The inability to follow directions

[Mumpu]

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In the immortal words of Paul Sr., "this really burns my ass."

So I cover a call for someone a few days ago. On the way out, I leave a detailed note on every patient's chart explaining in detail and in very legible handwriting that I'm off service and than cross-cover should be paged today, and the resident should be paged tomorrow. Even leave pager numbers of the people. Simple enough right?

Wrong! Come home today to find about 25 calls on my pager from the units where I was covering patients. Presumably, college-educated healthcare professionals who are entrusted with administering potentially lethal medications and monitoring critically ill patients should be capable of following basic directions. Or am I expecting too much? We even have the option of leaving a custom voice message on the pager saying we are off, etc. This does absolutely nothing to reduce the number of wrong pages because no one listens to it.

The calls per se don't bother me, but I took care of some sick patients and calling the wrong pager creates unnecessary and potentially dangerous delays in care.

 

[edinOH]

In the immortal words of Paul Sr., "this really burns my ass."

So I cover a call for someone a few days ago. On the way out, I leave a detailed note on every patient's chart explaining in detail and in very legible handwriting that I'm off service and than cross-cover should be paged today, and the resident should be paged tomorrow. Even leave pager numbers of the people. Simple enough right?

Wrong! Come home today to find about 25 calls on my pager from the units where I was covering patients. Presumably, college-educated healthcare professionals who are entrusted with administering potentially lethal medications and monitoring critically ill patients should be capable of following basic directions. Or am I expecting too much? We even have the option of leaving a custom voice message on the pager saying we are off, etc. This does absolutely nothing to reduce the number of wrong pages because no one listens to it.

The calls per se don't bother me, but I took care of some sick patients and calling the wrong pager creates unnecessary and potentially dangerous delays in care.

No you aren't asking too much.

Today in the ED I took care of a very sick patient with an inferior wall MI. The whole nine yards here. Sick as hell, intubated in the field, ST elevation, hypotensive, one 20 gage IV access courtesy of EMS.

During this nursing cluster-**** I thought how neat it would be for NBC to create a show in the spirit of "ER" called "Nursing School". I swear nursing school was what I was in the middle of while the charge nurse tried to teach three other completely clueless "BSN" nurses how to place monitor leads, start IV's and understand what I meant when I asked for such crazy things as lovenox, integrellin, saline and dopamine.

It was pathetic.

 

[Winged Scapula]

You are only asking too much if you actually expect people to read the charts. Hardly anyone does.

Your efforts are laudable, especially given the time it took to do it. But it happens all the time - to all of us.

Again and again.

I have the opposite problem - I can't get anyone to page me about my patients. They still page the Surg Onc intern who is likely to be a cross cover who doesn't know anything. You'd think an order in the chart would be enough...but I can count the number of pages I've had and they're almost all from our department secretary.

 

[Mumpu]

Nobody pages the fearsome surgery upper-level! Nobody! 🙂

I always feel so bad for the surgery intern laden with six pagers.

 

[Apollyon]

I always feel so bad for the surgery intern laden with six pagers.

Whenever I see that, I think that someone has an osteosarcoma of the hip/pelvis in their future, only compounded by a PDA or cell phone actively irradiating the bones.

 

[Winged Scapula]

Nobody pages the fearsome surgery upper-level! Nobody! 🙂

I always feel so bad for the surgery intern laden with six pagers.

I know...I even feel a bit odd complaining about it, after all those years as a resident hating my pager.

Now they say they didn't want to "bother me"...funny how just a few years ago, I believed they got extreme pleasure from paging me in the wee hours for a "does the patient really have to wear their SCDs while in bed?" query. Now they don't want to bother me..ahhh the power!

 

[deleted87716]

We had big stickers on the front of the charts with the name of the doctor or team to be paged. It usually worked pretty well...when people bothered to look at them. 😉

 

[radonc]

i get paged an average of once/week.

 

[Winged Scapula]

i get paged an average of once/week.

Calls from your S.O. don't count! 😉

 

[TaiShan]

I have another problem. I was orignially assigned to Dr. A's service for this month and later changed to Dr. B's service. However, unit secreaty pre-made intern assignment before switch and now I get paged about Dr. A's patients EVERY DAY! I crossed my name off the service list on three differennt laminated sheets but there must be much more cause I am still paged in the middle of night for the patients I never met.

Yes, each service has its own service pager number but somehow they still page my personal pager directly...

 

[Annette]

I always feel so bad for the surgery intern laden with six pagers.

I hated when you had to run to a code and the pants kept falling down because of the pagers!

 

[NinerNiner999]

Here's a tip - write the correct pager numbers in the nursing orders from now on. They don't read the doctor's notes or any other section of the chart except for the orders and the MAR. This should help a little next time 😎 As an added bonus - if they call the wrong pager and you don't answer it, they are in the wrong (especially if they have signed the order as "done," which they all do). Turn your pager off when you go home. Don't answer it when your team knows you are off. Ever.

 

[8744]

Here's a tip - write the correct pager numbers in the nursing orders from now on. They don't read the doctor's notes or any other section of the chart except for the orders and the MAR. This should help a little next time 😎 As an added bonus - if they call the wrong pager and you don't answer it, they are in the wrong (especially if they have signed the order as "done," which they all do). Turn your pager off when you go home. Don't answer it when your team knows you are off. Ever.

Hey, I turn my pager off as soon as I have signed out or handed off to the guy taking my place. On off-service rotations I turn my pager off as soon as we are done "runnning the list" or rounding in the afternoon and somebody says, "OK, see you guys tomorrow."

Does this make me a bad person?

(I got a letter of reprimand at "Earl" for having my pager turned off while I was at home, post-call, sleeping. I excrete you not.)

 

[Apollyon]

(I got a letter of reprimand at "Earl" for having my pager turned off while I was at home, post-call, sleeping. I excrete you not.)

Dude, it's Duke policy, which you signed on to. How did anyone find out? Did one of your clinic patients try to call you, and couldn't reach you, and, when asked, you told them that you had turned your pager off? I asked IM residents about that, and they said that it was Duke policy to have your pager on at all times, unless signed out to someone else (which was kosher), to give yet more responsibility of a "real, practicing physician".

I don't think you'll find a lot of support about this point - hell, as part of my group in practice in EM, I have to have a pager turned on. It has never gone off yet, but I have to have it. I'm also required by my contract to check my email at least once a day. The degree of enforcement is in question.

 

[8744]

Dude, it's Duke policy, which you signed on to. How did anyone find out? Did one of your clinic patients try to call you, and couldn't reach you, and, when asked, you told them that you had turned your pager off? I asked IM residents about that, and they said that it was Duke policy to have your pager on at all times, unless signed out to someone else (which was kosher), to give yet more responsibility of a "real, practicing physician".

I don't think you'll find a lot of support about this point - hell, as part of my group in practice in EM, I have to have a pager turned on. It has never gone off yet, but I have to have it. I'm also required by my contract to check my email at least once a day. The degree of enforcement is in question.

No. The residency office wanted to talk to me about some paperwork thing or another. That was the extent of it. And the remarkable thing was that they had my home number and could have easily called me. I am not hard to reach.

This was after I had "come out" as wanting to switch out of family medicine so I think there was a little animosity. At my current program, I am required to carry my pager when I am on "backup call" (generally a couple of days a month) but other than that I signed nothing specifying checking email or carrying a pager when I am not on duty.

Oh, and I never got a single page from a patient the entire year I was there. Once we started following OB patients, however, you had to have your pager with you or roll it over to someones else.

 

[Mumpu]

I never turn my pager off but I don't carry it on me and it's on vibrate at all times, so I rarely answer if I'm not working or on jeopardy. I don't worry about my clinic patients getting my pager number because I simply will not return their pages (sorry, but I'm not a lovvy-huggy family doc, and my clinic has a nurse line).

Being on call 24/7/365 for your OB patients sucks. I'll be a happy man if I don't pick up another speculum in my life.

 

[Hurricane]

What mystifies me is this:

When I rotate onto a service, the floor starts paging me at 6AM the first day before I've even met my senior resident and had a chance to learn the patients' names, let alone anything about them. Yet when I go off a service, they manage to page me for days after my rotation has ended...

And yeah, I turn my pager off when I'm post-call and in the evenings. That's what cross-cover is for.

 

[DOtobe]

Being on call 24/7/365 for your OB patients sucks. I'll be a happy man if I don't pick up another speculum in my life.

I can never turn off my pager for this reason.

Our nurses are so frustrating because every day the hospital operators send a listing of the interns/senior resident who are on call for the day, but the floor doesn't always throw away the old list and put up the new one. So sometimes there are nurses in a huff who see me on the floor (when I am the senior) and say "I paged Dr. So and So four times and they didn't call me back!!!" Then they hand me the list that shows that Dr. So and So was on call 3 days prior. How damn hard is it to look at the date on the list????

 

[Winged Scapula]

Turn your pager off when you go home. Don't answer it when your team knows you are off. Ever.

That might work for some specialties, but in some (especially Surgery and Ob-Gyn), the senior/Chief resident is ALWAYS on call. We may not be in-house, but we are the first call for those who are, to back them up. So the pager was on 24/7 except for the rare vacation (and thank goodness they weren't long-range pagers because they would have tried to reach us).

 

[fuzzyerin]

I think my attitude towards my pager has changed over the last year. I used to hate having it go off at home, but now I figure if it's going off, someone's trying to get ahold of me. I like to take ownership of my services, especially when I'm on onc. Regardless of the reason, if I'm awake, I'll call back and try to figure out what's going on. The times it does get my goat is when I'm post call from nights and people are calling because I either placed a note in the chart overnight or did a consult overnight and they page me instead of the gyn resident who is now on. (All it takes is to call the operator and ask them to page the gyn resident. It's easier than trying to decipher my name...)

The best post-call page I got I returned and it was an attending radiologist. He wanted to know what we found since we had taken a patient to the OR without the rads resident reading the U/S (I had read it myself). I told him the findings and explained why we took her (she only had one ovary and now had acute abdomen and a 8 cm left ovarian cyst - concerned for torsion). At the end of the conversation, he said "so, when you answered this page with 'This is Erin, Nights Gyn resident' does that mean that you're home sleeping right now?" And when I said yes, he profusely apologized. But I was impressed that he was following up, so I didn't really care. Except that I couldn't fall asleep for two hours after that call.