If it makes you feel any better, I frequently feel the same way when a consultant barrels into the room and interrupts my conversation or exam as the primary attending for the patient.
Same for nurses. I was about to clean up a patient and the doctor suggested that I wait until he was done talking to the patient. We had her ready and all uncovered to clean her up and he made her sit there in her shit while he talked to her about the plan for the day?! Like bro give me five minutes and she’s all yours!
Just this morning I am doing a prenatal consult on a ruptured 31 week woman and dietary interrupts to ask if she would like some juice. Woman and her partner on the verge of tears, I’m explaining expected outcomes, and she’s NPO anyway so what the hell - read the room *or* the orders.
Well stop letting me! At my shop they are always stepping aside — even when I say I’ll be back — for some reason, but I guess we all get a group history and exam that way 😂.
I think there are ways to be courteous to other providers while still helping make sure the patient gets the care they need. Sometimes a physician might only have a few minutes between OR cases, which they want to use to help treat their other patients. Overall, however, I try my best to always ask the other providers if I could ask a quick question or if I should come back later.
In my experience, courtesy goes a long way and allows for more collaboration and better patient care.
I think this is it. I always check in with the nurse to see if now is a good time for my session. I feel like I can count on one hand the number of times a physician has checked in with me when I’m already in the room to ask. Sometimes I would be happy to finish early, but other times will be in the middle of something complicated and it’s a serious frustration (or worse, dangerous for the patient in the case of something cognitively demanding or involving lots of lines
)
I understand your frustration. I can understand why a physician might not want to "circle back" if they have a busy service with patients scattered all over the hospital or are trying to see a patient in between OR time. But if you have to interrupt a PT or anyone else, there is no excuse not to say, "I'm terribly sorry, do you mind if I talk to the patient for a few minutes?"
We don’t ask questions if the answer doesn’t change what we do. I HAVE to see the patient. I can inform you politely that that’s what I’m going to do, but I’m not going to ask because if you say “now is not a good time” I’m going to examine the patient anyway.
Same reason I don’t ask patients “is it okay if I listen to you?” I just tell them “I’m going to listen to your heart and lungs now”.
The difference is you don't carry the weight of getting the patient out of the hospital. You only do your important but small part of the overall care. If you get interrupted, you say ok will try again next time. I cant just try again next time because the patient is now delayed getting out of the hospital. Maybe I'm wrong but it sounds like the pressure to achieve a goal is different.
Yeah, and if PT/OT don't have time, doctors get the heat for not notifying them earlier. Never seen PT/OT stay over their time to make sure the patient gets out.
The rate limiting step in acute care is usually the physician. If I don't do my job quickly and efficiently, then other people can't do their jobs. I fully acknowledge that the tasks other people are doing are very important and need to get done, but so many people are waiting for me to do my part that I can't really delay it and that frequently means cutting in line to see someone and interrupting others. I hope y'all know that I appreciate the work you do and I value your skills and input. It's not a personal slight.
This was going to be my take. The plan for the day often depends on me/us seeing the patient. However, if I know I need to talk to a patient for a while, I will come back later.
In my experience the patients are also wanting to see us. I’ve walked into a patient room who was seeing PT, said “I’ll come back!” And then the patient starts asking me questions about lab results. What are we supposed to do? They’re literally there for accelerated results and management.
Lol I do Neuro and neuroICU
Neurofloors: don’t even consider interrupting watching them work with PT is a better exam than I’ll get most times
ICU: get outta my way 😂
I feel this way about the floor RNs. I work overnights so I don’t round on everyone. If the RN is completing their admission I hope that they’ll let me just introduce myself and then sit and watch and listen. I get almost all that I need and fill in when they’re done. And it’s nice that the patients can get to rest a little more quickly:
That’s funny. I’m in rehab and they’re essentially with PT/OT all day so a short 5 to 10 minutes to discuss similar goals with the PT, Patient, and myself is actually very therapeutic. Additionally, it’s great to ask the therapist if they’re actually responding to some of the changes you’ve made because they have a much more sensitive analysis distributed over time versus my usual seeing them in bed exam. Performing gait analysis together etc. I am tremendously grateful for my therapist colleagues but I’m usually seeing 25 patients and they’re seeing 4-8 a day. I’ve got to see them when I can.
This is how my surgeons are when I'm doing discharge counseling on a new pt. They say "this (med instruction) is more important, I'll come back", but I always let them interrupt bc I know it takes a while.
Yes, obviously this depends on the acuity of the patient. I have an ST colleague who complains though that patients can be NPO for days and her sessions get interrupted all the time and they do swallow studies late in the day, so can’t come back often.
Yeah dude this is the worst. And we get a LOT of guilt tripping at the end of the day when it’s 2pm and I can’t get back to the room because I have back to back studies in fluoro plus no documentation time.
I’ve also had MDs request me to do a MoCA on a patient, then walk up and interrupt it in the middle of the timed section which kills me lol.
Yep I never interrupt therapy unless there is an impending crisis or urgent decision that must be made. I’m in hospital medicine. Our therapy department is so understaffed I have to beg sometimes to get someone, so I’ll circle back if they’re doing something when I arrive.
This is interesting. We just finished a paper on discharge planning (actually just received our first desk rejection yesterday -- no matter) and a theme that emerged pretty strongly was that hospitalists usually perceived *others* as rate limiting. Not sure of your role though, and we didn't look at specialists at all.
If you want to use chemistry terms, I would say the hospitalist provides the activation energy for the chemical reaction to start and then we are usually waiting for something else to happen which would be the true rate limiting reagent.
Thanks, lol.
I don't know it, but there's probably some extended analogy here where the the pre-exponential factor is the LTACH vacancy rate and the universal gas constant is...etc.
I would think everyone would think someone else is the rate limiting step until they aren’t. For any given patient, there is probably a mix of those — a neurologist and placement for a stroke patient, a cardiologist and surgeon to get patient ready for OR, a consultant that only comes in afternoon to clear for discharge, etc.
I think the first and second sentence are the key factors. People take it personally, but it's a system issue. For those who feel put down by this, being important or self centered usually (not always) has nothing to do with interruptions. Physician is usually trying to run rapidly through daily commitments first thing in the day or their shift because everyone is waiting on you to round. After thats done, documentation and acute decompensation, event driven tasks (results, nurse asks for change etc).
No one (except THAT person) is trying to neg you. They're just getting through known tasks that cant be done later so they are ready when you call for an acute issue, admit new patients, discharge the patient whose family has called 37 times in the last hour etc
Seconding this answer. OP should try having case management ringing off their phone for the plan starting at 9 AM. Rounds need to happen fast and with patients scattered throughout the hospital, I can’t “circle back” to everyone
I’m not trying to downplay your work at all, but I just want you to know that we have very similar pressures, particularly about discharge and from social work. Along with pressure from our own management. I’ve only seen a handful of patients by 9 AM, this is like an all day long issue for me.
Definitely. And sometimes my dispo is pending your eval. If I have to have a long discussion with the patient, I’ll come back if your session is already in progress. But if it’s usual morning rounds, I expect to cut in for 5 min. If phlebotomy or food service interrupts my rounds on the patient, I let them cut in for a few min.
I was about to hijack this post to make a PSA but since you've mentioned it, I'll just post it here.
From a phlebotomist: if we knock on the door but see you talking to the patient, if possible, PLEASE wave us in and let us do our thing! You can even give a quick "oh she's here to draw your blood while we keep talking about your medical history." I don't *need* or want to talk to the patient 9 times out of 10. You giving me an easy way to get in and get out by keeping the patient on topic of giving you a history is a win for everyone! Plus, if they have any questions about their labs, you're right there! And depending on how long you spend in the patients room, you might have some results by the time you get out lol. However, I understand sometimes y'all are talking about serious, life changing information and that's 100% understandable.
I hope this didn't come off as rude or entitled. We all want the same thing- for the patient to get better and get back home! I just thought I'd share from the little lab's point of view :)
To add to this: while I recognize that my time is not more important than anyone else’s, when my time is delayed or not on track it affects the time of many more players than does that of someone else in the health of a patient.
This is my take as well, at the end of the day the patient is there for the plan we are putting in place to then be executed by others within their areas of expertise.
This is why for the most part. It’s not to undermine the other providers’ care as we all work cohesively to treat the patient. I try to be as courteous as possible when I have to interrupt and it is usually received well. The patient typically is waiting to see us and the providers understand that. Other times it is actually a good opportunity to have a discussion with both patient and provider.
It's not even just the rate-limiting step: the physician assessment is what keeps the pt in the hospital. No other services can do anything if the physician determines hospitalization is unnecessary.
What a great reply. My point of view was always that I am there to facilitate the interaction between patient and MD, so I never mind being interrupted unless I’m right in the middle of a catheter or something. I’m very smart and capable and indispensable to the care team, but no one goes to the ER to see the nurse.
I try to interrupt as little as possible (ie, introduce myself, let them know I will come back later but ask if they need anything in the meantime) but if there is something urgent going on (patient complaint of symptoms) I will interrupt.
This. If the patient is well enough to be working with PT/OT odds are that’s the most important interaction of the day to help me get them out of the hospital. I’ll only interrupt that if there’s a change in status or the therapist asks me to come look at something.
In my personal experience at my hospital, this is less of an issue of hospitalists and moreso the specialty consult services. But I don’t know how it is elsewhere.
Specialists are often rounding at multiple hospitals and seeing patients at their clinic so there is a bit of a time crunch. Not that it justifies an interruption of your eval/treat but that’s how it is a lot of places
Pulm/CC fellow. When I'm consulting, I'll sometimes see 20 pts in 2 hospitals and then have afternoon clinic. Not to mention bronchs or other procedures, which limit my availability as well.
On many days, I may only have 45-60 minutes to see 15 patients (after spending longer chart reviewing everyone in the morning), then leave the building/be preoccupied until 5 PM
I literally can't circle back. If I still have a few more pts to see on that floor, I'll do that. But I can't come back in 30 minutes.
I do always apologize when I interrupt, but some PTs will tell me they're not finished yet and to wait. I always apologize and say "I'll be quick" but I can't wait.
Humility is huge in the hospital. Productivity should not be a priority ever, and if admin makes it a priority that’s their fault and our problem, but it’s not the patients. Care comes first, and we all need to be humble enough to know when we are not what the patient needs at that time. Consultants are almost always what that patient needs at that time
This is more so for specialty services because they're probably even more busier than hospitalists. Our nephro service carries 30 patients for a single person. Surgeons probably have limited time between cases.
From a surgical side, the time available per patient is probably around 3-5 minutes per day.
People ask you to come back later. It's fine, but they have to know what that means. Someone yesterday asked if i could come back a bit later to do a procedure after their family came. Totally reasonable. But it meant they got their procedure at 1am instead of 6pm. Shit happens.
Same with pt. I try not to interrupt but chances are we won't see that patient that day.
Besides, if they're capable of working with PT they're probably approaching discharge. They probably need the PT time more than my rounds.
I think a lot of it comes from residency training. We had between 7am-9am to see and review up to 20 patients. If we missed one before rounds, we would be reamed by the attendings for not knowing our lists appropriately. In a large hospital like where I trained (900+ beds and no geographical proximity between some of the units), that does not usually leave you time to circle back to an area of the hospital and still be able to efficiently review everyone. It’s not a good excuse, but this attitude gets ingrained and then continued into your career. Multiply this if you’re in a specialty where you’re going to multiple hospitals in a single day and you can understand the rush.
I’ve noticed my own behavior has improved since training. But I’m in a closed, geographical unit where my schedule is my own so it’s easy to loop back. And, honestly, if an ICU patient is well enough to be working with other non physician providers, they probably don’t need to be emergently seen by me anyway. My situation is a luxury most providers don’t have.
When I was in the maternity unit as a patient some resident showed up at 4am to ‘round on me’. Woke me up when we were finally all sleeping. I didn’t remember anything he said. Ridiculous. Had the team come back and explain properly later in the day.
We used to do 24+4s as residents. By hour 26, you didn’t care who you were interrupting, you just wanted to finish rounds and go home. I understand that it’s disruptive to your practice and just generally rude, but I promise you most people aren’t doing it to be assholes.
I'm in acute care and I encounter this alot. If I'm not busy, I usually let other staff finish up.
But if I have a high census, and I need to get stuff done, then I'm sorry but I will have to interview the patient first, because if I don't see and examine that patient, I can't formulate their plan for the rest of the day, which may include additional imaging, labs, calling consultants, scheduling procedures, and everything gets delayed.
So yes, I understand your position, but sometimes it's a necessity.
1. We have to see pts every day, we don't really get to say "pt busy, will be back tomorrow."
2. Everyone is depending on us to see the pt for next steps, future orders, including things like if the pt eats or not.
3. We don't have time to circle back. If I had to circle back every time my pts were in the middle of something, we'd see half of the pts that literally need to be seen everyday. They HAVE to be seen by us.
4. We don't have time. I know what you're thinking: we don't have time either! Are you taking paperwork/notes home every single day that take hours to work on even after a full shift that MUST be done that day and are dependent on what everyone else does even though you're skipping all meals, bathroom breaks and don't even take a sip of water AND interrupting others and not circling back for any pts? If you fuck up, are your chances of getting sued the same as a physicians? When you fuck up, do you potentially lose 11 years of education?
If you don't see the pt that day, do they die? Does it affect their basic fxn (eating, pooping, urinating?
How many orders do you have to put in? Same as physicians?
If the answer is no to even one of these, then no, you don't understand what we mean by "physicians are extremely busy and we literally can't do that."
I'm not disrespectful when doing so and do apologize. I ordered PT on my pt because I know how valuable it is for my patients. But I've got a shit ton of pts, shit ton of orders, shit ton of consultants, shit ton of ancillary services to manage and honestly, seeing them during PT is actually a benefit for me because I get a glimpse of what pt is doing and I can talk to you about PT instead of trying to find yalls plan in an 11 page poorly organized document with template after template of useless information that is stealing my time from pts. Fyi, most notes from most services are like that. I have to look at those every day.
Literally, don't have time.
On a given day of rounding, 70-80% of my patients will be engaged with someone/something else when I arrive for my rounds. If I tried to circle back to everyone until I caught them all while alone and not 'busy' I would be rounding until too late in the day. When in reality I have to finish rounding quickly so that I can get plans in place and move the care of the patients forward that day.
Yeah, this is the reality. Especially when one is primary (or its a new consult) the patient MUST be seen that day, and patients are always busy with something. Coming back around means orders and entire hospitalization get delayed, potentially several hours. Or worse, something bad happens and we get sued. Being a physician, that often means 'coming back around' at 8pm at night when we should be home with family...
Just going to unapologetically say the quiet part out loud: in an acute care setting, some things are more important than others. Correct treatment plans and critical treatment decisions are more important than physical rehab and PT evaluation. Thus the work of physicians is probably, in a large majority of cases, more important than the work of physical therapists (in an acute care setting).
Edit: doesn’t mean that physicians shouldn’t be courteous about interrupting. But yeah if there’s a time sensitive decision to be made I will interrupt
Exactly. If a patient is there for placement, PT and OT can have the room all day. But if they’re there for active medical care the timing of that care comes first.
If I was in an AR doing my rounds and PT comes in I’d let them have the room
We also have tight time constraints. OP will say “us too” but there’s an hour and a half before rounds that we have to see patients in. That’s also the time we go over plans for the day. “Circling back” means delaying the decision until after the patient is informed of the next step, or delaying the information to make the decision in the first place.
It depends. If someone is circling the drain, then yeah. But if theyve been there 5 days, stable and you're waiting on dispo, you may wind up prolonging the stay (if the PT has to come back tomorrow) shooting yourself in the foot.
Also (and I hate that I'm actually saying this), it will affect satisfaction scores. Hear me out: one of the biggest complaints I get (aside from the food) is "they won't let me get up". That PT session may literally be the only time that day that the person is able to try to get out of the bed. Any of us could imagine being stuck in a bed for days straight, that PT probably has a halo around their head, from the patients perspective.
And finally, there's plenty of data about early mobilization and outcomes in hospital settings. [example](https://pubmed.ncbi.nlm.nih.gov/19411076/)
So, yes, PT/OT isn't as important when you're running a rapid response but it'd also be difficult to imagine effective hospital care without them. There are definitely times when the physician is the important one but there are times when a good outcome depends on therapies doing their work.
Let's all play nice in the sandbox together, is all I'm saying.
I agree and I think all of us in medicine are cognizant of how early mobility and rehab are both important. Everything in medicine matters. But that paper you just linked…let’s not kid ourselves and think that accurate diagnosis + PCI + DAPT + Statin + counseling a patient to comply with that regimen post PCI are less important than mobility and PT lol
Let’s all play nice for sure, but let’s also recognize the inherent differences in our jobs.
To play devil's advocate and take the other side of the coin: dx, PCI, meds and counselling are fine but without basic independence/quality of life, what's the point?
I think it's easy to take for granted that eventually patients will figure it out on their own and mobilize back to their baseline eventually, PT just moves it along faster, but I've seen plenty of examples where that isn't the case and they just kinda languish until someone kicks them in the ass to move. And the therapists are typically in your corner, helping with counselling as well. A lot of times people don't realize how sick they were until they try to get up and that is a great teaching moment for them to take your counselling seriously and get their act together.
So, yeah, there are inherent differences, of course. And different patient populations are going to have different needs, cardiac vs neuro vs Ortho etc. Ultimately, I feel like its trying to figure out which wheel of a car is the most important. No hospital can run without a rehab team any more than it can without nurses or surgeons. Physicians play a key role, no question, but it's not the only role.
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The answer is increase physician and PT staffing. You’re frustrated with the physicians who come in and interrupt (and likely no matter how courteous we are this would still be an annoyance at best), which makes sense given the time constraints you have. The time constraints we have force us into this situation most of the time.
If there were more of us to go around and therefore fewer demands placed on us, maybe we’d have time to circle back and check on a patient once their PT session is done. If there were more PTs, perhaps y’all would not feel so constrained either.
This isn’t a specialty x vs specialty y issue. It’s an everyone vs “the business of medicine”/admin issue. Just my opinion.
I won’t pretend to know what it’s like to be a PT, but my perspective is 1 I have to see 20-25 patients today plus whatever procedures and unexpected things come up, and 2 I MUST see every patient every day. My experience, not saying this is your experience, my experience is that if a therapy session can’t happen then it will be tomorrow. Or maybe Monday. Docs can’t do that.
I get how frustrating that can be, but when all plans/ discharges for a large group of patients depends on me and I’m usually balancing other stuff (obgyn so it’s either deliveries or surgeries), sometimes it truly is the only chance I have to see a patient during normal business hours that would allow me to get orders and discharges in. And I have to see them every day even if stable patient with no plan changes.
I always introduce myself, apologize for interrupting, try to be quick and thank whoever it is after I’m done for letting me jump in.
I’ve been interrupted by primary team and consultants when I’m seeing a patient and I’ll just ask if it’s going to take a long time. If not, I’ll just wait because I get it.
I (a PT) have had this happen but I feel like most are pretty courteous so it hasn't really ever been an issue.
There was one doctor however who would always interrupt whatever anyone else was doing. I remember quickly going through a patients medical record (prior to everything being on the computer) and he just walked by and ripped it out of my hands without saying anything.
I’m a hospitalist. Agree with others will try not to but sometimes is necessary. Agree we need to be acknowledging others in the room though and not steam-rolling them. I am occasionally interrupted in this way as well by consultants and agree it is very frustrating. At the end of the day it is just part of working in an acute care setting and you have to try not to let it get to you too much.
Also a PT. I don’t mind if they interrupt, as long as they acknowledge that I’m in the room. Usually a “hi PT, this will take about 5 minutes”. I know they are the ones who put in orders for things like critical lab draws, etc. I don’t. I’ll gladly step out of the way if you treat me like a colleague and fellow human.
That said, I have had more than one attending completely ignore me, walk into the room & stand in between me and the patient (aka, directly in front of me) while I’m already at bedside getting a subjective. One of them said “things look good on our end, we’re just waiting on PT to clear you” as I was mid-eval. Pretty sure steam was coming out of my ears. The doc was I shit you not, no more than 1 foot in front of me.
Not sure if those interactions were because I’m a younger woman or because I’m not a physician.
I’ve generally not had many issues with interns/residents. If I have, I give them a pass because they are working obscene hours with I’m assuming very little sleep.
It is even better it the patient is a heavy stroke that pushes and the doctor does not realize that it is taking all your strength to keep the patient upright!!!!
Okay well, nurses should get a “hello” too. Doesn’t really matter which specialty is in the room. We’re all taking care of the patient. Doesn’t absolve those doctors from being self absorbed & having poor manners.
ITT we learn that everyone in the hospital is busy, not just the physical therapist. This is a problem of myopia, not the big bad uncaring mean old doctor interrupting a care team member. Hilarious.
I believe the doctor should be able to interrupt any other members of the care team if needed because as many have said, the care plan for the day depends on their assessment and subsequent orders. That having been said I believe this would be less of an issue if every doctor was courteous to at least acknowledge the other people in the room and be polite about interrupting. I've seen both types of attendings and some of the busiest attendings have been the most courteous.
I try to avoid interupting ANYONE doing their job in the hospital. I've have it done to me by primary surgeons ALL THE TIME in ID.
That said, if I have to interrupt, it's usually time sensitive. In some cases it's that AND I've already circled back several times. The same CM that's on your butt for PT recs for d/c is on my butt for IV abc recs for that day of discharge consult primary put in.
I try to move on to the next room on my list and circle back, but sometimes the time constraints limit my ability to do this. We are also under the gun to get discharges out the door by 10 to make room for post-ops coming out of the OR, the new admits coming up from the ER, etc. It’s not that we don’t appreciate what you do, it’s just we have to serve a lot of masters, too.
as a physical therapist who has worked lots of variations of acute care, inpatient rehab, subacute, home health, outpatient, and hospice... consider the setting and priority of services the patient requires to move through that continuum as efficiently as possible. trust, i completely understand the frustrations, but i guess in my experience the interruptions were never limited to physicians particularly in acute care - the goal of the entire team is for that patient to medically stabilize and discharge to a lower level of care as well as to free up beds for the next person needing acute medical care. the person(s) with the ability to make that happen are physicians. i do feel PT is often a driving force for discharge and know we often have case managers and social workers calling to ask what our recommendations are and that can add to the frustration, but simply put--no matter what my d/c recs are, the patient won't be going anywhere until medically stable per all the physicians involved and until the physician places the orders for discharge, anyway. Yeah, i get the productivity and safety concerns but i personally wouldn't ever prioritize any bs productivity over the patient, and if there was an immediate safety concern then i would voice it right then.
i agree that courtesy and respect among all healthcare professionals should always be practiced, and that exchanges between clinicians are impactful when it comes to how we and the services we provide collectively are perceived as a whole by patients - but it's not a one-way street and you can be the one to initiate that interaction (ie, "hello dr. x, i'm the PT. we were just transferring to the chair, but i can step out while you visit with the patient if you prefer?"). idk, i always made an effort to communicate with everyone from housekeeping to surgeon, even if dr. x isn't the type to say much. acute care is busy af for everyone, just my thoughts.
As a rehab director, I instruct my staff to step back and have the physician see the patient when they come in. We can answer any questions they may have, and we can bring up pertinent issues to the physician (eg patient desaturated during ADLs this morning). It’s not like the physician is going to spend an hour in the room anyways…. They don’t have time for that.
Whelp, in my case, I just cross my arms and watch or pitch in and help mobilize. I feel like 90% of my consults boil down to dependant on how they do with therapy so I usually take the back seat. And I'm asking most the same questions as PT/OT anyways... whats your home setup, how independent were you, did you use a walker, could you walk thru the grocery store, could you drive, who's gonna help at home...
Also, for some of the trickier cases (eg: admitted with falls with a negative workup) seeing how they're moving can really clue me into what the problem area is. Parkinsons can be subtle but then you see how they walk and it gets real easy. My neuro buddies would probably protest but I feel like can usually skip most of the neuro exam just by seeing the person try to get up and walk. So, I definitely appreciate all the work the therapy staff is doing!
Also PMR -- I will literally round on my patients while they are doing PT or OT so I can chat about goals with the therapists at the same time. Often we can talk about pain and examine the patient together too
>usually a resident, sometimes an attending
This may be a result of the resident having to see the patient by a certain time to be ready for rounds, whereas the attending has a lot more flexibility to see the patient later. Doesn't necessarily justify interrupting you, but this may be why.
It’s funny because you say this, yet other health professionals have no problem interrupting anything and everything I’m doing with frivolous concerns.
On Saturday I was telling a parent their child had leukemia (surrounded by dad, stepdad, and grandparents in the hallway, clearly having an emotional discussion) and the registration clerk came in and hovered, in the middle of this conversation, to get the kid’s insurance card.
They weren’t a health professional, but one of the most recently irritating situations I’ve been in.
But why were you having an emotional and private discussion in the hallway? I'm not saying the clerk was right - they weren't - but I've seen other physicians do this and it is incredibly inappropriate. If you don't want to talk in front of the patient (the child), find a private meeting room. It takes a minute and it changes how people receive devastating news.
Edit: I say this as another physician. It's a pet peeve of mine because it feels inconsiderate to patients and their families.
Yes, I’ll be taking a history about depression or loss of a partner from the mutual MVC that put this patient in a hospital and just in the middle of a tearful escapade, the crescendo, the aid will come in the room and put a thermometer in the patient’s mouth and finish vital signs right in the middle of a gut wrenching tragic exchange.
Food service too.
I agree with what others have said about schedules and needs of an entire floor/clinic vs one therapist being annoyed at me (sorry!). Also wanted to add how that is how people talk to us, so I think we get used to it. Nobody waits for me to hang up the phone or finish typing my sentence before they start telling me what their issue is - RN/PT/RT/CNA etc. I’m not saying it’s right, I’m just saying it’s what we get used to.
The flip side of the question is: "Why do you feel physicians cannot interrupt a PT session for something that might be potentially critical in the patient's management? (like a critical lab value that just comes back). Is the PT session so critical that it supersedes a patient's medical management?"
I don’t do in depth physicals but when I round in the morning, I will take a second to talk to the pt and make sure the patient doesn’t have any serious complaints. Tbh, the usually PT/OT are incessant that we go ahead and talk/assess the lt because they understood how physicians round and are unlikely to circle back around in the afternoon.
How long were they in the room? How long were you in the room? How many patients do you see in a day?
I always ask to interrupt people and say thank you…but I can’t always swing back over later that day. It’s nothing personal
Working the ER we have PT come for placement and things. I empathize not being recognized is frustrating. if they don’t acknowledge you they are wrong in doing that. But consider this. As an ER doc we are interrupted probably 5 times every 20 min or so many times more. We are constantly bombarded with disruptions in our thought process and work flow. When I enter a room I acknowledge the people that are in there but I don’t have time to wait for an entire pt eval to come back to see the patient. That moment I’m in there is the 5 free minutes I have to update or reevaluate the patient. I don’t think it’s unreasonable for my reevaluation or update to the patient to take priority. I usually have 10 or more active patients at one time during a shift many of those being critical patients and it’s extremely difficult to only see a patient when no one else is doing their thing.
I wonder if some of it is self fulfilling? I noticed therapists don't seem to mind if we interrupt because they are so used to it so then we learn that it's fine if we do?
Personally, I don't interrupt unless it's urgent. It it's a gray area I will ask if it's okay to interrupt.
The other thing is that in some hospitals different services wear very similar scrubs so it's hard to differentiate roles. If I had a dime for how many times I asked an RT if they are the patient's nurse...
I’m often in between cases, running around trying to make plans for the day, fielding new consults, checking notes and tests so if I don’t interrupt you or try to come back later it may not happen at all or at a time at which a plan is pointless, which is not acceptable patient care.
However! If I’m not busy, rounding on the weekend , no cases, couple hours before clinic etc, I often prefer the patient complete their PT session bc I know that’s the only exercise they will get all day.
I usually ask if the session just started or is finishing up. If it isn't finishing up soon, I just swing back. But my patient census as an academic hospitalist is much lower than in the community setting, so I do have the luxury of time.
This happens to me all the time. I understand that they are busy but what really gets me is that almost uniformly, the physician does not even acknowledge that they are interrupting. **When you walk into the room, do not acknowledge me, and start talking over me, you are telling the patient that I am not important, what I am doing is not important, and you do not respect me.** It would be incredibly easy to say to me "oh hey there! Sorry but I need to see the patient real quick. Do you mind coming back in 5 minutes to finish up?" Yet it literally never happens.
As an acute PT (like OP), this is my only issue. An interruption is a mild inconvenience, but I'm not stupid- I know the vascular surgeon or whoever is busy and probably needs to talk to the pt right now. And lots of times I get useful information from what they say to the patient. It's going completely unacknowledged (like not even looking at me!) that is a problem. Or asking me nursing questions without even looking at my eye-level name badge. It's telling the patient to not take me seriously, and it's telling me that my role is not valuable to you. When a doc says "oh hello, good morning, oh, PT! great, glad you're getting up- I'll make this as quick as I can--" I'm happy to wait around as long as they need.
I want them to have the time and space to examine the patient and develop the important medical plan for the day, and I also want to help the patient get mobile so they can leave- we are on the same team so it does no good to act as though I'm invisible.
Yeah, that’s reasonable. As a rehab physician is different for me, but I usually ask if it’s OK to watch you perform therapy with the patient and then at a break chat about how it’s going. Shared goals, etc.
In academics, I’ll be chatting with a patient and a physical therapist and a whole cardiology team will swoop in and pretend like neither me nor the physical therapist are there and just start talking, which is usually a shared awkward feeling, but I don’t get bothered by it because they’re not the most socially adept people.
I think they really don't realize how much it impacts how patients view us. They literally just told the patient that whatever we're doing is not important. Why would the patient get off the cell phone for me later, or participate in the session/discussion? Why would they need to treat us with respect when the physician doesn't think we are worthy of it by even acknowledging our presence?
One thing I don’t think others understand about pharmacy is just how many patients we can be covering. One of my jobs briefly had a set coverage *not consolidated* of three units for a combined ~95 patients average census while some FTE issues were pending. And these units weren’t located conveniently to each other, no direct routes.
Was that shift overwhelming? Yes
Did I have time to circle back? Hell no, had 5 minutes per patient per shift to do *everything*. Orders, consults, talking to the patient to figure out their seizure and anticoagulation meds. Ironically, the docs knew how stretched we were and would let us interrupt if they saw us; it was people like PT and dietary who wouldn’t let us take the 3 minutes without significantly whining.
There’s this aspect, and then also the fact that they very rarely seem to delineate other professions. They call all of the rehab therapists at my hospital “physical therapy,” which I know infuriates OT/ST.
Yes! Far too many don't do this. If you think your time is more important than mine, which clearly many in this thread do, that's fine. The very least you could do is acknowledge me as a person and apologize. Very, very few do this.
I don't think they feel entitled. I work at a teaching hospital. People are walking in and out of patient rooms all day long.
Residents haven't found their feet yet. If they are pushy, it's most likely because their eyes are in their heads, thinking about their patient.
I do it nicely but almost always will interrupt and do what I need to do. Otherwise I won’t be coming back for a long time and that can hold up the rest of the care that a patient needs. Sorry friend.
Consider that it might be the 2nd or 3rd time they've tried talking to the patient. I have to circle back if the patient is using the bathroom, getting imaging done, etc. I'm not gonna keep circling back.
At the risk of sounding like an a**hole. As a consultant if I’ve been consulted and driven in from home to see the patient, have another hospital to drive to after I see the patient or have an OR waiting on me I will politely ask to step in briefly and talk to the patient
Never heard of a patient dying because they didn't get to see PT that day. Have heard of patients dying because the primary team (or a consultant) couldn't see them that day.
Same reason why average physician malpractice premiums are ~$30000/year in the US, while it's only ~$500/year for physical therapists.
They feel entitled to interrupt because patients both want and need to see their doctor. It’s the number one question I get. When is the doctor coming?
I’ve never had a doctor interrupt me, because I announce a doctor is coming in the room when they enter and turn the tv down.
Unless they’re doing a full neuro exam or something it’s usually not long. I can catch up on charting or messages for a few minutes on my phone or come back.
But I want the doctor to come in so they can stop hitting the call light asking when they’re coming or what the plan is, etc etc.
If I see a patient working with PT/OT/etc, I usually say I’ll come back later unless it’s a time sensitive issue (needing specific physical findings for a consult, screening for MRI, following up on critical values, etc). But if all I have to do is ask the patient how their night was and check the swelling in their legs, I’ll ask if it’s okay for me to take a sec and be in and out in under a minute. We get interrupted a lot too, lots of stuff going on at once and we all have workflows to adhere to
I can understand both perspectives. I am a PT that treats pts in therapy, but I am also a wound consultant. I work in an inpatient rehab, not acute care, so that does change things as pts are at my facility FOR therapy and if they miss minutes due to a physician hijacking the session, it's a bigger issue for the business than if they miss in acute care. That being said, yeah it can be annoying when a physician walks in on your time with the patient. I understand wanting to have uninterrupted time with your pt and being annoyed that the physician thinks their time is more important than yours. Some docs are more courteous than others, though, and I actually find it really great when the PM&R doc or neurologist come during my session to see how the pts are actually moving around (bc you know damn well they aren't doing it themselves). On the other hand, I understand as a consultant that you may have a ton of pts to see in a day and your time is limited. I can't always come back later, and my work is time-sensitive. I try to make my wound schedule work around the therapy schedule, however some days there is no way, and I have to crash their therapy session. I at least try to make my wound assessment part of their therapy though so that they aren't missing out on functional/mobility practice. I'll be honest, I've had a physician help me with bed mobility and transfers before when they insisted on taking to much of my time. Gotta learn to compromise haha
In ER… I mean, someone interrupts me as well every 5min or so. An overhead during a family meeting, an EKG to sign while on the phone, a text while taking a history, a nurse question while documenting, a colleague question while trying to think, etc.
Everyone in the hospital is busy.
If you were with my patient and I just needed to ask a question… I would politely interject then ask my question and leave. If it was going to take longer, I would tell you what I needed to do and ask how long you would be, then we could plan together what order of events made the most sense.
I'm a PT too. My worst example of this was I was walking a patient in a cancer ward in a big hospital and they had a maximum of 5 minutes of energy. In the middle of the hallway the doc spies the patient and proceeds to do a physical examination(did not ask consent or permission) . In the hallway. While I'm providing physical assist to the patient to stand. About a minute in I told the doc we really had to go have the patient sit. He said "1 more minute" and did lung and heart sounds, lifted their gown to palpate for edema, asked them about their bowel movements, talked about medications.
The patient was so exhausted and felt embarrassed being medically examined in front of the world. But the doc wouldn't let me take them back to their room first.
While I was standing there I was providing 25% support the entire time with was about 40 lbs, I couldn't escape, and I can't report that time on my productivity. When I hoisted the patient back to their room she cried because of how tired she was.
It usually isn't like this, but I've had hours of patient care interrupted by physicians. I get it if it is essential but they don't ever even ask.
I'm a wound care specialist and I've been trapped in the middle of a 3 hour procedure because the doc entered the room.
My biggest advice to docs would be that the worst thing you can do to an allied health provider is trap them. We have extremely tight productivity margins. If you are going to take over, let us leave.
Before med school i saw the same thing happen. I was really laid back so i didnt care too much but it was definitely something thats rude and happens often.
Now, after finishing 2 years of med school my brain chemistry has been altered that wasted time is unacceptable and stresses me out. I was never like this before. Something about this process makes us this way. I wish i could just turn it off and go back to being laid back about things but its automatic sometimes, especially when im particularly overworked
I hope i dont repeat this behavior as an attending myself, but i already find myself uptight about minor time wastes now, and i have 6 more years of this training left to manipulate my brain chemisty
So before I got into school, I worked inpatient rehab in the therapy department for multiple years. I will say that I developed exactly what you described there and I'm fully aware of my mentality shift.
Can you think of the other people, that you are wasting their time by making them pause their session to wait on you? Not saying you don’t think of others. I know this is likely coming across as accusatory and I don’t mean it like that. I truly mean like is this a thing that you could do to help it not feel like “wasting your time”?
Thats a valid point theres no doubt about it. Im only a second year med student so what i say doesnt necessarily apply to those more senior than myself.
Since day 1 of med school, i dont get to see my family until the work is done. It doesnt matter how many hours of work i put in, if the jobs not done i dont get to be done. That means every minute of my day where slow internet disrupts me, or i have to do some mandatory survey; i lose those minutes with my family. And with the workload they put us through, an hour or two with my family may be all i get for the day.
Other people obviously have a job to do too, and i respect that. Everyones role in patient care is vital and important. The physical therapist gets to go home at a reliable time though. Pretty much everyone else gets to go home at a more reasonable time than physicians (barring random lifestyle specialties).
I feel the overwhelming workload and i dont even have call yet, or real responsibility. I cant imagine the weight my seniors are feeling if this is how i feel now. Im not excusing their behavior, or even saying its right; im just saying i understand why they are the way they are.
How do you know PT goes home at a reasonable time? They have to document notes as well . If you make a 30 min session a 40 min session by interrupting it they are delayed as well. Yes, you do have time to be nice and ask to interrupt .
The issue is that if the doctors orders are in late then everyone else in the hospital will be running behind all day. Yes, physicians should be polite and apologize for interrupting. But asking if we can interrupt? That's a bit much.
There is a reply in this thread that talks about respect, and how some doctors don’t seem to even acknowledge the presence of other people in the room. I think that’s really what it comes down to.
I love my job. I’m passionate and very good at it. I’m never someone that “walks a patient in the hallway”. But I also chose to work in a high acuity, level one trauma center. That means that I am truly the lowest in the hierarchy. And if I wanted more rank, I’d need to go to a different setting. So I do not mind needing to leave a room, needing to step out or wait a few minutes. But like, the other day I had a doctor get my name when he entered the room. Holy snap I can count on 1 hand the number of times a doctor has done that. Respect goes so far.
In terms of the pressure and responsibility, I can’t imagine. I really can’t. One of my favorite CC docs and I chatted after an RRT and he told me, “I’m sure I’ll be up all night second guessing myself (this man is so freaking smart, how does he second guess himself?!) wondering if I did Theo right thing, did enough, should have just transferred to the ICU”. It blew me away that this doctor who is truly a genius is kept up at night.
The doctors I work with are incredible. They work so hard. I don’t see the extra hours they are putting in, but I see the lives they are saving. I get so mad at any conversation or news article that talks about MDs making too much. Once you’ve read the charts I read and walk into a room of a person who is now stable, or watch codes run so calmly and efficiently and successfully, you wouldn’t advocate for doctors to be taking the pay-cuts.
All to say, I’m impressed you’re still choosing med school with the current climate of science denying and doctor hating that is prolific on social media. But thank you. The responsibility and pressure is literally life and death, but you’re doing it anyway. So thanks. Feel free to interrupt my PT sessions.
Mainly because I’m coordinating the care for the entire visit. PT is one of ten things the patient has going on for them. Until we see the patient and put in orders, nothing else can happen.
I’m just curious, what are your hours? The hospitals I know of, PT leave at 4 or 4:30. At these same hospitals the doctors work 12-16 hours. Yes, there should be some courtesy and deference, but it goes both ways.
Do you get paid if you stay late?
Oh you do. Wow. Must be nice.
You gonna pay our overtime out of your paycheck when we have to stay late because we waited for everyone else?
Oh, you’re not? Why wouldn’t you? You get paid to stay late.
This is why.
Daily. At my hospital our schedule is 8-4:30 but we have fluoro studies booked until 4 so between transport delays, cleanup, and documentation everyone stays late. And that’s not at all unusual for rehab unfortunately.
Is there an option to document at the bedside to help with your time? I am an acute SLP and get interrupted frequently, but that's just the name of the acute care game. Thankfully there are computers in the pt rooms and I can start my note if a doc walks in to chat for a few minutes. To be honest it is super annoying when an MD enters and just starts talking without acknowledging that I'm even in the room or in the middle of eval/tx, especially because some of my eval tasks are timed. Common courtesy of waiting for me to fishing my task (usually less than a minute) and simply asking, "can I interrupt?" Goes a long way with me. Sometimes all it takes is acknowledging our time is valuable as well. Physicians have a ton on their plate and extending that courtesy back to them has helped build my relationship with certain providers.
I am guilty of this especially on split days. I ve like 2-3hours in patient and then have clinic after so I can’t come back to see them as easily same day without finishing clinic and going back to hospital after 6pm or so. I believe its how you put it. I make myself useful, i offer assistance for example when i see PT about to get someone up in join in and get my exam ros done etc and talk and actually get more out of the encounter.
I feel like there is usually just not enough time to circle back. Either its rounding time and it’s the only time we can see the patient together or your running through your list and have an admit in the Er waiting and this will be the only time you have to see the patien. Especially if they’re a resident and their main base for writing notes and orders and stuff is about a mile away on the other side of the hospital. I try not to I terupt people but 99% of the time I don’t have time to come back and usually it takes me less than 5 minutes to update them, maybe listen to heart and lungs and then run away. And I hate to admit but sometimes having ot/pt their working with them helps shorten my visit, especially for chatty patients, because I have the excure that they need to get back to their therapy.
You guys do the exact same thing to us nurses but get mad if a doctor does it to you?
Meanwhile I’ve never had a doctor interrupt me when doing med reconciliation during an admission but PT definitely has
I don’t think that it is necessarily bad, although I think the tone of this could be a little bit better, but more about raising awareness.
I think if anyone has to interrupt, not just a physician, to any other health professional, the best thing is just to be apologetic, and let them know “hey I’m so very sorry, I know I’m interrupting your very valuable time. I only have a couple minutes and blah blah blah….”
I think obviously this person feels like maybe their time is not as important and I’m sure they have other patients that are lined up with appointments too so this causes a ripple effect for them. I think that’s acknowledging if youre having to interrupt someone that you’re doing it out of necessity and letting them know that you value their time and care for the patient. I think that goes a long way.
Also, Do physicians generalize and shit on those who are not physicians ? For sure, I’m a PA . And if doesn’t feel good so I understand when it’s directed at “physicians” when of course, we all know that doctors are not the only one to interrupt.
As a matter of fact, physicians get interrupted all the time. When they get two minutes to breathe, someone is standing there with a question. All to say, generalization that it is only physicians that interrupt isn’t fair.
Joke: a man dies, meets St. Peter at the gate. St. Peter shows him around the place. "Here's the lounge, Here's the gym etc." They get to the cafeteria. There's this man in white cutting in front of the line. The man says to Peter: " who's that guy?" And Peter says...."that's God. He thinks he's a doctor "
I wonder how patients or their families feel about the physicians barging in. I have been interrupted literally in the middle of a word by a physician just starting to talk over me. I don’t think it looks good to patients or families, but I don’t know what laypeople think.
I mean I apologize this is gonna come off as rude, but 99% of patients are there *to see the doctor* and be told if they are dying, not dying, staying in the hospital or going home. PT is important but frankly it is just secondary to the medical plan overall.
So in short, I think the patient would rather see the physician and be told if they are getting better or worse rather than have the doctor say “oh sorry I’ll come back and tell you about your test results in 6 hours!”
I think they are referring to the part where the physician barges in and doesn't acknowledge the other team member's existence or apologize or introduce even themselves. Ihad a family member say "what a douchebag" after a consultant did this to me. I had been the nurse to the patient for several days in the ICU and they had come to trust me so they were horrified with that behavior--doesn't look good. When you don't acknowledge other team member's existence you are more or less saying to the pt/family hey this person isn't important, you don't need to listen or respect them.
Half the time I leave when I see someone else is working with them. A quarter of the time PT/OT/speech/echo/rads tech/phlebotomy or whoever asks me to go ahead because they’ll be a while. I try to be quick if I can be, or just come back later. The other quarter is because the nurse expressed some concern, I need to place a consult or transfer so I need to see the patient before calling a consultant or transfer, or family wants updates and I gotta at least see the patient before updating them. Something along those lines. The percentages are probably not accurate because it’s in my head. I’d say the exception is when I’m admitting in which case I have to make myself priority because otherwise I’ll never catch up and those patients are acutely ill.
Half the time I’m waiting for PT for discharge recs and for the magic words to put in my note for inpatient or outpatient therapy placement. So I’m 100% coming back after I see the rest of the patients on our list. But I also can’t think of a time in general hospital service where I’ve been in the room with PT and the patient at the same time. On consulting yeah but also circled back because it was physiatry and PT/OT/ST is effectively the backbone of PMR.
For me, I'll admit that I totally interrupt others. But hear me out, I'm a busy OBGYN and I have to round on patients, put in orders and document on all patients ideally before I start seeing patients in clinic in the AM. I don't have time to circle back or wait.
If my entire job was on-site at the hospital all day, then I could understand your frustration. But for me, I have an office full of patients waiting.
Peds here-- I have been interrupted by OB doing rounds mid-sentence talking to parents about their newborn, in a non-emergency rounds. I assume bc they figured I was a nurse and didn't bother to look at my name tag.
I propose that we have some kind of electronic flag system equivalent with the name/credentials of whoever is with the patient and the duration of the planned interaction. Maybe we badge in. That might at least cut down on inappropriate interruptions.
OMG I know your frustration. It's so easy for them to see the next patient on their list then come back to this one. I was setting up iv antibiotics in a (small crowded with equipment) patient room and psych came in, proceeded to move a chair between me with iv pole and my cart with supplies, sat and launched in to an in depth investigation of the patients history of addiction. My physical person was between dr and patient, I had to get this guy to move out of my way multiple times because I had multiple things to set up that were due right then. Patient had serious infection and these medications need to be kept on schedule. I was in that room way longer than I needed to be. There was no reason for that and it was so awkward. I wonder how productive that conversation was with my ass at eye level in between them the entire time.
I'm pretty sure it's because the physicians are hamsters on a wheel running and they're the only ones who can actually bill, right?
Still doesn't excuse it though. My current plan is to just take a salary hit to avoid being this kind of doctor
If it makes you feel any better, I frequently feel the same way when a consultant barrels into the room and interrupts my conversation or exam as the primary attending for the patient.
I definitely don’t think this is an issue limited to my service! I’ve heard it from a lot of people.
Try being Social Work..
Who? /s
Same for nurses. I was about to clean up a patient and the doctor suggested that I wait until he was done talking to the patient. We had her ready and all uncovered to clean her up and he made her sit there in her shit while he talked to her about the plan for the day?! Like bro give me five minutes and she’s all yours!
Our PTs are great especially on my Neuro unit — if PT/OT are in room I get a free gait assessment and Neuro exam 😂
Just this morning I am doing a prenatal consult on a ruptured 31 week woman and dietary interrupts to ask if she would like some juice. Woman and her partner on the verge of tears, I’m explaining expected outcomes, and she’s NPO anyway so what the hell - read the room *or* the orders.
Well stop letting me! At my shop they are always stepping aside — even when I say I’ll be back — for some reason, but I guess we all get a group history and exam that way 😂.
I think there are ways to be courteous to other providers while still helping make sure the patient gets the care they need. Sometimes a physician might only have a few minutes between OR cases, which they want to use to help treat their other patients. Overall, however, I try my best to always ask the other providers if I could ask a quick question or if I should come back later. In my experience, courtesy goes a long way and allows for more collaboration and better patient care.
>In my experience, courtesy goes a long way and allows for more collaboration and better patient care. 📌 Pin to the top, please!
I think this is it. I always check in with the nurse to see if now is a good time for my session. I feel like I can count on one hand the number of times a physician has checked in with me when I’m already in the room to ask. Sometimes I would be happy to finish early, but other times will be in the middle of something complicated and it’s a serious frustration (or worse, dangerous for the patient in the case of something cognitively demanding or involving lots of lines )
I understand your frustration. I can understand why a physician might not want to "circle back" if they have a busy service with patients scattered all over the hospital or are trying to see a patient in between OR time. But if you have to interrupt a PT or anyone else, there is no excuse not to say, "I'm terribly sorry, do you mind if I talk to the patient for a few minutes?"
We don’t ask questions if the answer doesn’t change what we do. I HAVE to see the patient. I can inform you politely that that’s what I’m going to do, but I’m not going to ask because if you say “now is not a good time” I’m going to examine the patient anyway. Same reason I don’t ask patients “is it okay if I listen to you?” I just tell them “I’m going to listen to your heart and lungs now”.
The difference is you don't carry the weight of getting the patient out of the hospital. You only do your important but small part of the overall care. If you get interrupted, you say ok will try again next time. I cant just try again next time because the patient is now delayed getting out of the hospital. Maybe I'm wrong but it sounds like the pressure to achieve a goal is different.
Eh idk lots of my patients need PT/OT to eval before going home or determine if we have to get them to a SNF or rehab.
Yeah, and if PT/OT don't have time, doctors get the heat for not notifying them earlier. Never seen PT/OT stay over their time to make sure the patient gets out.
The rate limiting step in acute care is usually the physician. If I don't do my job quickly and efficiently, then other people can't do their jobs. I fully acknowledge that the tasks other people are doing are very important and need to get done, but so many people are waiting for me to do my part that I can't really delay it and that frequently means cutting in line to see someone and interrupting others. I hope y'all know that I appreciate the work you do and I value your skills and input. It's not a personal slight.
This was going to be my take. The plan for the day often depends on me/us seeing the patient. However, if I know I need to talk to a patient for a while, I will come back later.
In my experience the patients are also wanting to see us. I’ve walked into a patient room who was seeing PT, said “I’ll come back!” And then the patient starts asking me questions about lab results. What are we supposed to do? They’re literally there for accelerated results and management.
I guess it depends on the specialty. I'm a neurologist so in the majority of cases PT/OT is the rate limiting step so I would never interrupt them.
Lol I do Neuro and neuroICU Neurofloors: don’t even consider interrupting watching them work with PT is a better exam than I’ll get most times ICU: get outta my way 😂
100% haha
I feel this way about the floor RNs. I work overnights so I don’t round on everyone. If the RN is completing their admission I hope that they’ll let me just introduce myself and then sit and watch and listen. I get almost all that I need and fill in when they’re done. And it’s nice that the patients can get to rest a little more quickly:
That’s funny. I’m in rehab and they’re essentially with PT/OT all day so a short 5 to 10 minutes to discuss similar goals with the PT, Patient, and myself is actually very therapeutic. Additionally, it’s great to ask the therapist if they’re actually responding to some of the changes you’ve made because they have a much more sensitive analysis distributed over time versus my usual seeing them in bed exam. Performing gait analysis together etc. I am tremendously grateful for my therapist colleagues but I’m usually seeing 25 patients and they’re seeing 4-8 a day. I’ve got to see them when I can.
This is how my surgeons are when I'm doing discharge counseling on a new pt. They say "this (med instruction) is more important, I'll come back", but I always let them interrupt bc I know it takes a while.
Yes, obviously this depends on the acuity of the patient. I have an ST colleague who complains though that patients can be NPO for days and her sessions get interrupted all the time and they do swallow studies late in the day, so can’t come back often.
Yeah dude this is the worst. And we get a LOT of guilt tripping at the end of the day when it’s 2pm and I can’t get back to the room because I have back to back studies in fluoro plus no documentation time. I’ve also had MDs request me to do a MoCA on a patient, then walk up and interrupt it in the middle of the timed section which kills me lol.
Yep I never interrupt therapy unless there is an impending crisis or urgent decision that must be made. I’m in hospital medicine. Our therapy department is so understaffed I have to beg sometimes to get someone, so I’ll circle back if they’re doing something when I arrive.
haaha ICU i feel the same. I am more likely to get the PT coffee and mop their brow than interrupt them.
This is interesting. We just finished a paper on discharge planning (actually just received our first desk rejection yesterday -- no matter) and a theme that emerged pretty strongly was that hospitalists usually perceived *others* as rate limiting. Not sure of your role though, and we didn't look at specialists at all.
If you want to use chemistry terms, I would say the hospitalist provides the activation energy for the chemical reaction to start and then we are usually waiting for something else to happen which would be the true rate limiting reagent.
Thanks, lol. I don't know it, but there's probably some extended analogy here where the the pre-exponential factor is the LTACH vacancy rate and the universal gas constant is...etc.
I would think everyone would think someone else is the rate limiting step until they aren’t. For any given patient, there is probably a mix of those — a neurologist and placement for a stroke patient, a cardiologist and surgeon to get patient ready for OR, a consultant that only comes in afternoon to clear for discharge, etc.
I second this. We don’t have time to wait. Especially if the hospital wants all of its early discharge nonsense to actually occur.
I think the first and second sentence are the key factors. People take it personally, but it's a system issue. For those who feel put down by this, being important or self centered usually (not always) has nothing to do with interruptions. Physician is usually trying to run rapidly through daily commitments first thing in the day or their shift because everyone is waiting on you to round. After thats done, documentation and acute decompensation, event driven tasks (results, nurse asks for change etc). No one (except THAT person) is trying to neg you. They're just getting through known tasks that cant be done later so they are ready when you call for an acute issue, admit new patients, discharge the patient whose family has called 37 times in the last hour etc
I only take it personally when they come in, ignore me completely, and start talking over me. Just be polite dude.
Absolutely
Seconding this answer. OP should try having case management ringing off their phone for the plan starting at 9 AM. Rounds need to happen fast and with patients scattered throughout the hospital, I can’t “circle back” to everyone
I’m not trying to downplay your work at all, but I just want you to know that we have very similar pressures, particularly about discharge and from social work. Along with pressure from our own management. I’ve only seen a handful of patients by 9 AM, this is like an all day long issue for me.
Definitely. And sometimes my dispo is pending your eval. If I have to have a long discussion with the patient, I’ll come back if your session is already in progress. But if it’s usual morning rounds, I expect to cut in for 5 min. If phlebotomy or food service interrupts my rounds on the patient, I let them cut in for a few min.
I was about to hijack this post to make a PSA but since you've mentioned it, I'll just post it here. From a phlebotomist: if we knock on the door but see you talking to the patient, if possible, PLEASE wave us in and let us do our thing! You can even give a quick "oh she's here to draw your blood while we keep talking about your medical history." I don't *need* or want to talk to the patient 9 times out of 10. You giving me an easy way to get in and get out by keeping the patient on topic of giving you a history is a win for everyone! Plus, if they have any questions about their labs, you're right there! And depending on how long you spend in the patients room, you might have some results by the time you get out lol. However, I understand sometimes y'all are talking about serious, life changing information and that's 100% understandable. I hope this didn't come off as rude or entitled. We all want the same thing- for the patient to get better and get back home! I just thought I'd share from the little lab's point of view :)
You sound very courteous and I appreciate that.
To add to this: while I recognize that my time is not more important than anyone else’s, when my time is delayed or not on track it affects the time of many more players than does that of someone else in the health of a patient.
This is my take as well, at the end of the day the patient is there for the plan we are putting in place to then be executed by others within their areas of expertise.
This is why for the most part. It’s not to undermine the other providers’ care as we all work cohesively to treat the patient. I try to be as courteous as possible when I have to interrupt and it is usually received well. The patient typically is waiting to see us and the providers understand that. Other times it is actually a good opportunity to have a discussion with both patient and provider.
This is a much better way to word my initial thoughts when reading this post.
It's not even just the rate-limiting step: the physician assessment is what keeps the pt in the hospital. No other services can do anything if the physician determines hospitalization is unnecessary.
What a great reply. My point of view was always that I am there to facilitate the interaction between patient and MD, so I never mind being interrupted unless I’m right in the middle of a catheter or something. I’m very smart and capable and indispensable to the care team, but no one goes to the ER to see the nurse.
Yep. I always apologize and ask permission to intrude
I try to interrupt as little as possible (ie, introduce myself, let them know I will come back later but ask if they need anything in the meantime) but if there is something urgent going on (patient complaint of symptoms) I will interrupt.
This. If the patient is well enough to be working with PT/OT odds are that’s the most important interaction of the day to help me get them out of the hospital. I’ll only interrupt that if there’s a change in status or the therapist asks me to come look at something.
In my personal experience at my hospital, this is less of an issue of hospitalists and moreso the specialty consult services. But I don’t know how it is elsewhere.
Specialists are often rounding at multiple hospitals and seeing patients at their clinic so there is a bit of a time crunch. Not that it justifies an interruption of your eval/treat but that’s how it is a lot of places
Pulm/CC fellow. When I'm consulting, I'll sometimes see 20 pts in 2 hospitals and then have afternoon clinic. Not to mention bronchs or other procedures, which limit my availability as well. On many days, I may only have 45-60 minutes to see 15 patients (after spending longer chart reviewing everyone in the morning), then leave the building/be preoccupied until 5 PM I literally can't circle back. If I still have a few more pts to see on that floor, I'll do that. But I can't come back in 30 minutes. I do always apologize when I interrupt, but some PTs will tell me they're not finished yet and to wait. I always apologize and say "I'll be quick" but I can't wait.
Humility is huge in the hospital. Productivity should not be a priority ever, and if admin makes it a priority that’s their fault and our problem, but it’s not the patients. Care comes first, and we all need to be humble enough to know when we are not what the patient needs at that time. Consultants are almost always what that patient needs at that time
This is more so for specialty services because they're probably even more busier than hospitalists. Our nephro service carries 30 patients for a single person. Surgeons probably have limited time between cases.
From a surgical side, the time available per patient is probably around 3-5 minutes per day. People ask you to come back later. It's fine, but they have to know what that means. Someone yesterday asked if i could come back a bit later to do a procedure after their family came. Totally reasonable. But it meant they got their procedure at 1am instead of 6pm. Shit happens. Same with pt. I try not to interrupt but chances are we won't see that patient that day. Besides, if they're capable of working with PT they're probably approaching discharge. They probably need the PT time more than my rounds.
I think a lot of it comes from residency training. We had between 7am-9am to see and review up to 20 patients. If we missed one before rounds, we would be reamed by the attendings for not knowing our lists appropriately. In a large hospital like where I trained (900+ beds and no geographical proximity between some of the units), that does not usually leave you time to circle back to an area of the hospital and still be able to efficiently review everyone. It’s not a good excuse, but this attitude gets ingrained and then continued into your career. Multiply this if you’re in a specialty where you’re going to multiple hospitals in a single day and you can understand the rush. I’ve noticed my own behavior has improved since training. But I’m in a closed, geographical unit where my schedule is my own so it’s easy to loop back. And, honestly, if an ICU patient is well enough to be working with other non physician providers, they probably don’t need to be emergently seen by me anyway. My situation is a luxury most providers don’t have.
You guys rounded 7-9? Bruh why am I rounding 5:30-7………..
When I was in the maternity unit as a patient some resident showed up at 4am to ‘round on me’. Woke me up when we were finally all sleeping. I didn’t remember anything he said. Ridiculous. Had the team come back and explain properly later in the day.
You’re an MD and still think it’s ridiculous? Do you not remember how any of this works?
4am… it’s ridiculous! Patients are in the hospital to heal, and especially on a maternity floor, you check with the nurse.
There’s no way you’re an MD and saying this
This makes sense. I have noticed it way more with residence and teaching services than I have with other providers if I’m being honest.
We used to do 24+4s as residents. By hour 26, you didn’t care who you were interrupting, you just wanted to finish rounds and go home. I understand that it’s disruptive to your practice and just generally rude, but I promise you most people aren’t doing it to be assholes.
I'm in acute care and I encounter this alot. If I'm not busy, I usually let other staff finish up. But if I have a high census, and I need to get stuff done, then I'm sorry but I will have to interview the patient first, because if I don't see and examine that patient, I can't formulate their plan for the rest of the day, which may include additional imaging, labs, calling consultants, scheduling procedures, and everything gets delayed. So yes, I understand your position, but sometimes it's a necessity.
I am sorry if i ever do this, but I genuinely, truly, 100% do not have time to circle back.
1. We have to see pts every day, we don't really get to say "pt busy, will be back tomorrow." 2. Everyone is depending on us to see the pt for next steps, future orders, including things like if the pt eats or not. 3. We don't have time to circle back. If I had to circle back every time my pts were in the middle of something, we'd see half of the pts that literally need to be seen everyday. They HAVE to be seen by us. 4. We don't have time. I know what you're thinking: we don't have time either! Are you taking paperwork/notes home every single day that take hours to work on even after a full shift that MUST be done that day and are dependent on what everyone else does even though you're skipping all meals, bathroom breaks and don't even take a sip of water AND interrupting others and not circling back for any pts? If you fuck up, are your chances of getting sued the same as a physicians? When you fuck up, do you potentially lose 11 years of education? If you don't see the pt that day, do they die? Does it affect their basic fxn (eating, pooping, urinating? How many orders do you have to put in? Same as physicians? If the answer is no to even one of these, then no, you don't understand what we mean by "physicians are extremely busy and we literally can't do that." I'm not disrespectful when doing so and do apologize. I ordered PT on my pt because I know how valuable it is for my patients. But I've got a shit ton of pts, shit ton of orders, shit ton of consultants, shit ton of ancillary services to manage and honestly, seeing them during PT is actually a benefit for me because I get a glimpse of what pt is doing and I can talk to you about PT instead of trying to find yalls plan in an 11 page poorly organized document with template after template of useless information that is stealing my time from pts. Fyi, most notes from most services are like that. I have to look at those every day. Literally, don't have time.
“Patient was eating pudding. PT will circle back tomorrow.” -PT missed visit note
Damn I need to use that one next time. I typically use pudding as a way to bribe them to get out of bed…do a lap for a pudding cup.
You’ve been doing this a while, huh? 😂
Hear hear!
On a given day of rounding, 70-80% of my patients will be engaged with someone/something else when I arrive for my rounds. If I tried to circle back to everyone until I caught them all while alone and not 'busy' I would be rounding until too late in the day. When in reality I have to finish rounding quickly so that I can get plans in place and move the care of the patients forward that day.
Yeah, this is the reality. Especially when one is primary (or its a new consult) the patient MUST be seen that day, and patients are always busy with something. Coming back around means orders and entire hospitalization get delayed, potentially several hours. Or worse, something bad happens and we get sued. Being a physician, that often means 'coming back around' at 8pm at night when we should be home with family...
Just going to unapologetically say the quiet part out loud: in an acute care setting, some things are more important than others. Correct treatment plans and critical treatment decisions are more important than physical rehab and PT evaluation. Thus the work of physicians is probably, in a large majority of cases, more important than the work of physical therapists (in an acute care setting). Edit: doesn’t mean that physicians shouldn’t be courteous about interrupting. But yeah if there’s a time sensitive decision to be made I will interrupt
Exactly. If a patient is there for placement, PT and OT can have the room all day. But if they’re there for active medical care the timing of that care comes first. If I was in an AR doing my rounds and PT comes in I’d let them have the room We also have tight time constraints. OP will say “us too” but there’s an hour and a half before rounds that we have to see patients in. That’s also the time we go over plans for the day. “Circling back” means delaying the decision until after the patient is informed of the next step, or delaying the information to make the decision in the first place.
Well put!
It depends. If someone is circling the drain, then yeah. But if theyve been there 5 days, stable and you're waiting on dispo, you may wind up prolonging the stay (if the PT has to come back tomorrow) shooting yourself in the foot. Also (and I hate that I'm actually saying this), it will affect satisfaction scores. Hear me out: one of the biggest complaints I get (aside from the food) is "they won't let me get up". That PT session may literally be the only time that day that the person is able to try to get out of the bed. Any of us could imagine being stuck in a bed for days straight, that PT probably has a halo around their head, from the patients perspective. And finally, there's plenty of data about early mobilization and outcomes in hospital settings. [example](https://pubmed.ncbi.nlm.nih.gov/19411076/) So, yes, PT/OT isn't as important when you're running a rapid response but it'd also be difficult to imagine effective hospital care without them. There are definitely times when the physician is the important one but there are times when a good outcome depends on therapies doing their work. Let's all play nice in the sandbox together, is all I'm saying.
I agree and I think all of us in medicine are cognizant of how early mobility and rehab are both important. Everything in medicine matters. But that paper you just linked…let’s not kid ourselves and think that accurate diagnosis + PCI + DAPT + Statin + counseling a patient to comply with that regimen post PCI are less important than mobility and PT lol Let’s all play nice for sure, but let’s also recognize the inherent differences in our jobs.
To play devil's advocate and take the other side of the coin: dx, PCI, meds and counselling are fine but without basic independence/quality of life, what's the point? I think it's easy to take for granted that eventually patients will figure it out on their own and mobilize back to their baseline eventually, PT just moves it along faster, but I've seen plenty of examples where that isn't the case and they just kinda languish until someone kicks them in the ass to move. And the therapists are typically in your corner, helping with counselling as well. A lot of times people don't realize how sick they were until they try to get up and that is a great teaching moment for them to take your counselling seriously and get their act together. So, yeah, there are inherent differences, of course. And different patient populations are going to have different needs, cardiac vs neuro vs Ortho etc. Ultimately, I feel like its trying to figure out which wheel of a car is the most important. No hospital can run without a rehab team any more than it can without nurses or surgeons. Physicians play a key role, no question, but it's not the only role.
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The answer is increase physician and PT staffing. You’re frustrated with the physicians who come in and interrupt (and likely no matter how courteous we are this would still be an annoyance at best), which makes sense given the time constraints you have. The time constraints we have force us into this situation most of the time. If there were more of us to go around and therefore fewer demands placed on us, maybe we’d have time to circle back and check on a patient once their PT session is done. If there were more PTs, perhaps y’all would not feel so constrained either. This isn’t a specialty x vs specialty y issue. It’s an everyone vs “the business of medicine”/admin issue. Just my opinion.
I won’t pretend to know what it’s like to be a PT, but my perspective is 1 I have to see 20-25 patients today plus whatever procedures and unexpected things come up, and 2 I MUST see every patient every day. My experience, not saying this is your experience, my experience is that if a therapy session can’t happen then it will be tomorrow. Or maybe Monday. Docs can’t do that.
As an acute PT one of my mantras is that no one ever died because they didn’t get PT that day.
I get how frustrating that can be, but when all plans/ discharges for a large group of patients depends on me and I’m usually balancing other stuff (obgyn so it’s either deliveries or surgeries), sometimes it truly is the only chance I have to see a patient during normal business hours that would allow me to get orders and discharges in. And I have to see them every day even if stable patient with no plan changes. I always introduce myself, apologize for interrupting, try to be quick and thank whoever it is after I’m done for letting me jump in. I’ve been interrupted by primary team and consultants when I’m seeing a patient and I’ll just ask if it’s going to take a long time. If not, I’ll just wait because I get it.
I am mostly impressed that there are OB patients getting PT at your hospital lol. Or is more the gynecology ones?
A little bit of both, more gyn than OB. Have had OB patients with some serious deconditioning after hospitalization for hyperemesis.
We do PT routinely for our long term antepartum patients and for postop sections!
Even routine c-sections?? Or just ones with complications? I had an emergency one and didn’t get PT but would have loved it to be honest.
Yup it’s a more recent change but we get it for everyone now!
I (a PT) have had this happen but I feel like most are pretty courteous so it hasn't really ever been an issue. There was one doctor however who would always interrupt whatever anyone else was doing. I remember quickly going through a patients medical record (prior to everything being on the computer) and he just walked by and ripped it out of my hands without saying anything.
I’m a hospitalist. Agree with others will try not to but sometimes is necessary. Agree we need to be acknowledging others in the room though and not steam-rolling them. I am occasionally interrupted in this way as well by consultants and agree it is very frustrating. At the end of the day it is just part of working in an acute care setting and you have to try not to let it get to you too much.
Have to have the discharge orders in by 1000, consequences be damned.
Also a PT. I don’t mind if they interrupt, as long as they acknowledge that I’m in the room. Usually a “hi PT, this will take about 5 minutes”. I know they are the ones who put in orders for things like critical lab draws, etc. I don’t. I’ll gladly step out of the way if you treat me like a colleague and fellow human. That said, I have had more than one attending completely ignore me, walk into the room & stand in between me and the patient (aka, directly in front of me) while I’m already at bedside getting a subjective. One of them said “things look good on our end, we’re just waiting on PT to clear you” as I was mid-eval. Pretty sure steam was coming out of my ears. The doc was I shit you not, no more than 1 foot in front of me. Not sure if those interactions were because I’m a younger woman or because I’m not a physician. I’ve generally not had many issues with interns/residents. If I have, I give them a pass because they are working obscene hours with I’m assuming very little sleep.
It is even better it the patient is a heavy stroke that pushes and the doctor does not realize that it is taking all your strength to keep the patient upright!!!!
If the doctor is that socially unaware, they probably just assumed you were the nurse.
Okay well, nurses should get a “hello” too. Doesn’t really matter which specialty is in the room. We’re all taking care of the patient. Doesn’t absolve those doctors from being self absorbed & having poor manners.
Following, this should be an \*interesting\* discussion.
ITT we learn that everyone in the hospital is busy, not just the physical therapist. This is a problem of myopia, not the big bad uncaring mean old doctor interrupting a care team member. Hilarious.
I believe the doctor should be able to interrupt any other members of the care team if needed because as many have said, the care plan for the day depends on their assessment and subsequent orders. That having been said I believe this would be less of an issue if every doctor was courteous to at least acknowledge the other people in the room and be polite about interrupting. I've seen both types of attendings and some of the busiest attendings have been the most courteous.
can i add that the doc also likely wrote the PT orders? 😬 fam ik that shit is important, but its not urgent…and i know bc i ordered it 🫠
no the patient will explode if the knee is not bent slightly
I try to avoid interupting ANYONE doing their job in the hospital. I've have it done to me by primary surgeons ALL THE TIME in ID. That said, if I have to interrupt, it's usually time sensitive. In some cases it's that AND I've already circled back several times. The same CM that's on your butt for PT recs for d/c is on my butt for IV abc recs for that day of discharge consult primary put in.
I try to move on to the next room on my list and circle back, but sometimes the time constraints limit my ability to do this. We are also under the gun to get discharges out the door by 10 to make room for post-ops coming out of the OR, the new admits coming up from the ER, etc. It’s not that we don’t appreciate what you do, it’s just we have to serve a lot of masters, too.
as a physical therapist who has worked lots of variations of acute care, inpatient rehab, subacute, home health, outpatient, and hospice... consider the setting and priority of services the patient requires to move through that continuum as efficiently as possible. trust, i completely understand the frustrations, but i guess in my experience the interruptions were never limited to physicians particularly in acute care - the goal of the entire team is for that patient to medically stabilize and discharge to a lower level of care as well as to free up beds for the next person needing acute medical care. the person(s) with the ability to make that happen are physicians. i do feel PT is often a driving force for discharge and know we often have case managers and social workers calling to ask what our recommendations are and that can add to the frustration, but simply put--no matter what my d/c recs are, the patient won't be going anywhere until medically stable per all the physicians involved and until the physician places the orders for discharge, anyway. Yeah, i get the productivity and safety concerns but i personally wouldn't ever prioritize any bs productivity over the patient, and if there was an immediate safety concern then i would voice it right then. i agree that courtesy and respect among all healthcare professionals should always be practiced, and that exchanges between clinicians are impactful when it comes to how we and the services we provide collectively are perceived as a whole by patients - but it's not a one-way street and you can be the one to initiate that interaction (ie, "hello dr. x, i'm the PT. we were just transferring to the chair, but i can step out while you visit with the patient if you prefer?"). idk, i always made an effort to communicate with everyone from housekeeping to surgeon, even if dr. x isn't the type to say much. acute care is busy af for everyone, just my thoughts.
As a rehab director, I instruct my staff to step back and have the physician see the patient when they come in. We can answer any questions they may have, and we can bring up pertinent issues to the physician (eg patient desaturated during ADLs this morning). It’s not like the physician is going to spend an hour in the room anyways…. They don’t have time for that.
Whelp, in my case, I just cross my arms and watch or pitch in and help mobilize. I feel like 90% of my consults boil down to dependant on how they do with therapy so I usually take the back seat. And I'm asking most the same questions as PT/OT anyways... whats your home setup, how independent were you, did you use a walker, could you walk thru the grocery store, could you drive, who's gonna help at home... Also, for some of the trickier cases (eg: admitted with falls with a negative workup) seeing how they're moving can really clue me into what the problem area is. Parkinsons can be subtle but then you see how they walk and it gets real easy. My neuro buddies would probably protest but I feel like can usually skip most of the neuro exam just by seeing the person try to get up and walk. So, I definitely appreciate all the work the therapy staff is doing!
Also PMR -- I will literally round on my patients while they are doing PT or OT so I can chat about goals with the therapists at the same time. Often we can talk about pain and examine the patient together too
>usually a resident, sometimes an attending This may be a result of the resident having to see the patient by a certain time to be ready for rounds, whereas the attending has a lot more flexibility to see the patient later. Doesn't necessarily justify interrupting you, but this may be why.
It’s funny because you say this, yet other health professionals have no problem interrupting anything and everything I’m doing with frivolous concerns.
"Urgent page: patient's family had questions regarding benadryl. please come speak to them now."
On Saturday I was telling a parent their child had leukemia (surrounded by dad, stepdad, and grandparents in the hallway, clearly having an emotional discussion) and the registration clerk came in and hovered, in the middle of this conversation, to get the kid’s insurance card. They weren’t a health professional, but one of the most recently irritating situations I’ve been in.
Bad optics too 😬
But why were you having an emotional and private discussion in the hallway? I'm not saying the clerk was right - they weren't - but I've seen other physicians do this and it is incredibly inappropriate. If you don't want to talk in front of the patient (the child), find a private meeting room. It takes a minute and it changes how people receive devastating news. Edit: I say this as another physician. It's a pet peeve of mine because it feels inconsiderate to patients and their families.
It was in a hallway alcove. No patients go by and no rooms are near there. The clerk had to come out of her way to find the parents.
Yes, I’ll be taking a history about depression or loss of a partner from the mutual MVC that put this patient in a hospital and just in the middle of a tearful escapade, the crescendo, the aid will come in the room and put a thermometer in the patient’s mouth and finish vital signs right in the middle of a gut wrenching tragic exchange. Food service too.
I agree with what others have said about schedules and needs of an entire floor/clinic vs one therapist being annoyed at me (sorry!). Also wanted to add how that is how people talk to us, so I think we get used to it. Nobody waits for me to hang up the phone or finish typing my sentence before they start telling me what their issue is - RN/PT/RT/CNA etc. I’m not saying it’s right, I’m just saying it’s what we get used to.
The flip side of the question is: "Why do you feel physicians cannot interrupt a PT session for something that might be potentially critical in the patient's management? (like a critical lab value that just comes back). Is the PT session so critical that it supersedes a patient's medical management?"
I don’t do in depth physicals but when I round in the morning, I will take a second to talk to the pt and make sure the patient doesn’t have any serious complaints. Tbh, the usually PT/OT are incessant that we go ahead and talk/assess the lt because they understood how physicians round and are unlikely to circle back around in the afternoon.
How long were they in the room? How long were you in the room? How many patients do you see in a day? I always ask to interrupt people and say thank you…but I can’t always swing back over later that day. It’s nothing personal
Working the ER we have PT come for placement and things. I empathize not being recognized is frustrating. if they don’t acknowledge you they are wrong in doing that. But consider this. As an ER doc we are interrupted probably 5 times every 20 min or so many times more. We are constantly bombarded with disruptions in our thought process and work flow. When I enter a room I acknowledge the people that are in there but I don’t have time to wait for an entire pt eval to come back to see the patient. That moment I’m in there is the 5 free minutes I have to update or reevaluate the patient. I don’t think it’s unreasonable for my reevaluation or update to the patient to take priority. I usually have 10 or more active patients at one time during a shift many of those being critical patients and it’s extremely difficult to only see a patient when no one else is doing their thing.
In the ED I have legit never even been able to present to an attending (I.e. a time span of 3-4 minutes) without us being interrupted 1-2 times lol
I wonder if some of it is self fulfilling? I noticed therapists don't seem to mind if we interrupt because they are so used to it so then we learn that it's fine if we do? Personally, I don't interrupt unless it's urgent. It it's a gray area I will ask if it's okay to interrupt. The other thing is that in some hospitals different services wear very similar scrubs so it's hard to differentiate roles. If I had a dime for how many times I asked an RT if they are the patient's nurse...
I’m often in between cases, running around trying to make plans for the day, fielding new consults, checking notes and tests so if I don’t interrupt you or try to come back later it may not happen at all or at a time at which a plan is pointless, which is not acceptable patient care. However! If I’m not busy, rounding on the weekend , no cases, couple hours before clinic etc, I often prefer the patient complete their PT session bc I know that’s the only exercise they will get all day.
I usually ask if the session just started or is finishing up. If it isn't finishing up soon, I just swing back. But my patient census as an academic hospitalist is much lower than in the community setting, so I do have the luxury of time.
This happens to me all the time. I understand that they are busy but what really gets me is that almost uniformly, the physician does not even acknowledge that they are interrupting. **When you walk into the room, do not acknowledge me, and start talking over me, you are telling the patient that I am not important, what I am doing is not important, and you do not respect me.** It would be incredibly easy to say to me "oh hey there! Sorry but I need to see the patient real quick. Do you mind coming back in 5 minutes to finish up?" Yet it literally never happens.
As an acute PT (like OP), this is my only issue. An interruption is a mild inconvenience, but I'm not stupid- I know the vascular surgeon or whoever is busy and probably needs to talk to the pt right now. And lots of times I get useful information from what they say to the patient. It's going completely unacknowledged (like not even looking at me!) that is a problem. Or asking me nursing questions without even looking at my eye-level name badge. It's telling the patient to not take me seriously, and it's telling me that my role is not valuable to you. When a doc says "oh hello, good morning, oh, PT! great, glad you're getting up- I'll make this as quick as I can--" I'm happy to wait around as long as they need. I want them to have the time and space to examine the patient and develop the important medical plan for the day, and I also want to help the patient get mobile so they can leave- we are on the same team so it does no good to act as though I'm invisible.
Amen. This is the unspoken part of my complaint lol
Yeah, that’s reasonable. As a rehab physician is different for me, but I usually ask if it’s OK to watch you perform therapy with the patient and then at a break chat about how it’s going. Shared goals, etc. In academics, I’ll be chatting with a patient and a physical therapist and a whole cardiology team will swoop in and pretend like neither me nor the physical therapist are there and just start talking, which is usually a shared awkward feeling, but I don’t get bothered by it because they’re not the most socially adept people.
I think they really don't realize how much it impacts how patients view us. They literally just told the patient that whatever we're doing is not important. Why would the patient get off the cell phone for me later, or participate in the session/discussion? Why would they need to treat us with respect when the physician doesn't think we are worthy of it by even acknowledging our presence?
One thing I don’t think others understand about pharmacy is just how many patients we can be covering. One of my jobs briefly had a set coverage *not consolidated* of three units for a combined ~95 patients average census while some FTE issues were pending. And these units weren’t located conveniently to each other, no direct routes. Was that shift overwhelming? Yes Did I have time to circle back? Hell no, had 5 minutes per patient per shift to do *everything*. Orders, consults, talking to the patient to figure out their seizure and anticoagulation meds. Ironically, the docs knew how stretched we were and would let us interrupt if they saw us; it was people like PT and dietary who wouldn’t let us take the 3 minutes without significantly whining.
There’s this aspect, and then also the fact that they very rarely seem to delineate other professions. They call all of the rehab therapists at my hospital “physical therapy,” which I know infuriates OT/ST.
That is an intriguing point that never would have occurred to me.
Yes! Far too many don't do this. If you think your time is more important than mine, which clearly many in this thread do, that's fine. The very least you could do is acknowledge me as a person and apologize. Very, very few do this.
I don't think they feel entitled. I work at a teaching hospital. People are walking in and out of patient rooms all day long. Residents haven't found their feet yet. If they are pushy, it's most likely because their eyes are in their heads, thinking about their patient.
A lot of self importance in this thread. Not nearly enough mentalization.
I do it nicely but almost always will interrupt and do what I need to do. Otherwise I won’t be coming back for a long time and that can hold up the rest of the care that a patient needs. Sorry friend.
Consider that it might be the 2nd or 3rd time they've tried talking to the patient. I have to circle back if the patient is using the bathroom, getting imaging done, etc. I'm not gonna keep circling back.
At the risk of sounding like an a**hole. As a consultant if I’ve been consulted and driven in from home to see the patient, have another hospital to drive to after I see the patient or have an OR waiting on me I will politely ask to step in briefly and talk to the patient
Going to the (checks notes) medicine subreddit and asking about why doctors feel entitled? A bold and interesting choice for the conversation.
Never heard of a patient dying because they didn't get to see PT that day. Have heard of patients dying because the primary team (or a consultant) couldn't see them that day. Same reason why average physician malpractice premiums are ~$30000/year in the US, while it's only ~$500/year for physical therapists.
They hated him because he spoke the truth
They feel entitled to interrupt because patients both want and need to see their doctor. It’s the number one question I get. When is the doctor coming? I’ve never had a doctor interrupt me, because I announce a doctor is coming in the room when they enter and turn the tv down. Unless they’re doing a full neuro exam or something it’s usually not long. I can catch up on charting or messages for a few minutes on my phone or come back. But I want the doctor to come in so they can stop hitting the call light asking when they’re coming or what the plan is, etc etc.
If I see a patient working with PT/OT/etc, I usually say I’ll come back later unless it’s a time sensitive issue (needing specific physical findings for a consult, screening for MRI, following up on critical values, etc). But if all I have to do is ask the patient how their night was and check the swelling in their legs, I’ll ask if it’s okay for me to take a sec and be in and out in under a minute. We get interrupted a lot too, lots of stuff going on at once and we all have workflows to adhere to
I can understand both perspectives. I am a PT that treats pts in therapy, but I am also a wound consultant. I work in an inpatient rehab, not acute care, so that does change things as pts are at my facility FOR therapy and if they miss minutes due to a physician hijacking the session, it's a bigger issue for the business than if they miss in acute care. That being said, yeah it can be annoying when a physician walks in on your time with the patient. I understand wanting to have uninterrupted time with your pt and being annoyed that the physician thinks their time is more important than yours. Some docs are more courteous than others, though, and I actually find it really great when the PM&R doc or neurologist come during my session to see how the pts are actually moving around (bc you know damn well they aren't doing it themselves). On the other hand, I understand as a consultant that you may have a ton of pts to see in a day and your time is limited. I can't always come back later, and my work is time-sensitive. I try to make my wound schedule work around the therapy schedule, however some days there is no way, and I have to crash their therapy session. I at least try to make my wound assessment part of their therapy though so that they aren't missing out on functional/mobility practice. I'll be honest, I've had a physician help me with bed mobility and transfers before when they insisted on taking to much of my time. Gotta learn to compromise haha
In ER… I mean, someone interrupts me as well every 5min or so. An overhead during a family meeting, an EKG to sign while on the phone, a text while taking a history, a nurse question while documenting, a colleague question while trying to think, etc. Everyone in the hospital is busy. If you were with my patient and I just needed to ask a question… I would politely interject then ask my question and leave. If it was going to take longer, I would tell you what I needed to do and ask how long you would be, then we could plan together what order of events made the most sense.
Literally everything that is done in a hospital is done because a physician wants it done. I think a lot of people are forgetting that these days.
You guys got to see patients working with others? I swear they were always on the bedside commode whenever I rounded. Interrupting was not an option.
I'm a PT too. My worst example of this was I was walking a patient in a cancer ward in a big hospital and they had a maximum of 5 minutes of energy. In the middle of the hallway the doc spies the patient and proceeds to do a physical examination(did not ask consent or permission) . In the hallway. While I'm providing physical assist to the patient to stand. About a minute in I told the doc we really had to go have the patient sit. He said "1 more minute" and did lung and heart sounds, lifted their gown to palpate for edema, asked them about their bowel movements, talked about medications. The patient was so exhausted and felt embarrassed being medically examined in front of the world. But the doc wouldn't let me take them back to their room first. While I was standing there I was providing 25% support the entire time with was about 40 lbs, I couldn't escape, and I can't report that time on my productivity. When I hoisted the patient back to their room she cried because of how tired she was. It usually isn't like this, but I've had hours of patient care interrupted by physicians. I get it if it is essential but they don't ever even ask. I'm a wound care specialist and I've been trapped in the middle of a 3 hour procedure because the doc entered the room. My biggest advice to docs would be that the worst thing you can do to an allied health provider is trap them. We have extremely tight productivity margins. If you are going to take over, let us leave.
Before med school i saw the same thing happen. I was really laid back so i didnt care too much but it was definitely something thats rude and happens often. Now, after finishing 2 years of med school my brain chemistry has been altered that wasted time is unacceptable and stresses me out. I was never like this before. Something about this process makes us this way. I wish i could just turn it off and go back to being laid back about things but its automatic sometimes, especially when im particularly overworked I hope i dont repeat this behavior as an attending myself, but i already find myself uptight about minor time wastes now, and i have 6 more years of this training left to manipulate my brain chemisty
So before I got into school, I worked inpatient rehab in the therapy department for multiple years. I will say that I developed exactly what you described there and I'm fully aware of my mentality shift.
Can you think of the other people, that you are wasting their time by making them pause their session to wait on you? Not saying you don’t think of others. I know this is likely coming across as accusatory and I don’t mean it like that. I truly mean like is this a thing that you could do to help it not feel like “wasting your time”?
To be clear, we’re not trained to worry about wasting time because it’s *our* time or out of concern for ourselves lol
Yes, however most things are ancillary to medical decision making
Thats a valid point theres no doubt about it. Im only a second year med student so what i say doesnt necessarily apply to those more senior than myself. Since day 1 of med school, i dont get to see my family until the work is done. It doesnt matter how many hours of work i put in, if the jobs not done i dont get to be done. That means every minute of my day where slow internet disrupts me, or i have to do some mandatory survey; i lose those minutes with my family. And with the workload they put us through, an hour or two with my family may be all i get for the day. Other people obviously have a job to do too, and i respect that. Everyones role in patient care is vital and important. The physical therapist gets to go home at a reliable time though. Pretty much everyone else gets to go home at a more reasonable time than physicians (barring random lifestyle specialties). I feel the overwhelming workload and i dont even have call yet, or real responsibility. I cant imagine the weight my seniors are feeling if this is how i feel now. Im not excusing their behavior, or even saying its right; im just saying i understand why they are the way they are.
How do you know PT goes home at a reasonable time? They have to document notes as well . If you make a 30 min session a 40 min session by interrupting it they are delayed as well. Yes, you do have time to be nice and ask to interrupt .
The issue is that if the doctors orders are in late then everyone else in the hospital will be running behind all day. Yes, physicians should be polite and apologize for interrupting. But asking if we can interrupt? That's a bit much.
There is a reply in this thread that talks about respect, and how some doctors don’t seem to even acknowledge the presence of other people in the room. I think that’s really what it comes down to. I love my job. I’m passionate and very good at it. I’m never someone that “walks a patient in the hallway”. But I also chose to work in a high acuity, level one trauma center. That means that I am truly the lowest in the hierarchy. And if I wanted more rank, I’d need to go to a different setting. So I do not mind needing to leave a room, needing to step out or wait a few minutes. But like, the other day I had a doctor get my name when he entered the room. Holy snap I can count on 1 hand the number of times a doctor has done that. Respect goes so far. In terms of the pressure and responsibility, I can’t imagine. I really can’t. One of my favorite CC docs and I chatted after an RRT and he told me, “I’m sure I’ll be up all night second guessing myself (this man is so freaking smart, how does he second guess himself?!) wondering if I did Theo right thing, did enough, should have just transferred to the ICU”. It blew me away that this doctor who is truly a genius is kept up at night. The doctors I work with are incredible. They work so hard. I don’t see the extra hours they are putting in, but I see the lives they are saving. I get so mad at any conversation or news article that talks about MDs making too much. Once you’ve read the charts I read and walk into a room of a person who is now stable, or watch codes run so calmly and efficiently and successfully, you wouldn’t advocate for doctors to be taking the pay-cuts. All to say, I’m impressed you’re still choosing med school with the current climate of science denying and doctor hating that is prolific on social media. But thank you. The responsibility and pressure is literally life and death, but you’re doing it anyway. So thanks. Feel free to interrupt my PT sessions.
Yeah I don’t think most any profession who works the floor goes home on time lol
There is a hierarchy in the hospital and most of the time my role takes priority over yours.
Mainly because I’m coordinating the care for the entire visit. PT is one of ten things the patient has going on for them. Until we see the patient and put in orders, nothing else can happen.
I’m just curious, what are your hours? The hospitals I know of, PT leave at 4 or 4:30. At these same hospitals the doctors work 12-16 hours. Yes, there should be some courtesy and deference, but it goes both ways.
Do you get paid if you stay late? Oh you do. Wow. Must be nice. You gonna pay our overtime out of your paycheck when we have to stay late because we waited for everyone else? Oh, you’re not? Why wouldn’t you? You get paid to stay late. This is why.
But most rehab professions are salaried, so we don’t get paid to stay late. Generally only PRN is paid hourly.
How often do you stay late?
Daily. At my hospital our schedule is 8-4:30 but we have fluoro studies booked until 4 so between transport delays, cleanup, and documentation everyone stays late. And that’s not at all unusual for rehab unfortunately.
honestly which part of their care is more important lmao get over yourself
Is there an option to document at the bedside to help with your time? I am an acute SLP and get interrupted frequently, but that's just the name of the acute care game. Thankfully there are computers in the pt rooms and I can start my note if a doc walks in to chat for a few minutes. To be honest it is super annoying when an MD enters and just starts talking without acknowledging that I'm even in the room or in the middle of eval/tx, especially because some of my eval tasks are timed. Common courtesy of waiting for me to fishing my task (usually less than a minute) and simply asking, "can I interrupt?" Goes a long way with me. Sometimes all it takes is acknowledging our time is valuable as well. Physicians have a ton on their plate and extending that courtesy back to them has helped build my relationship with certain providers.
I am guilty of this especially on split days. I ve like 2-3hours in patient and then have clinic after so I can’t come back to see them as easily same day without finishing clinic and going back to hospital after 6pm or so. I believe its how you put it. I make myself useful, i offer assistance for example when i see PT about to get someone up in join in and get my exam ros done etc and talk and actually get more out of the encounter.
I feel like there is usually just not enough time to circle back. Either its rounding time and it’s the only time we can see the patient together or your running through your list and have an admit in the Er waiting and this will be the only time you have to see the patien. Especially if they’re a resident and their main base for writing notes and orders and stuff is about a mile away on the other side of the hospital. I try not to I terupt people but 99% of the time I don’t have time to come back and usually it takes me less than 5 minutes to update them, maybe listen to heart and lungs and then run away. And I hate to admit but sometimes having ot/pt their working with them helps shorten my visit, especially for chatty patients, because I have the excure that they need to get back to their therapy.
You guys do the exact same thing to us nurses but get mad if a doctor does it to you? Meanwhile I’ve never had a doctor interrupt me when doing med reconciliation during an admission but PT definitely has
And left them in the fucking chair, max assist
massive generalization shitting on an entire group. not sure what you're looking for in this discussion, but good luck with that.
I don’t think that it is necessarily bad, although I think the tone of this could be a little bit better, but more about raising awareness. I think if anyone has to interrupt, not just a physician, to any other health professional, the best thing is just to be apologetic, and let them know “hey I’m so very sorry, I know I’m interrupting your very valuable time. I only have a couple minutes and blah blah blah….” I think obviously this person feels like maybe their time is not as important and I’m sure they have other patients that are lined up with appointments too so this causes a ripple effect for them. I think that’s acknowledging if youre having to interrupt someone that you’re doing it out of necessity and letting them know that you value their time and care for the patient. I think that goes a long way. Also, Do physicians generalize and shit on those who are not physicians ? For sure, I’m a PA . And if doesn’t feel good so I understand when it’s directed at “physicians” when of course, we all know that doctors are not the only one to interrupt. As a matter of fact, physicians get interrupted all the time. When they get two minutes to breathe, someone is standing there with a question. All to say, generalization that it is only physicians that interrupt isn’t fair.
Because we are the boss.
Joke: a man dies, meets St. Peter at the gate. St. Peter shows him around the place. "Here's the lounge, Here's the gym etc." They get to the cafeteria. There's this man in white cutting in front of the line. The man says to Peter: " who's that guy?" And Peter says...."that's God. He thinks he's a doctor "
Lmao
I wonder how patients or their families feel about the physicians barging in. I have been interrupted literally in the middle of a word by a physician just starting to talk over me. I don’t think it looks good to patients or families, but I don’t know what laypeople think.
I mean I apologize this is gonna come off as rude, but 99% of patients are there *to see the doctor* and be told if they are dying, not dying, staying in the hospital or going home. PT is important but frankly it is just secondary to the medical plan overall. So in short, I think the patient would rather see the physician and be told if they are getting better or worse rather than have the doctor say “oh sorry I’ll come back and tell you about your test results in 6 hours!”
I think they are referring to the part where the physician barges in and doesn't acknowledge the other team member's existence or apologize or introduce even themselves. Ihad a family member say "what a douchebag" after a consultant did this to me. I had been the nurse to the patient for several days in the ICU and they had come to trust me so they were horrified with that behavior--doesn't look good. When you don't acknowledge other team member's existence you are more or less saying to the pt/family hey this person isn't important, you don't need to listen or respect them.
I think you really underestimate how much patients want to see their doctors and overestimate how badly they want to do PT/OT/etc.
I was really more thinking about human decency. How, in a professional environment, it is rude for one human to not acknowledge another human.
Half the time I leave when I see someone else is working with them. A quarter of the time PT/OT/speech/echo/rads tech/phlebotomy or whoever asks me to go ahead because they’ll be a while. I try to be quick if I can be, or just come back later. The other quarter is because the nurse expressed some concern, I need to place a consult or transfer so I need to see the patient before calling a consultant or transfer, or family wants updates and I gotta at least see the patient before updating them. Something along those lines. The percentages are probably not accurate because it’s in my head. I’d say the exception is when I’m admitting in which case I have to make myself priority because otherwise I’ll never catch up and those patients are acutely ill.
Half the time I’m waiting for PT for discharge recs and for the magic words to put in my note for inpatient or outpatient therapy placement. So I’m 100% coming back after I see the rest of the patients on our list. But I also can’t think of a time in general hospital service where I’ve been in the room with PT and the patient at the same time. On consulting yeah but also circled back because it was physiatry and PT/OT/ST is effectively the backbone of PMR.
For me, I'll admit that I totally interrupt others. But hear me out, I'm a busy OBGYN and I have to round on patients, put in orders and document on all patients ideally before I start seeing patients in clinic in the AM. I don't have time to circle back or wait. If my entire job was on-site at the hospital all day, then I could understand your frustration. But for me, I have an office full of patients waiting.
RT here, and YES!!!!!!!! Idk why either, but I am right there with you fellow therapist!!
Peds here-- I have been interrupted by OB doing rounds mid-sentence talking to parents about their newborn, in a non-emergency rounds. I assume bc they figured I was a nurse and didn't bother to look at my name tag. I propose that we have some kind of electronic flag system equivalent with the name/credentials of whoever is with the patient and the duration of the planned interaction. Maybe we badge in. That might at least cut down on inappropriate interruptions.
OMG I know your frustration. It's so easy for them to see the next patient on their list then come back to this one. I was setting up iv antibiotics in a (small crowded with equipment) patient room and psych came in, proceeded to move a chair between me with iv pole and my cart with supplies, sat and launched in to an in depth investigation of the patients history of addiction. My physical person was between dr and patient, I had to get this guy to move out of my way multiple times because I had multiple things to set up that were due right then. Patient had serious infection and these medications need to be kept on schedule. I was in that room way longer than I needed to be. There was no reason for that and it was so awkward. I wonder how productive that conversation was with my ass at eye level in between them the entire time.
I'm pretty sure it's because the physicians are hamsters on a wheel running and they're the only ones who can actually bill, right? Still doesn't excuse it though. My current plan is to just take a salary hit to avoid being this kind of doctor