August 17, 2006, 8:54 pm

Just the Facts, Ma’am: Talking to Doctors

pepsi

Awwwwww….

Look at those itty bitty wittle Pepsi cups!

No thanks!

Speaking as someone who thinks the arrival of the KFC Mega-Jug is on par with the discovery of penicillin, I hope they didn’t have to pay more than a nickle for that.

Probably didn’t even come with ice….

************

And what are they talking about?

They obviously know each other well enough to invade personal space, so I suspect they aren’t discussing the latest technique in abdominoplasty.

Full hospital soap opera plot lines have been developed around less than you can imply from this ad!

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Let me clarify one thing.

This is not a “Men are from Alpha-Seti 5, Women are from K-PAX” issue.

Both sexes are represented in nursing and medicine.

This is about communication in a medical setting.

  • Telling a doctor something you believe they need to know about your patient.
  • Getting an order from a doctor for something you believe a patient needs.
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Here is what I have learned regarding communication with physicians, in any setting.

  • Unless your patient is dying, don’t interrupt.
    • This is Basic Manners 101
    • If the doctor is talking to a patient, another physician, a nurse or is in the middle of a dictation, try to wait until the conversation/dicatation is complete.
    • If the situation is urgent, approach the doctor, apologize for the interruption and state your concerns as succinctly as possible.
    • Remember, in the Emergency Department, while you, as the nurse may have a 3-4 patient (or more!) assignment, the ED doc has every patient in the department and is bombarded from all sides, just as you are. Patients, families, lab, radiology, primary doctors, hospitalists and even the Administration all want a piece of them. Sometimes ya just gotta wait your turn.
  • Have all pertinent information available when you call a doctor on the phone, such as from a med/surg unit.
    • If you know what you want from the doctor, ask for it directly. Examples would be restraint orders or additional pain medication before it is due.
    • Just calling and saying “there’s something wrong with Mr. Doe” will get you nowhere. Especially at 0400.
    • State the issue. Mr. Doe is confused, you suspect an adverse reaction to a medication, no urine output for 2 hours, new onset fever, Mr. Doe has chest pain, unrelieved abdominal pain etc.
    • Be sure you have done all that you have orders for before you place the call. If the patient has a prn order for Tylenol, give it. If IV Lasix is to be used for a low urine output, use it. If there are orders for blood cultures if fever > 101, do them, etc.
    • State what you have already tried to rectify the situation, if applicable. You gave Tylenol with no change, the prn Lasix did not work, everything was fine until 30 minutes after the little purple pill, blood and urine cultures are in progess, etc.
    • Be ready for questions
      • Have the patient’s chart in front of you.
      • This includes the medication record, the vital sign sheet, including the most recent set of vital signs (which should be taken just before you call), access to the lab work and a doctor’s order sheet to write down any new orders.
      • KNOW THE PATIENT
      • You may be speaking to an on-call doc who has no clue who your patient is. Be ready to give a brief history of the present illness, previous surgeries, etc.
        • Eyeball a dictated history and physical before you call or keep it in front of you.
        • If you don’t know the answer to a question or the information is not accessible to you, say so. Don’t try to explain around it.
  • Doctors are human.
    • Do not, under any circumstances, take anything said by a physician in the heat of the moment or at 0400 personally. You will hear four-letter words on occasion. They’re venting.
    • You will run across doctors who are angry, exhausted, sick themselves, half-asleep, exasperated, sad, mourning, or just plain stressed because this is their weekend call and they have been in surgery for 95% of the time and they just hit the bed when you called.
    • Cut them some slack.

(Yes, I know all the comments: they knew what they were getting into when they went into medicine, they get paid to get calls at 0400, yadda…yadda…yadda.

Give ‘em a break, they earn every bit of that money and then some.

It took me a long time to see a “person” under that “MD”, but life will be much less stressful for you when you can.)

Now, what to do if you are confronted by an out-of-control, abusive, screaming physician? Male or female?

  • Understand that the odds of this occuring decrease with each year that passes. Doctors and nurses have a different relationship today.
  • While it is happening:
    • Stay calm – do not burst into tears or punch ‘em in the nose. What is happening is not your fault (unless you have just backed into their BMW, then you got it coming!)
    • Stand upright and face the physician. Make eye contact.
    • Wait until the anger dissipates. It will.
    • Don’t yell back, in fact, drop your voice a few decibels.
    • Ask the doctor to step away with you to discuss why they are angry.
    • Acknowledge any error or lack of communication on your part that may have contributed to the situation at hand. This will deflate the anger faster than anything.
    • Do one of two things
      • Take a breather for a minute or two to get your adrenaline under control. Or, if you feel like you are going to lose it with either tears or retaliatory anger,
      • Get busy with something else ASAP
  • If it happens to a co-worker
    • Go stand next to them. Encourage others to do so, also.
    • It is really hard to be abusive to a person with a crowd of support around them.
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Now for those of you who are stuck in an OR with a possibly not-so-nice surgeon for hours on end, I have no advice, having no experience in that area. I will say that I have heard that neurosurgeons have a rather dismal reputation for OR ettiquette.Given the nature of the work, it’s probably understandable. But take heart, you neurosurgical nurses, I just read that Dr. Sanjay Gupta, MD,H.U.N.K of Time Magazine and CNN is now a board-certified neurosurgeon.

He can work on my central nervous system anytime….

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20 Comments

  • NPs Save Lives
    NPs Save Lives

    August 18, 2006 at 5:41 am

    Excellent post! You hit the nail right on the head. I try to wait until people are finished speaking before I interrupt also. I also try to have all of the info ready prior to calls. It makes me look more professional.


  • Mother Jones RN
    Mother Jones RN

    August 18, 2006 at 7:54 am

    You make excellent points on how to improve communicate with physicians. I think most physicians, like nurses, are feeling overwhelmed by the health care system. Your pointers bring down communication barriers that add to a physician’s stress, and promote good patient care.


  • TC
    TC

    August 18, 2006 at 9:39 am

    Good post, as usual. They’re not too much you can do in the OR if they’re operating, but cutting open a living person is pretty stressful. Things you should never take in the OR-threats, throwing things and being careless with the sharps. I got stabbed with a bloody scalpel once-not nice, fortunately the patient was cooperative about getting blood tests done.


  • birdy
    birdy

    August 18, 2006 at 10:33 am

    That is really good advice! I’m sure I’ll think about it a lot–I’m starting my preceptorship in a few weeks!


  • Dawn
    Dawn

    August 18, 2006 at 1:47 pm

    Thanks Kim – I start my last round of clinicals in ten days, and I’ll heed this advice!

    Birdy – good luck w/your preceptorship! Mine will be (hopefully) in November!


  • ltaylor
    ltaylor

    August 18, 2006 at 2:45 pm

    Well, well, well….and I thought I was the only one who had a little “thing” for the good doctor. He could peek into my brain anytime!!


  • Too Fat 4 Ponies
    Too Fat 4 Ponies

    August 19, 2006 at 8:10 am

    Great post! I’m definitely referring some of my fellow students to read this post.

    Sorry. Dr. Gupta does nothing for me.

    ;-)


  • Melissa
    Melissa

    August 19, 2006 at 8:58 pm

    Unless I’m trapped, I simply walk away if a doctor becomes abusive. They can vent to the wall all they want.


  • scan man
    scan man

    August 20, 2006 at 5:04 am

    Great post Kim.
    I would like your permission to copy & print the advice to nurses and circulate it to my hospital’s nursing staff and student nurses.


  • lpn dave
    lpn dave

    August 20, 2006 at 10:07 am

    Thanks this is very good information to keep in mind for future nurses. Communication is key and this information is a good tool to assist with that.


  • Intelinurse2b
    Intelinurse2b

    August 20, 2006 at 4:27 pm

    Am I a geek if I print this out and post it somewhere it can be studied and memorized?

    Great advice!


  • fatdoctor
    fatdoctor

    August 20, 2006 at 4:39 pm

    May I add a comment or three?
    1) When a doc does not respond when you interrupt her, it helps if you cry out “Code Blue!”

    2) Once a doctor was extremely, extremely rude to me. I responded, “You have a right to correct me, but you do not have a right to use foul language while doing it.” Sounded fair to me. He called my attending to complain about me!

    3) When still a unit secretary, Sister, now an MD, asked a physician to please stop touching her breast. I think it is fair to interrupt the physician’s work when he is touching your breasts (as a side note, her supervisor told her she should NEVER talk to Dr. Famous-Surgeon that way).

    Otherwise, your rules are applicable in every career in every field. Manners are good.


  • Prisca
    Prisca

    August 20, 2006 at 7:56 pm

    This post is brilliant–I am printing it out and putting it on my clipboard for clinicals. Your blog is so inspiring and full of great stuff-I fear I will be here all night reading…


  • [...] I recently posted a missive here on Emergiblog with my ideas about How To Talk To Doctors. I knew I had read a post addressing the same issue, but could not remember when or by whom. [...]


  • Greg P
    Greg P

    August 24, 2006 at 2:07 pm

    Interesting to see the similarity between your post and mine:

    http://infoisfree.blogspot.com/2006/06/cold-calls-when-you-are-in-situation_21.html


  • missbhavens
    missbhavens

    August 24, 2006 at 2:54 pm

    Superb post!

    …bursting into tears…my instant emotional-overload reaction.

    Must learn to curb that.


  • ThirdDegreeNurse
    ThirdDegreeNurse

    August 25, 2006 at 4:03 pm

    Great post, Kim! They should teach us this stuff in nursing school. But, alas. Not a word.

    All the docs I’ve dealt with so far have treated me with respect — not necessarily immediately, but after a few hours of observing me.

    Now, how about a post on dealing with immature, catty, gossippy, intimidating nurses? You know — the kind who eat student nurses for lunch? Oh..maybe I should write that one.


  • scalpel
    scalpel

    August 26, 2006 at 12:41 am

    Great advice! I can manage a dozen patients at once, but if I’m in the middle of writing something or on the phone with another physician, I really prefer to get to a good stopping point before I want to hear anything that isn’t immediately life-threatening.


  • NurseFran
    NurseFran

    September 20, 2006 at 10:58 am

    Great tips, for additional communication help I have taught students and nursing staff to use SBAR technique. This way they sound confident and competant from the start.
    S-Situation (why you are calling or speaking)
    B-Background (significant clinical past)
    A-Assessment (what the nurse actually thinks)
    R-Reccommendation (state what you are asking for)
    Our physicians love it and they have adopted SBAR for their hand off communication.


  • San Diego NP
    San Diego NP

    July 19, 2007 at 10:51 am

    Good tips overall….but still, as a fellow clinician, I cannot understand why the “great divide” still exists between MD/PA/NP/RN/MA….and the list goes on. The reality is that we are all an integral part of the healthcare delivery system, regardless of our hour worked or money earned. I believe that any well trained RN/NP can communicate efficiently with their colleagues if they use a “SOAP” format, prepare in advance what they are going to say, and make sure to familiarize themselves with the situation prior to calling….the reality is that we are ALL overworked, over stressed, and in some ways, underpaid….and we should all be PROFESSIONALLY CIVIL with each other regardless of specialty or expertise…. when we associate on an equal playing field, collaboration and team work will offer our patients the BEST of care.


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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