have to suggest everything. Be prepared for both.

Talking to doctors can be scary...I was TERRIFIED when I first started and I didn't want to talk to them at all lol. During my first few days my preceptor asked if I wanted to talk to them, and I told her "not really, but I need to start getting used to it so I'll call them" lol. I work nights and at times I still dread calling the doc, especially if it's at say, 0200, but if it needs to be done, it needs to be done! If it is something that can wait until morning then I will wait, unless another coworker has to call, then I will ask to speak to the doc when they are done. My unit (at least on nights!) is really good about pooling together when calling the docs. We just pass the phone around, and I think the docs appreciate this more because then they're not receiving 20397609276097236 calls at night - at least not from my unit!

Thats what we do too. If we need the doctor we page him and let the other unit know we have a call out to him and send his call up to the other unit so hes not called 100 times from us.

As with most everything else, talking to the doc will get easier the more you do it. We use a different tool than SBAR, but it helps organize the information before you make the call. I've talked to many many docs about this issue. Their biggest problem they say is when a nurse calls and doesn't have enough information for them. Remember many times you'll be calling a covering who doesn't know the patient at all. It's up to you to give him/her enough information. "Mrs Jones is sick" doesn't work. You should at the very least have a current set of vitals and if those differ from the patient's norm, a brief medical history, an explanation of why you are calling, and lastly some suggestions for what orders you want. It'll certainly help if you know what meds are in your e-kits...nothing makes you feel as dumb as getting an order for a med you don't have and having to call the doc back. And, if it is a covering, make sure he knows the capabilities of your facility.....IVs,trachs, whatever you can do in house so he doesn't just say ship them to the hospital.

My sister tells this story on herself and I'll pass it along. She was a new RN working in a CCU and a patient was admitted with an irregular atrial rhythm and a peculiar heart sound. She called the Cardiologist and was trying to describe this. He said, 'what does the heart sound like?' She said, 'you know when you have just one tennis shoe in the drier? It sounds like that.' Her patient had new onset atrial fibrillation and was treated correctly. What you can describe accurately to the best of your ability really is the best you can do! SBAR and fresh vital signs and lab results and current meds are important, YES! But don't be afraid to tell the MD what you hear and see and smell. You are his/her ears and eyes and nose.