If you are a junior doctor, you now belong to the only profession in the developed world where you can be REQUIRED by contract to work a basic 90 - 100 hours in a week 'on-call'. When you work nights over Christmas and New Years you might be the lowest paid person in the whole hospital per hour (roughly minimum wage).
This group is for everyone who has been on call, on ward cover, or carrying a bleep/pager of any kind. At medical school you longed for the day when you could carry one, and be a REAL doctor, didn't you?! Now you think of a few places you would like to shove the irritating, noisy bleeping thing...
We all love nurses, because they do the jobs we hate, and look out for us when we are just learning. They also gave the correct dose of drugs when you accidentally wrote milligrams instead of micrograms on your first day. We need them. But...
...there are a few points of etiquette that are unwritten, unspoken, but you just wish every nurse read, understood and inwardly digested:
1. Bleeping/paging 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. If you hang up before telling me, chances are I won't come along. This is called the 'bingo-bleep'.
3. If you bleep/page 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/page 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/pager. 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/paged 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/page 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 when I'm on call. 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/pager and the line is engaged because you are bleeping/paging 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 / MET' 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 bleep/page me and then instantly walk over to the other side of the ward to continue washing a patient behind a curtain. That makes the person who picks up the phone have to search for you miles away from the phone. This is called the 'bleep-and-hide' (See also point 3).
20. Don't have someone else (e.g. a student) bleep/page 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/pages 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)
26. Please don't bleep me half way through a ward round to ask whether we will be seeing a patient on the ward round. The answer is yes, and I've just missed what my Consultant said because I had to answer the phone to tell you that.
27. If I've told you I'm on my way to your ward, please don't bleep again. Chances are that you have actually STOPPED me getting there while I went to the nearest phone. This is called the 'road-block-bleep'
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