03 May 2012

Bleep etiquette

I'm not going to claim to own this, but I saw a copy pinned to a doctors office wall this week and it reminded me to post it here.

Most of these have happened to me....

1. Bleeping is not a spinal reflex. Please take a few seconds to breathe, think and organise your thoughts, and stop flapping about. Half the time you may realise you didn't even need to pick up the phone.

2. Mention what ward you are on. I don't have the whole hospital directory of numbers memorised. This is called the 'bingo-bleep'.

3. If you bleep someone, please wait by the phone. How can there be no-one picking up the phone at your end when I ring back?! This is called the 'bleep-and-run' and is exceptionally irritating.

4. Have the notes, obs chart and drug chart in front of you. Chances are I need to know what the obs were without waiting for you to run over to the bed and look, then run back over to the trolley to get the notes when I ask the next question. This is called the 'relay-bleep' and is probably not fun for you.

5. Please mention the name, age, and working diagnosis of the patient. The following is not acceptable: "Hello doctor, please see patient in 4, 6, she has chest pain". That is 'bleep-spam'

6. All patients with chest pain need an ECG. Don't bleep me until one is being done or there in front of you.

7. If I'm in theatre (surgery), leave a clear message. The following is not acceptable: "Can you come to the ward afterwards, there are a few things to do". This also counts as 'bleep-spam'

8. Once in a while I will not respond to my bleep. This is because I am jumping on top of someone's chest trying to save their life. I am NOT 'on break'. Doctors don't have these.

9. Please check with the other nurses that you aren't asking the same question as them. I really hate being bleeped from the same ward from two phones and two nurses for same patient. This is called the 'déjà-bleep' and is distinctly un-fun

10. You spend twenty times as much time with each patient than we do. We appreciate your opinion and pertinent information. The following is not acceptable: "Well you're the doctor, you should know". Well actually I'm on call and have never met this patient who has spent 5 weeks with you.

11. Please be cheery on the phone and perhaps even flirt a little. I've just spent 12 hours running around the hospital doing mundane tasks, talking to angry relatives, putting my finger up bums, taking blood and ordering xrays. You will get your way far easier by making me smile.

12. When I answer the bleep please don't say 'Oops, sorry I had a question but not any more". This is called the 'fart-bleep' and gets on my nerves (See also point 1).

13. Please don't ask me to see virtually every patient on your ward. That's called a ward round.

14. If you do cannulae on the ward regularly you will be my favourite nurse and I will do anything you say.

15. If I answer my bleep and the line is engaged because you are bleeping me from that phone again, I may well explode. This is called the 'torpedo-bleep' because of its incessant battle with my morale. Three hits and the boat may sink.

16. If a patient has died, he/she no longer cares how long it takes me to get to the ward. That's a medical fact. Chances are I can do a few other jobs on my way there. If you bleep me again for this patient it better be because they have miraculously come back to life. This is called the 'Lazarus-bleep'

17. The 'MEWS / EWS / EWSS / PARS' score is a trigger for you to call me and is useless after that. I don't give a crap what the score is. Tell me WHY the patient has scored it (e.g. respiratory rate? BP? heart rate?).

18. Please don't start a sentence "Just to let you know..." or "Just so you know..." I hear this 50 times per shift. This is called the 'zombie-bleep' and you have just inadvertently disengaged my brain.

19. Please don't make the person who picks up the phone have find to you from the other end of the ward. This is called the 'bleep-and-hide' (See also point 3).

20. Don't have someone else (e.g. a student) bleep for you. It's cruel to them, and they are not your secretary. This is called the 'kamikaze-bleep' (see also points 4, 5 and 19)

21. Dosing a patient's warfarin (whom you have never met and don't know their history) at 4am is horrible, tedious, legally dubious and just plain bad for the patient. Please slap the day team round their faces when they arrive the next morning and don't let it happen again.

22. Sit down! You may be surprised with how much this helps points 1, 2, 3, 4, 5, 9, 11, and 19

23a. If you happen to have a spare moment, eavesdrop when a doctor bleeps another doctor. The majority of the time you will see how it should be done.

23b. Sometimes point 23a doesn't work because the doctor is a week old and still learning the 'etiquette'. He/she will learn very quickly as their senior on the other end shouts them down!

24. When a patient is in an ACUTE confusional state, please do not repeatedly ask me for, or demand sedation. This is not the year 1912. I might give sedation AFTER ruling out an infection, over-medication, drug withdrawal, metabolic cause, trauma, neurological, hypoxic, endocrine, and vascular causes, and AFTER using every other method of calming down the patient.

25. Read the latest entry/entries in the medical notes. Your question may be answered already (see also points 1, 4, 12, 13)"


GrumpyRN said...

No 1, Cheeky mare, I've been doing this since before you were born. Don't patronise me.

No 3, I might just have other things to do while waiting for you to answer the bleep. See point 8.

No 7, Why are you in theatre if you are on call? Huge bug bear of mine. Bleeps answered by theatre nurse, "sorry, s/he's scrubbed," I don't care.

11, Seriously? You want cheery? Flirting? Jings you are delusional or work in some utopia. If you get polite you should be grateful, and our demeanour should not influence how you do your job.

12, Hey I'm getting old. I don't remember why I went into a cupboard, why should you miss out on my incipient Alzhiemers?

13, Oh c'mon your here already.

15, You do realise we do this on purpose to see how far we can push you? It passes an otherwise boring afternoon watching you meltdown.

16, But we need the bed and can't get rid of the body until you pronounce death.

17, I hate this dumbing down, I don't need an arbitrary number to know when to get help.

18, Sometimes it may be important, honest.

19 & 20, See number 3 above. And it is good for students, develops character and lets them think they are involved.

23a & 23b I have listened, sometimes the otherwise most intelligent people can't string a sentence together.

24, How am I ever going to finsh my book if you won't sedate those damn patients.

You should have added the 'lying bleep' thats where the doctor denies ever getting any bleeps while he sat drinking coffee in the mess. Compounding the 'lying bleep' by telling the nurses "you are terrible liars" will only get you a visit to a max facs surgeon to fix the fractured mandible that I have applied if you ever call me a liar again. ;-)

GrumpyRN said...

Just re-read my comment, first 4 were supposed to sound a bit more tongue in cheek. Sorry.

Anti Money Laundering said...

Manner is personality—the outward manifestation of one’s innate character and attitude toward life.

AnnoyingPatient said...

1. You don't need to be telephoned, bleeped or anything else. You should be there. Otherwise I get to say "bloody NHS" just because I don't have a doctor to hold my hand 24h/day.

2. All wards look the same, they only smell different. As smell is the most evocative of the senses, you should investigate this as a way of finding your way around. But you won't need to because you'll be doing point 1.

3. Seeing harried-looking staff standing next to a telephone looking agitated while that weird old bloke who reads the Daily Mail and couldn't speak properly anyway is on the floor and more importantly my TV NEEDS ADJUSTING is not good for the NHS's image. Sort it out. I pay your wages, I can tell you this shit.

4. My notes are a lie. You should consult me before any decision anyway. Being unconscious is not an excuse. My family can still sue your ass, sorebones.

5. You want to make a decision without having seen the patient. What sort of diagnostician are you?!

6. I don't want machines, I want drugs. I don't care if that's the reason I am there in the first place. I HAVE RIGHTS!

7. Being on a night out to some poncey play or having become a GP is irrelevant to me. Come and give me drugs. Also, the nurses aren't pretty enough.

8. You so do take breaks all the time. Don't lie to me. The NHS is always sitting on its arse and that arbitrarily includes you, quack.

9. The nurses should be giving me attention, not you. I pay all your wages, I get to say!

10. They really don't spend time with us. They should though. I need something to wank over and the page three from the smelly man next to me isn't going to do it four days running.

11. I'm ill. The last thing I want to see is a fat agency nurse flirting with the on-call doctor on the phone. You'll thank me when you see her face anyway.

12. They are clearly taking the piss. The fact that you haven't noticed this is funny.

13. It's because you are pretty/handsome. Keep your mouth shut and smile. It's the best advert for the NHS you can give. Well, apart from other things but you'd probably think they were unhygienic.

14. What's a cannulae? Nurses are here for me, biatch, not you.

15. Are you a boat? Sounds like you are on as many drugs as me.

16. If I'm dead, you should rally round. It's what happens on the telly, so you should do it.

17. I score because I am amazing. End of.

18. The nurse is being charming to you. She should be being charming to *me*. I am really angry with the NHS now.

19. This is a risky rule, what if it's the pretty blonde and she's sucking me off?

20. Students need training so they can be you one day. However, they are not training on me, because I am too important.

21. I don't want warfarin, it's what my dead gran had. I want a joint. Now. And a ham sandwich.

22. You sit down too much anyway. Go and do some work. I pay your wages.

23a. You should be working, not eavesdropping. And my telly still needs adjusting.

23b. If it's a week old it should be in maternity with the other babies. Also, see point 20.

24. It's 1912 as far as the newspaper I read (right wing) or the kind thing to do (left wing) so just do it. What if it's what I want?! I get to say, I know everything.

25. My notes are wrong and I'll sue. See point 4.