Posts Tagged ‘Communication’

You’re on-call and it’s three in the morning. You get called from the ER and you call them back from your call room, because you had just laid down. You’ll find that it’s almost like they have a direct connection to your pillow. As soon as your head hits that pillow, they’ll call you.

You call back and they see the in-house caller ID “resident call room” and the ER doc says, “Whoa! Dr. Tori, trying to get some sleep? Trying to rest your head? Why don’t you come on down? I have a few admissions for you.”

Great. That kind of stuff starts to tick you off after awhile. The first few times you’re like sure and you head on down. The next few times you start to get the idea that people think you’re a slacker because you’re in your call room.

Well, here’s the thing… (more…)

OK. Normally, I probably wouldn’t highlight a hospital ranking article for new interns and residents, but this one is very well done. It is a great article to learn from. US News and World Report’s America’s Best Hospitals covers ventilator associated pneumonia (VAP) protocols, bedside manner, handoffs and signout, turf battles between specialties, getting feedback from patients, and more. Although it is written as if you know very little about medicine and surgery, there are some great lessons and perspective changers for med students, interns, and residents.

OK. It’s official. I’m tired of this phrase. (Just heard this from a ward secretary in a normally vibrant, happy-go-lucky hospital.)

• Not in my job description
• They don’t pay me enough to do that
• If they want me to do that, they’ll have to pay me more
• Blah, blah, I, blah, me, blah, Me, me, me, I, I

“Not in my job description”, in all of its forms, is destructive. Don’t use it. It doesn’t help anyone, and, in fact, it hurts you.

Simple analogy… A ship is in a horrible storm, tossing and turning in mountainous waves. Rain pouring in. The ship can’t be controlled. What’s the next step? Get rid of the least important cargo. Start throwing stuff overboard. Are you that piece of cargo? If the ship starts sinking, are you the one they’ll get rid of?

If you are the cargo that’s thrown overboard, it’s not some conspiracy against you. It’s not your gender, your ethnicity, your haircut, your political stance, or your job title. It’s much more simple than a plot. It’s just a matter of – to get this ship sailing in the right direction, we have to get rid of the least valuable cargo. And that least valuable cargo is the stuff that only fits into a single purpose, a single task, or a single job description. If we can use the cargo for multiple things, even outside of it’s normal uses, then let’s keep it. It may come in handy.

Sure, there are times when something is outside of your power, your influence, your knowledge, etc. And sure, there are times where you are working on something more important than what you are being asked to do. But there are better ways to say it.

• “Actually, I don’t know the answer to that, but So-and-So might be able to help. Try extension 2345. They should be able to help.”
• “You know what? I’m sorry. As a secretary, I can’t take verbal orders. But let me get his nurse for you.”
• “Normally, I’d help you and send off that fax, but I have heavy patients right now. Sorry.”
• “Aw. I wish I could help. But I don’t even know where to begin finding an answer to that.”

You can say “No” without saying “It’s not in my job description.”

Don’t shoot yourself and everyone you work with in the foot!

If you’re a doc, then you shoot others in the foot when you tell patients in the hospital that you’re going to order a certain medicine or a certain test – without telling them that it’s going to take some time.

If you’re a nurse, you’re shooting the doctor in the foot when you say, “I paged the doctor, but they never called back.”

The fact is that both may be true… but you need to give more information. Think about it from the patient’s point of view…

“The doctor just now told me that pain medicine is ordered. Why doesn’t the nurse get it right when I ask for it?”

“Why isn’t my doctor calling back? I’m sick enough to be in the hospital, you’d think they’d call back. He comes in for 5 minutes a day, at least call back when the nurse has a concern!”

It takes less than twenty seconds to change the way you say things, and in the process you can save the patient, other nurses, other doctors, patients’ family members, etc a lot of grief.

It’s all about managing expectations…

Many patients have never been in the hospital before. Many family members have never had someone so close to them in the hospital. Listen to what you say with their ears. See what they see.

They see the doctor in their room for 5 minutes a day… They don’t see the doc

1. Checking labs
2. Discussing things with consultants
3. Reviewing old records
4. Discussing the dispo with the case managers and social workers
5. Arguing Advocating for the patients with the insurance companies
6. Writing progress notes
7. Dictating consults
8. etc.

If you’re a nurse, you can change all of that if you just say something like, “Behind the scenes, we’ve all put our heads together and the doctor has reviewed your labs. Although she’ll be by a little later, she’s up to date on everything that’s been going on. She has some pretty sick patients on another floor.”

Likewise, the patients don’t know that when the you (Doc) write an order that…

1. The secretary has to take that order off
2. The secretary faxes it to the pharmacy or enters it into the computer
3. The secretary alerts the nurse or flags the chart
4. The nurse reviews the order
5. The pharmacy checks for duplicate orders, drug interactions, therapeutic substitutions, etc
6. The pharmacy sends the med up
7. And, finally the nurse brings the med to the patient

All it takes is saying something like, “I’m going to order a stronger pain medicine for you. But, I apologize, it’s going to take a little while for it to come up from the pharmacy.”