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You have a concern or question for a doctor and need to call them. This is a daily occurrence and you will become more skilled as you progress through your career and get to know the people you’re calling better. But let’s fast track that development with some key tips.
Who wrote this Guide?
I am a nurse of nearly 20 years and working in education for more than a decade. I work with undergraduates from 2nd year through to people completing Masters level qualifications. I am very passionate about supporting and growing the profession of nursing to better care for our communities.
I’m sure you’ve heard of the ISBAR1,2 (identification, situation, background, assessment, recommendation) or ISOBAR1,2 (identification, situation, observation, background, assessment, recommendation) framework. We are going to use this framework with some tips to make it more useful in practice.
Before you contact the doctor you need to spend a little time, a few minutes, collating key information and that’s how ISBAR, and I prefer ISBAR, helps you prepare for the phone call.
Identification and Background can be easily combined.
Introduce yourself and the patient you’re calling about… the patient’s name and reason for admission is key. Remember you’re calling someone with no warning, you need to give context and a little time for the person on the other end of the call to understand why you’re calling and who you’re calling about.
eg. Hello Dr. Nick, it’s Tony from Ward 2 South, I’m calling about your patient Tom Cruise who was admitted this morning with cellulitis of his calf.
This is the main reason for calling, the big information, the headline… keywords matter.
If you have a vital sign you’re concerned about, start with that vital sign:
Eg. the blood pressure is low, it’s 90/35
If you’re simply worried, start with, “I’m worried about ….”:
Eg. I’m worried that the rash on his leg is getting bigger.
If it is a less urgent request, you could start with, “this isn’t urgent…”:
Eg. This isn’t urgent but the patient needs pathology ordered for this evening.
The first minute or two is your moment to get the doctors attention. They only need the critical information, not an entire handover. Remember in most instances they will have some idea of who you’re talking about, they just need time to think, and they will ask for other information from you once they understand why you’re calling. That leads us to why it’s important to spend a couple of minutes thinking about why you’re calling and do you have the key information available to you.
You may not have a recommendation. Perhaps you’re calling because you’re concerned and would like guidance. That’s perfectly ok, you should have already discussed your concern with a senior colleague and you can talk through what you’re going to ask of the doctor.
You may have a good idea of what is needed, doctors are trained to be cautious of decision making bias, that is to question the assessments, findings and recommendations of their colleagues, both medical, nursing and other to prevent missing something else. Don’t take it personally if they don’t agree with your recommendation, or if they agree but want more information. This is why preparation for a phone call is so important. Gathering the patient's file/notes, being able to access pathology or other results if asked, stating you’ve discussed this with your nurse in charge will help, as the doctors often have a closer relationship with the senior staff on the ward.
Most interactions will feel routine and go well with your colleagues. If you have ongoing concern and it’s related to an abnormal vital sign or other worrying clinical sign, all workplaces should have escalation pathways such as a Medical Emergency Team2,3 to call upon.
If it’s lack of decision making, poor communication, lack of action, then discuss your experience with the nurse in charge and get their guidance as to what you could both do next, or next time.
The main thing to be aware of when calling our medical colleagues is that we are calling out of the blue, and we need to give them clear context for why you’re calling and a little time to think. Don’t overload the person you’re calling with too much information.
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