Friday, 23 November 2007

Bleep etiquette

A friend showed me this Facebook Group, it made me smile:

"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 91 hours in a week 'on-call'. When you work nights over Christmas and New Years you will 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 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, crappy 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 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)"


Mousie said...

So true!

But can I also add a couple from our point of view, that I wish certain doctors (you know who you are!) could also remember?

When bleeped because the patient had developed chest pain, please do not "read" the ECG over the phone - you need to come and have a look at it AND the patient.

When your emergency bleep announces a cardiac arrest on one of the wards, please don't bother to finish writing up your notes on an A&E patient before casually picking up your handbag and strolling up the corridor.

When bleeped to come and see someone in a lot of pain, because you forgot to prescribe any analgesia earlier, please don't say "I'll be there in half an hour, I'm just doing my washing in the laundry room."

the little medic said...

I've been answering my F1's bleep (as a 5th year) when they've been busy and the thing that really pisses me off is the bleep-and-run. What is the fricken point!

kingmagic said...

Just off topic ever so slightly...I was on scene at a heroin o/d, male in early twenties. (His age not the decade!)

Needle still hanging out of arm, profound cyanosis and onset of rigor mortis.

Police on scene asked about attendance of GP for certification (this was a few years ago before we started DOD Diagnosis of Death procedure in Ambulance Service).

Control rang the patients GP to ask him to attend. 5 minutes later the GP rang the address and asked me to relay the patients S&S over the phone.

"No Doctor, you have to turn up and certify properly...not over the phone!"

Hugh said...

I found that brilliant too - so I set up a website -

Now everyone can join in the bleeping!

Anonymous said...

Bleep and run is usually because us nurses are also running around like blue arse flies and don't have the time to hang around by the phone just by chance should the doctor answer the bleep within 5 minutes!!! ( which happens almost never)

Anonymous said...

Sure you are...and us doctors are always sitting on our asses in the res watching TV. I have never seen the night staff running around "like blue arse flies"; still they still practice bleep and run quite efficiently.

Anonymous said...

If you page, you stay by the phone, that or leave a mobile. The end

Anonymous said...

"flirt a little" That is the most vulgar thing i have read. What do you think nurses are there for? your entertainment? If you think that's what nurses are for then get your head re-examined.

You may have been there 12 hours or so but so have the poor nurses! In fact the nurses have probably been there for longer! So flipping well, they should have to feel "flirtatious" just so so they "will get your way far easier by making me smile".

Surely the your concern about the patient should come first not how well the nurses flirt with you.
I don't care if this piece was meant to be sarcastic or jokey it comes across like a very arrogant, out-date 1970's doctor wrote this crap. Highly disgusted.

Anonymous said...

Clearly some significant humour bypasses have taken place given some of the comments.....either that or the truth hurts.

I have never met a nurse who doesn't take their break and it is rare for them to work more than 3 or 4 long days in a row before having a day off.

Oh and finally, when nurses get out of their depth (whether they accept it or not) the Doctors are there to take over!

Just enjoy this piece for what it is, observational humour...not a genuine attack on any profession!!

Anonymous said...

Am on nights now and generally its more serene than day shifts. But if a patient needs my assistance, I can't say 'I can't come help, I'm waiting for the doc to return my call'. I'm not suggesting docs aren't busy (I see you are as busy as we are) but no need to generalise.

Anonymous said...

if you genuinely cannot wait by the phone, get another nurse to come and help. There has probably only been 1 instance in human history EVER when all of the nursing staff, HCAs, student nurses etc etc on one ward have needed 100% to be with patients at exactly the same time. If a patient is genuinely that sick that they require you to bleep the doctor to come see them, how will we know if no-one answers the phone??
Think about it.

Anonymous said...

Theres not only drs carry bleeps. (stroke thrombolysis nurse) as a nurse tho i have t fight back and say when answering your bleep please tell me who u r. If i'v bleeped dr on call, ecg and sister acting up, u calling n saying "hi u bleeped?" is too damn annoying.

Anonymous said...

This is so patronising to nurses, stop gurning, pull your finger out and work a wee bit harder...just like the nursing profession....who wouldn't have so much work to do if we weren't going behind the likes of yourself tidying up your mess, chasing you to complete your documentation, write a proper and legal drug kardax plus don't forget look for the notes that are in the same allocated space the way hugh! This ridiculous list should not warrant a website it is evidence of you not being in the job long enough to do the job in hand properly in the first place...i have noted this was originally posted in 2007 id love to see if the author has now gained enough experience to write how jr doctors should speak to the nursing staff etiquette

Anonymous said...

this clearly has never happened

Anonymous said...

Anonymous above you clearly have had some bad experiences but apart from the flirting one (bad taste i agree) the author makes some universal points... Especially the one about assuming jr docs are "on a break". Seriously apart from one gynae job during a month where gynae lists were cancelled, i have never actually managed a proper break when on-call... Remember we have 11 other wards to deal with other than yours, all of them have jobs and some of those jobs are more urgent than others and unfortunately there sometimes is a need to run fast towards a sickie rather than stay and write up prn paracetamol when the patient cant have any more for 4hours yet anyway. Can always do that later, *after* that BP on ward 5 has come up from 59/30....

Anonymous said...

flirt a little is possibly the best advice i have ever received, i read this last year, started a little flirting and now have no trouble getting whatever i want...which also includes my new fiance who's a med reg. Flirt it up ladies!

Anonymous said...

I feel the some valid points here. Not always phrased correctly. They will obviously vary by hospital and ward. I find some nursing teams are excellent at knowing their patients and organising appropriate measures before bleeping. However, there are a few aggressive and unprofessional comments above I would like to address. 1. What the dayteam failed to do is not my fault ( just the same as you - the patient has had an EWS of 10 since midday?) I have been known to write "dayteam to consider" and appreciate it makes both of our jobs more difficult.
2. We are equally busy. Doctors are expected to be in 10 wards, HDU and admissions all at the same time. We often have to leave patients mid task. If you don't have someone answering the phone I have to assume that the problem cannot be that important to you and nor is my time. If all members of staff are required with a patient prioritise. Mr x who wants a sleeping tablet can wait.
3. A little compassion or being nice never hurts. When I get a spare moment I don't go for breaks. I hand out meals or will take forgotten possessions of a transferred patient. I have an excellent relationship with the nursing staff on my ward.
4. Inexperience is not synonymous with incompetence and it works both ways.
5. I will not be waking a patient everynight at 4am for their 24 hour aptt ratio for heparin monitoring, especially when they have been stable for days. It can be done at 9am.
6. If you ask me to prescribe fluids please give them. I will often do the first bag for you if you are busy. If the patient needs another in 8 hours. 16 hours later is not acceptable.
7. The night matron is possibly the best thing ever at my hospital and long may they reign.

Anonymous said...

I've read this a couple of times now. It's written to good comic effect and many of the points are valid. Unsurprisingly it has triggered some fairly defensive responses from the nursing profession.
Firstly, let's get that comment about flirting out the way: Patronising and sexist, end of.
The rest of the responses (from nurses and doctors) are largely to do with a lack of understanding of what each other's jobs involve.
As a doctor, I can't say I have a proper understanding of all the things that nurses have to do in a shift, but I'm sure I frequently interrupt them without realising they're in the middle of doing something. Likewise, doing a ward round on my own can take forever because of constant (mostly reasonable) requests from nurses who probably don't even realise I'm trying to crack through 15 patients before the midday meeting.
In terms of bleep/ phone etiquette, I do find that doctors are better at giving a structured query (although there are exceptions!). This is because we have it drummed into us as students and, as the author says, we get an extremely hostile response from our seniors if we don't do it well. So if a nurse bleeps with a vague request when we are on call, we are likely to be snappy. It's a learned response.
However, I try to "teach as I go", encouraging nurses to use the RSVP structure & ultimately reducing the number of rubbish bleeps I get for the rest of my shift.
As for not answering our bleeps, the suggestion that we're "jumping on someone's chest" is a little grandiose, but we may well be doing something far less glamorous such as putting in a catheter! If we are particularly busy/stressed, we may forget you have bleeped at all (in which case, Sorry. Bleep again in 10 minutes, I won't mind).
There's no point arguing about who works harder, we all work effing hard, it's the NHS! All I'll say on this is: Nurses, try to remember that a doctor on call is covering a huge number of patients, carrying a huge weight of responsibility and making a huge number of fairly taxing decisions, probably alone, all day, for 12+ hours straight, several days in a row.
Doctors, try to remember that nurses are bound by all sorts of silly rules which often force them to work BELOW their level of competence/common sense and they do not have the same leeway for rule-bending that we do. Also, nurses do have set breaks but they are paid considerably less than us.
Now let's please all just get along!
*Makes paper chain of little people holding hands*

Anonymous said...

YOU - as a profession are clearly intent on blaming the nurse for the work you signed up for... =p

primarily you are generally paged to do things other doctors have ordered you to do - often - with little clinical significance - as you very well know but somehow blame the nurse for your workload

+ you seem to forget that we are the ones who have to deal with the actual patient, you will review the patient with chest pain after the ECG technician casually stroles down the corridor to take said URGENT ECG, 45 minutes after the first page, then take 30-60 minutes to get to the ward yourself, in the mean time the patient has buzzed us 20+ times insisting that he/she has chest pain, then SOB, then needs analgesia, then better analgesia, then a vomit bag, then when is the doc comin, the when is the doc comin and ... so on so forth.

+ the relatives

+ we page you with a abdo pain, or sob or nause, or drowsiness, or LOC, or pains and aches of all sorts and said scenario is repearted with a ratio of 1 page to 20+ buzzers

+ the relatives

then to further underline our plight - after said doc arrives on scene and prescribes/does something or anything - said doc leaves the ward, which leaves the nurse with 20+ buzzers, because the nausea, pain, drowsiness, lack of sleep, heartburn is still there --- because if the patient is for example in pain - even terminal CA patients (i've been through this endlessly) the doc first prescribes paracetamol, then codeine, then maybe 2.5ml of oromorph, the patient is still in pain

then the relatives complain

do you hear me complain for changing a nappy on a 200+kg nun 30 minutes after changing said nappy to find a 5cm by 2 cm patch of vagina discharge

do you hear me complain for carrying a fresh bilateral amputee to the toilet 6 times during a span of 4 hours because the consultant decided to remove the urine catheter, and insists the patient should not have a nappy put on, BUT Keep the 6 hourly IVI for the hydration

do you hear me complain NOT for putting a finger up a anus and wriggling it around, BUT to shite out, then a high phosphate enema, and wait for all hell to break loose and clean it up because the doc forgot to prescibe lactulose on a patient with oromorph, mst and codeine

well i could go on and on because i had a shite night duty, but i'm not blaming anyone, alchohol hand rub and carry on

nursing is a profession which deals with complains, constant and neverending, please DOC do your bit - dont add more complaints - in regards to you pager, you already complain about everything else, + we have the patients, relatives, ecg technicians, physio, radiographers, cleaner and even the fire instructors, to deal with already

blany said...

Oh no, don't start on the Domestics lol

Anonymous said...

This is very true. To be honest, whenever any staff member (nurse or otherwise) complains about lazy doctors or stupid doctors etc etc and uses every opportunity to tear us down it just tells me that I cannot trust that nurse with my patients. I work hard and have a great relationship with the vast majority of the nurses at the hospital where I work - there are really brilliant nurses out there and thank goodness for that. Brilliant nurses are clinically capable, procedurally capable, able to identify patients they are really worried about and begin the process of investigation and treatment and then call me (which I appreciate beyond belief). These nurses I trust, if they say "I am worried about patient X" then I am out the door to see patient X and feel happy that when I leave that patient is in good hands. When I get a page from a nursing staff member who says, "Bed 10 (no staff or patient name) has chest pain, come and see them" and then can't tell me anything else about the patient like basic observations and in fact respond to my requests for basic obs with "they have chest pain, just come and see them." No ecg, nothing. There are many causes for chest pain and often I have had 5 pages in the space of 5 mins for patients with chest pain, they are not all having heart attacks usually. I prioritize based on the information I get over the phone - it's not so I can say "ah, doesn't sound that bad I'll continue napping or having a coffee." The amazing nurses will tell me how concerned they are about the chest pain and why, have done 1 or 2 serial ecgs by the time I get there and be ready for a third and will have taken bloods and tried pain relief/whatever else they have in their clinical arsenal. Amazing and I love working with these nurses because they are actually doing their jobs which involves clinical decision making and initiating investigation and management. I have 3 years experience as a doctor and I know in the scheme of doctoring that's not huge but I am at work ALL the time so my experience is accruing fast. All I can say is that I love working with amazing nurses.

Anonymous said...

You're complaining about it right now. Blaming doctors for the work you signed up for. Hate to tell you but the jobs of nurses and doctors have lots of similarities and overlap - there are some crap lazy doctors out there it's true. They make other doctors as angry as they do the nurses. Junior doctors do have a big workload, some of their work is not making "clinically significant" decisions. I am sure though if these insignificant jobs were not done you'd be there to complain about it and it would effect patient management and outcomes. You seem to expect respect but aren't professional enough to dish it out. Just go to medical school, become a doctor and see what it's like with the shoe on the other foot...I have to finish with this. When I have a "shite night duty" I am run off my feet covering a huge number of wards dealing with all manner of clinical presentations, procedures and admitting patients and I just LOVE it when I see a group of nurses sitting at the ward desk bitching and gossiping about doctors. I don't hear doctors bitching about nurses because we are usually too busy talking about something else...WORK.

Anonymous said...

Interested to see how many people immediately said the "flirt" comment was sexist.
I find I respond to good natured (not sleezy) flirting from any gender/age/humanoid. Sharing a smile and a bit of a joke helps us to connect as people, and remember that whilst we all have a stressful job to do, we are also humans under the uniform.
Is the comment sexist, or is your assumption that the instruction could only refer to a relationship between a female nurse and a male doctor sexist?

Anonymous said...

We junior doctors do ECGS bloods cannula, discharges, see sick patients, put in catheters. Like all that stuff so when a cannula fails and it's not urgent you can get 5 bleeps in a row for it while you're busy with something more important. I've actually been bleeped at 4 am to ask me where I put the patient file. When I asked did they check the patient slot they said no. It was there.

Anonymous said...

You arogant fuckers. Have you ever had a loved one in hospital? Wait until it is your mother, father, child.

Anonymous said...

This is so accurate. I'm currently an FY1 and the list is perfect. I wish I could print it off and stick it on the wards.

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