This is the 117th #WILTW
John has been admitted to hospital with pneumonia. He is on a bed near the nursing station on ward 22A. Around the station are a couple of doctors and nurses looking through the notes trolley. He watches the ward clerk stand up and walk off the ward to find some stationery.
The phone at the desk starts to ring. The doctors and nurses on the ward round continue their discussions.
The phone continues to ring. John watches a doctor walk past the station, look at the phone, look around the room and then continue to walk up the corridor.
The phone continues to ring. A nurse arrives at the station. She looks stressed. She sits next to the ringing phone, pulls out a diary, opens it, rolls her eyes and then walks away.
The phone continues to ring. Through the doors to the ward a consultant arrives with some medical students. They all look at the ringing phone. They look at doctors and nurses around the notes trolley and look back at the phone. They then move off to examine the patient next to John.
One of the doctors at the notes trolley then moves round to sit next to the ringing phone. He starts writing in the notes. He looks at the phone. The phone keeps ringing. He looks up at the remaining team around the notes trolley. He then continues to write in the notes.
The stressed nurse comes back to the nursing station, mutters something under her breath and then leaves the ward. The doctors and nurses around the notes trolley push it towards the patient opposite John. They are joined by the note writing doctor.
The phone continues to ring .
The ward clerk returns to the ward.
The phone stops ringing.
I had to call out our staff this week for leaving the phone ringing despite a number of people being quite capable of answering it. The act of picking up a phone seems an inherently simple task. Certainly to an external observer like John there seems no reason for someone not to do it. The assumption is staff are lazy, rude or completely uncompassionate. Imagine if John had been waiting for a phone call from a loved one with some important family news or maybe about his transfer home.
Some of the reasons are more complex than the assumptions though. A honest junior said to me once, “The problem with answering the phone is that the majority of the time you can’t help at all and get dragged into a situation where you become responsible for the problems/issues/concerns of the person on the other end of the line.” This doesn’t excuse not answering the phone but if you knew you could always respond with a yes or no I suspect answering times would decrease significantly.
The prompt for this muse comes from a powerful article by Dr. Ranjana Srivastava on professionalism and responsibilities in medicine. She questions why health care professionals ‘overlook’ potential poor or harmful practice by colleagues or in systems:
“So, while professional integrity is necessary, I think the question we ought to periodically ask all doctors is actually a far simpler one. “What kind of a person do you want to be?”
I want to be the consultant that sets a good example to the medical students. I want my juniors to understand how to prioritise tasks and I want nurses and doctors to realise that some jobs can be done by either professional.
This is really easy to say but much more difficult to put into practice. Maybe answering the phone is one place to start.
What have you learnt this week? #WILTW
You can now follow WILTW on Facebook by liking this page . Browse previous posts here or insert your e-mail address in the box on the right hand side to receive future posts.
Post release note:
#WILTW rarely produces responses and it is even less common for people to disagree (please see comments below). The topic of discussion is definitely in the grey zone though and I think it was a justified challenge. The tweet below perhaps was something I should have included within the blog.
Is the message here: never walk past an unanswered phone?
— Mat (@MatSilk) August 11, 2016
Fair Question
Answer: No e.g. emergency
But if you, or someone else could. Why don’t you? https://t.co/6YLNIitUST https://t.co/IsFEolOMDn
— Damian Roland (@Damian_Roland) August 11, 2016
Disagree. We all have our own (busy) jobs to do. I’m not there to answer the phone or sort notes, and the ward clerk is not there to see patients / do practical procedures / make referrals / assess scans. There is enough clinical work to do on a busy ward (with limited staff and resources) than for me to get sucked into someone’s complicated admin problem / grievance / request for missing notes / bed status / dinner order / scan time change / relative update. It is entirely appropriate for calls to be handled by someone employed to do so, with requests for clinical input being screened and prioritised appropriately. Everything – even something seemingly as simple as answering a ringing phone – has an opportunity cost, which increases dramatically when multipled across an entire health system. In the parlance of FOAM, that’s ‘how I work smarter’, and that’s the standard I’m happy to accept from my colleagues and my healthcare system.
You are completely wrong! Yu can easily spare 1 minute to write down a name and number so the ward clerk can take care of it upon return. Or just maybe the right person is standing across the nurses station! I’ve been an RN for over 40 years, much of it in CCU/ICU, some in nursing homes (director). No excuse for a non-answered phone. Well, perhaps running to the bathroom or a code or a patient’s fall but certainly not because “not my job”. That is plain shameful. – However, a process should already be in place that when the ward clerk has to leave for something (pick up/deliver something, lunch break, etc.), there is a designated person to answer the phone. Very simple and effective.
What a surprise to hear from a clinician with a very highly-developed sense of what their job isn’t.
So arrogant. One day that will be you waiting for someone to answer your call. Karma and all that…
Thanks for this comment. You raise a very valid point. The system shouldn’t need to have this dilemma arise as there should be specific staff for this role. In fact you could argue, as you have done with the opportunity cost approach, that even without ward clerks the benefits to the system are not outweighed by the time cost of nursing and medical staff answering phones.
The problem is that no boundary is completely black and white. You could say this argument applies to making beds in the Emergency Department or taking observations in resuscitation areas. So while I accept where possible we should maximise staff to be deployed and assigned with adequate and appropriate skills sometimes we can assist others when we have the capacity to do so.
It’s a really interesting discussion that I have been reflecting on. David Morrison spoke to our senior staff last night, a little about harassment and bullying, but more so about cultural change. How we perceive ourselves as doctors is not how patients perceive us. If you are happy to be thought of a jobsworth, someone that works to rule, and doesn’t consider the bigger picture then that i fine. You have no right to try and wheedle out of a parking ticket or ask anyone else to go beyond.
I think we all need to spend some time reflecting on exactly what Damian is asking. Is it beyond you to get a cold patient a blanket, or make a cup of tea for a relative who has lost a loved one? Some of the most meaningful interactions I have had in the emergency department required no medicine but humanity.
Several issues here for me:
1. My job is to look after patients and my first responsibility is to those that are in front of me in the ED. Now that may be the sexy stuff that we all love in EM, but it also may be telling a relative that their loved one is safe, is being looked after and that they are coming in to hospital to be admitted and no they don’t need to travel up from Bournemouth/Alicante/Adelaide in a mad panic, putting themselves and others at risk. EM, possibly more than any other speciality requires skills to manage difficult and challenging interactions of many different forms. Andy says it well.
2. Someone’s job/anyone’s job/Noone’s job. No boundary is black and white. No job belongs to just one just one staff group. In healthcare and particularly in EM we are a team. Now it may not be pleasant for me to dispose of a urinal and dip that urine. It may not even be the best use of my time, but that surely is for employer to decide upon and employ the appropriate staff. It does speed things up though and there is always the danger that if you assume that it’s someone else’s job then no one will actually do it. This is a part of leadership: role model that no job is too small and the loyalty and support of your colleagues increases far more than it should do for a simple act.
3. Dealing with the asinine calls that come in. I quite like to take the ED nurse coordinators phone so they can pee/drink/etc. This is without doubt the most stressful and thankless task in our ED and possibly yours. They field an innumerable amount of stupid requests largely from people who cannot be bothered to think for themselves or who have a box to tick. It’s much easier for me to suggest that they do just that. An hour of a forthright, possibly cantankerous Yorkshireman rebuffing stupid questions does seem to reduce the volume of these calls (n=1, personal observations, unpublished).
In short: answer the phone, make the beds and dip the wee. Your ED and your patient care is better for it. Away from the shop floor try to make systemic changes to have more ward clerks and support workers to do this so that you can crack on with sorting patients.
Have a good weekend each
VB
AliG
Thank you so much for your comments AliG which made me think and laugh in equal measure! You conclusion is brilliant..
Absolutely ,and have to say often not about ‘too busy with my own stuff’ it is more about ‘I don’t do that ‘
Humanity should be what drives any individual working within healthcare at any level and so when that phone rings and actually ‘I’m not busy right now ‘ (honestly) then pick it up .
In response to ‘anon’.It may be notes that have been found for your patient , but need collection. The Ward Clerks that I have ever met seem to have to be very adept at multi tasking because they have to be . Why shouldn’t you lend a hand in that when you can . There is no place in the Health Service for ‘burning martyrs’ or should I say there shouldn’t be.
Elizabeth Meatyard
As a consultant, I would make a point of answering the ward phone in front of my team. One can usually deal with the query quite quickly, even if only to say ‘please call back in 15 minutes’.
I always imagine the person on the other end of the line – how many of us have become increasingly exasperated waiting to speak to someone while the rings pile up?
I see this as a part of role modelling – actively *showing* your team what you see as important, rather than just telling them. Doctors are smart: they follow their bosses’ lead, not what guidelines say!
Very much agree Kit – Role Modelling is such an underrated part of a consultants job!
This is an interesting one Damian. I think there are multiple reasons as to why an individual of any healthcare profession would choose not to answer phones. It isn’t just doctors. I had to ask an agency nurse recently why they were not answering the phone when I was simultaneously trying to coordinate/take ambulance hand over/prepare IVABX and also TTO’s. Their reason was very specific “I don’t normally work here so I probably won’t know the answer”. It seems like a logical response, however I argued that they could take the query and find someone who can help. Again though this only solves the problem of the phone ringing it then creates a new one when they have to find someone who can help. The other reason I feel is a contributing factor in a department with multiple staff members is a simple diffusion of responsibility. Each person thinks the person next to them will answer it. I don’t think anybody who has chosen to enter the arena of healthcare (regardless of profession) could ever be accused of being lazy by nature :). Thought provoking article once again.
Thanks Felix – concept of feeling you need to help effectively is important. Many feel that not knowing how to do something will always slow things down. That will be true the first time but then once you know….
Because often the voice on the other end of the phone asks a question completely irrelevant to my knowledge, skills and attitudes…
I just funished resuscitating a mortally unwell patient with sepsis, i sit diwn to recollect my thoughts before writing a long entry in the notes, the family are with that patient so i give them some privacy and write at the reception desk, the doctors office is now the territory of the advanced nurse specialist practitioner.
I answer the phone as I feel it embarrassing to hear more than a few rings.
It is with trepidation, the voice asks what the bed state is, or whether the meal cards have been completed, or where the generic ward leader is, or when a specific nurse is taking their break. Occasionally, the voice asks about a patient.
After establishing some identifiers, listening to a crying relative, I put the phone on hold and go and find out as I inevitably have not had the time to memorise all the patients admitted overnight in the now nonexistent morning ward round which has now become a morning board round of who we can discharge first.
I come back with information, I speak with honesty and no illusion over the phone about a terminally ill patient who has been in 3 locations within the hospital for the last 3 days. I diffuse the anger, provide an ear for the grief, arrange to speak to them in person at visiting times.
I end the call, and resume writing my original notes.
I get a moderately abrasive telling off from the ward sister for giving confidential clinical details over the phone, this will if course be accompanied by an IR1, a copy of which automatically ends up with my consultant and educational supervisor, which will of course provide an opportunity for reflection.
Still another 20 patients to see, I get back to writing my notes…
The phone rings again.
Thanks Marc – I’d like to be able to come back with a pithy response which is able to suggest that your experiences are unique or potentially alterable. I think we are all aware that what you describe is not an uncommon scenario…
The issue with phones on wards is a very real one – it makes us look uncaring and unprofessional as well as wasting huge amounts of time for all concerned – however I find the solution sanctimonious and overly simplistic.
Where is the analysis?
What are these phone calls? Who are they trying to reach? Why is nobody answering the phone?
On our ward, phone calls are almost always for the nurses, and almost always are internal communication. Much better to rethink modes of communication and employ enough admin staff than preach, no?
Btw, at least on our wards, phone calls are almost never for patients and families as they all have mobiles. The last time I took a call for John in bed 3 must have been last century.
You are completely wrong! You can easily spare 1 minute to write down a name and number so the ward clerk can take care of it upon return. Tape it to the computer monitor. Or just maybe the right person is standing across the nurses station! You don’t have to know the answer – all you have to do is take a message. It is ok to not know the answer but you can say that you’ll see that the message is given to the right person. (Again, tape it to the monitor so the ward clerk can take care of it later, if possible.)
I’ve been an RN for over 40 years, much of it in CCU/ICU, some in nursing homes (director). No excuse for a non-answered phone. Well, perhaps running to the bathroom or a code or a patient’s fall/choking/other_emergency but certainly not because “not my job”. That is plain shameful.
However, a process should already be in place that when the ward clerk has to leave for something (pick up/deliver something, lunch break, etc.), there is a designated person to answer the phone. Very simple and effective.
For all of you who say “not my job” or “takes too long” – you just wait until it is your turn to be on the waiting end. I’m very confident you’ll sing a very different tune.
wow nice blog, kindly keep sharing blogs, kindly go through our we belong to one of the best neuro hospital in Banashankari, Bangalore. we offer treatment facilities to a cross spectrum of patients – right from infants to senior citizens.
Appreciate this is an old thread but will add anyway.
I’ve been on both sides of the coin. As a busy Consultant Anaesthetist visiting wards I often see a ringing phone – I never answered as didn’t want to be drawn into a problem that I saw as not mine as I didn’t work on that ward or know the patients.
Fast forward to now.
My mother who is end of life, is admitted 350 miles away during Covid, so no visiting, and has cognitive impairment. Today I watched her increasingly distressed texts fussing about not being able to charge her mobile as the battery was going.
I spent 4 hours trying to call through last night and looks like it will be same again now.
No one has answered.
What have I learned – next time I will answer the phone!
I have been ringing endlessly a particular ward at a particular hospital. Why? Because they literally asked me to. But why ask if you have a policy of never answering? Doah!
If you had a loved one in the hospital and just wanted to get an update, it’s the responsibility of the people working on that floor to answer the phone, what if it was one of there family in there, we have produced a generation of people that JUST don’t care how sad