Talking to MDs

FireStarterRN, BSN, RN · Jul 14, 2007

Hello everyone!
I'm a new LPN working LTC for about 4 months now...love it!! I have 10 years experience in Healthcare as a medical assistant and phlebotomist. I'm having a very hard time speaking to physicians (never happened before). Most of the time if there is an issue and I make a call I usually get "well, what do u want to do/give". How do I answer this?? He's the doctor....right? I get very flustered when I get a call back, even for the easiest things like labs! I ran a coumadin clinic for years and never had a problem speaking w/ any MDs, all of a sudden I forget how to speak!! How can I get over this!!!

I'm a person who is a terrible public speaker, or at least I think I am. I also have a phone phobia. Yet, my phone calls with doctors always go well. First I announce who I am, where I'm calling from, and what patient I'm referring to. Then I apoligise very sincerely for interrupting him/her, or bothering or waking him/her. Then I state what my worry, concern, or question is. I always have the chart and vitals in front of me.

If the doctor asks you what you think he should do or what you want for the patient, by all means give him a suggestion. In LTC often it's more routine things like needing a UA and an antibiotic. That might be why the doctors are asking for your opinion on their LTC patients. In longterm care, the doctor might not have all the information close at hand like they have with their hospitalized patients. Also, during the day I imagine you are going through the office nurse. Sometimes the office nurses can act annoyed at me even when I'm calling from the ICU, I'm not sure why they do that. I have more trouble with the office nurses than I ever do with the M.D.s...

EmilyUSFRN, RN · Jul 14, 2007

i just finished going through transition classes (from student to nurse) at work, and a lot of emphasis was put on the SBAR method of communication when talking to MDs.

S- Situation: state your name, where you're calling from, pt name, breif summary of concerns

B- Background: pt admitting dx, recent tx, code status

A- Assessment: most recent vitals, labs, on/off O2, changes in assessment

R- Recommendations: labs, scans, drugs... "when should i expect a response and I will notify you in (x amount of time) if I don't see improvement"

the recommendations is the scariest to me, as I'm new, and how the heck am I supposed to know? but so far when I've had to call, things have gone really smoothly and fine.

Maybe just think of similar situations you have seen and what was done? I think comfort with being able to recommend things will just come with time. Good luck to you!

Blee O'Myacin, BSN, RN · Jul 14, 2007

Hello everyone!
I'm a new LPN working LTC for about 4 months now...love it!! I have 10 years experience in Healthcare as a medical assistant and phlebotomist. I'm having a very hard time speaking to physicians (never happened before). Most of the time if there is an issue and I make a call I usually get "well, what do u want to do/give". How do I answer this?? He's the doctor....right? I get very flustered when I get a call back, even for the easiest things like labs! I ran a coumadin clinic for years and never had a problem speaking w/ any MDs, all of a sudden I forget how to speak!! How can I get over this!!!

Well, I usually have a plan when I talk to the doc. (Usually a resident or an intern - I work ICU, so I need to have one) If it isn't what I had in mind, we talk about it and I explain my rationale. If you aren't comfortable with doing that, you can always say "that's why I'm calling you, it isn't in my scope of practice to prescribe..." I keep a piece of paper in my pocket to jot down any pertinent info about a phone call - this way I have the information when I am talking (alcohol wipe wrappers and my hands do in a pinch.) You'll get used to it. In the meantime, stick to a script and make the docs do their jobs!

Blee

gonzo1, ASN, RN · Jul 14, 2007

I learned in nursing school, and have found it to be true on the floor, the docs really appreciate it if you have a plan in mind and suggestions to make when you call them, unless you are totally unsure which happens sometimes.

Now and then you will get a crabby doc who doesn't want input from you but just remember taking care of patients is teamwork and the docs couldn't do it without us no matter how much they delude themselves.

I have found 99 percent of docs are nice and who cares about the rest.

If that doesnt help just picture them wiping their butts when they take a poop.

That always does it for me.

Daytonite, BSN, RN · Jul 15, 2007

part of what is happening is your lack of confidence as well as not knowing the doctor at the other end of the phone. it's amazing how being confident and knowing the other person can change our whole attitude and behavior.

keep in mind that at work the phone is a tool and you shouldn't be too quick to pick it up to make a call to the doctor before you have all your ducks in a row. get all the information the doctor is likely to ask in front of you and ready to give him in case he asks. as you've found, some doctors will ask for the nurse's recommendation, particularly in ltc. i would only offer this if the doctor asks. some docs will ream you a new one if you suggest things and they aren't particularly open to nurses doing that. ha! ha! otherwise, you have to find really tactful ways to ask for an order that they aren't giving you. when i was a night shift supervisor, all nurses had to get approval from us before calling mds during the night. i always asked "what kind of order do you expect the doctor to give you?" that and to inform him of a change in the patient's condition is why you are calling. otherwise, a call is not urgent.

the sbar technique was developed to break down the preparatory process of calling docs. it's been discussed a number of times on allnurses forums. here are some of the previous threads on it:

NurseguyFL · Jul 15, 2007

I find that docs who ask "what do you think/want to give" are great people to work with. They are usually the more experienced clinicians who respect our professional judgment and assessment skills and will go along with whatever we suggest most of the time, as long as it makes sense for the situation and is safe for the patient. Once they are confident that you know what you are talking about they will go along with your suggestions most of the time.

Daytonite is right. What they want is the facts. They're always going to want to know the latest vital signs, the patient's current condition, latest labs, etc, so have all your information in order before you call them. You could always say something like 'well the patient has a history of so and so, but the latest workup shows so and so, and she hasn't been responding to the previously ordered treatment, so maybe we could try so and so, and see how that works for her...' Of course, you always want to end the suggestion with 'how does this sound to you?' because you don't want them to think you are telling them how to do their job.

About a year ago I invested in a critical care software program for my PDA, and it lists in detail, almost all medical problems, things to assess for, labs and tests to order, and all possible medical and nursing interventions. The program was written by a physician so it approaches the interventions mostly from a medical point of view. I use it all the time, especially when I suggest things to docs who ask for my opinion. Some of them think I'm exceptionally smart when I suggest these things, but the credit really belongs to Elsevier, Inc's wonderful software.