the Telephone Game

I can only assume everyone played this game as a kid, but as rescuers, we play it everyday.
For those not familiar, you and your friends sit in a circle and one person whispers a sentence to the person to their right and so on and so on. The gist of the game is to see how much the sentence changes from person to person either by forgetting the exact words, or rewording it for whatever reason.

Funny thing is, I get to see each step of the game as it goes. This was brought to mind one morning when I got another one of my blog starting runs when I asked, “You called 911…for this?”

The game started when the client (See Glossary of Terms) had a sore throat and went to the doctor yesterday. Our story should end there, but this is managed care, so of course there is more.
This morning, 10 hours after starting the course of antibiotics, our citizen phones the expensive private health care nursing advice line. According to her, she told the nurse, “My throat still hurts, can I use a throat spray to eat? It hurts to swallow.”
The nurse told her to “…hang up, call 911 and tell them you need an ambulance.”

Our client calls 911 and, in clear words, tells the call taker she needs an ambulance for a sore throat.
Call taker follows instructions coding the call as a 26A25, Non-emergent sore throat. It worries me the 911 system even recognizes this, but…
The dispatcher changed the call to a 11D2, choking with difficulty breathing.
The notes on the MDT state she is unable to swallow.
As we arrive code 3 as instructed, we are met by a young woman with a diagnosed and medicated case of strep throat.

“Did you call your doctor today?” I ask after checking all vitals without disturbing findings.
“No, the office said he was too busy, they had me call the nurse line.” She hands me the card.
“What did the nurse say?” I can’t wait to hear this.
“To call 911 for an ambulance.” She says with a small laugh.

After a small conversation I discovered she didn’t feel different, just wanted advice on a throat spray so she could have breakfast. Her throat hurt, but no more than yesterday.

We went full circle in the telephone game this time, where the sentence was the same at the beginning and end, but it was all the junk in the middle that got messed up.

Maybe folks should be able to call us directly in the ambulance for advice since the dial-a-nurse seems to default to us most of the time anyways.

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27 thoughts on “the Telephone Game”

  1. Happy, you need to put your reporter hat on and call the dial-a-nurse. Why on earth would they tell the client to call for an ambulance? We need answers for their stupidity.

    1. Easy. The perceived erasure of liability on the part of the dial-a-nurse by “passing the buck” onto EMS. They get the premiums and we get the workload. Capitalism at it’s finest. Now imagine if I had the authority to call that same nurse back and tell her to give honest advice.

      1. I would love to give honest advice! However, honest advice might get me sued up to my eyeballs. As an ER nurse, when I receive calls from patients asking if they should come to the ER, if it is a situation where it is not clear cut that they definitely should come in, I try to put the decision back in the patient’s hands by giving them information and alternatives. I have to tell you I hate these calls. You always wonder a) did you get the full story from the patient so your decision making was informed? b) does the patient have the intelligence and common sense to take good medical advice and use it sensibly.

        Don’t be too hard on telephone nurses. They are trying to make a decision based on limited and possibly corrupted data.

  2. Happy, you need to put your reporter hat on and call the dial-a-nurse. Why on earth would they tell the client to call for an ambulance? We need answers for their stupidity.

  3. This is so true! A patient (“client”) trying to do the right thing by asking a simple question about a simple problem is led by someone, that should know better, into the realm of calling EMS to “solve” the problem. It starts with the doctor’s office that is “too busy” to take the phone call, then goes to the managed care “dial-a-nurse” who has no apparent personal vested interest in solving this person’s problem and finally to EMS, who is left to solve the problem.

    EMS is constantly becoming the stop gap for many situations like this. We NEED a way to meet this need without responding with undue haste to a situation that could be solved by having a simple conversation, with all the facts in hand, about the right throat spray to use to make it easier to swallow food. The healthcare system FAILED this person miserably!!

    It seems that we have taken the ability to think out of the hands of people that should be doing some thinking. There is legalistic thinking that is rigidly contained inside the box and then there is the ability to take the facts…all of the facts…and making a decision or initiating a response that is truly appropriate for the situation.

  4. This is so true! A patient (“client”) trying to do the right thing by asking a simple question about a simple problem is led by someone, that should know better, into the realm of calling EMS to “solve” the problem. It starts with the doctor's office that is “too busy” to take the phone call, then goes to the managed care “dial-a-nurse” who has no apparent personal vested interest in solving this person's problem and finally to EMS, who is left to solve the problem.

    EMS is constantly becoming the stop gap for many situations like this. We NEED a way to meet this need without responding with undue haste to a situation that could be solved by having a simple conversation, with all the facts in hand, about the right throat spray to use to make it easier to swallow food. The healthcare system FAILED this person miserably!!

    It seems that we have taken the ability to think out of the hands of people that should be doing some thinking. There is legalistic thinking that is rigidly contained inside the box and then there is the ability to take the facts…all of the facts…and making a decision or initiating a response that is truly appropriate for the situation.

  5. The fault here (other than the nurse) lies with the dispatcher. If the 9-1-1 operator spoke with the patient and coded the call correctly, why did the dispatcher change the type code and priority? He should have to explain that to his supervisor, in writing.

    Ryan, we don’t need a way to meet this need, we need a way to stop doctors, nurses, and other so called health care professionals from dumping their problems and lack of resources on us. Civil or criminal penalties would be my solution, but I also know that the politicians won’t do that.

    1. Indeed penalties would get their attention, and if we got that penalty straight into our pockets we might understand the occasional misunderstanding.
      You and I both know why this non emergent call got bumped up, the magical time target was likely approaching and to keep he bar graph from changing colors this week, it was upgraded and “flushed” out of the call center with a “successful” call to dispatch time.

  6. The fault here (other than the nurse) lies with the dispatcher. If the 9-1-1 operator spoke with the patient and coded the call correctly, why did the dispatcher change the type code and priority? He should have to explain that to his supervisor, in writing.

    Ryan, we don't need a way to meet this need, we need a way to stop doctors, nurses, and other so called health care professionals from dumping their problems and lack of resources on us. Civil or criminal penalties would be my solution, but I also know that the politicians won't do that.

  7. Indeed penalties would get their attention, and if we got that penalty straight into our pockets we might understand the occasional misunderstanding.
    You and I both know why this non emergent call got bumped up, the magical time target was likely approaching and to keep he bar graph from changing colors this week, it was upgraded and “flushed” out of the call center with a “successful” call to dispatch time.

  8. Easy. The perceived erasure of liability on the part of the dial-a-nurse by “passing the buck” onto EMS. They get the premiums and we get the workload. Capitalism at it's finest. Now imagine if I had the authority to call that same nurse back and tell her to give honest advice.

  9. I hate when doctors and nurses call 911 for a patient transport rather than direct to the private ambulance. It seems the only reason is because they want the patient out of the office NOW because they are taking up a room. I never thought someone would expects a fireman to take over from a doctor on a medical problem.

  10. I hate when doctors and nurses call 911 for a patient transport rather than direct to the private ambulance. It seems the only reason is because they want the patient out of the office NOW because they are taking up a room. I never thought someone would expects a fireman to take over from a doctor on a medical problem.

    1. Oh, I forgot to say something … I think you should inquire with your Dispatch Centre to see why the Dispatcher thought it was necessary to change a 26A25 to an 11D2. Ultimately sending an ambulance lights and siren to a person with a sore throat, when an ambulance should have driven over with no lights or siren to the pt locate.

      If the pt was having trouble breathing it should have been determined earlier in the call interrogation, and coded as an 06C or 26C – card 11 should only be used for CHOKING calls, that is why it is called the CHOKING card, not the ‘I have a sore throat, and can’t swallow without it hurts’ card.

      (Okay, I sound a little b!tchy here, but this is the prime reason why EMS responding crews dislike Dispatch and think we do a horrible job.)

  11. Oh, I forgot to say something … I think you should inquire with your Dispatch Centre to see why the Dispatcher thought it was necessary to change a 26A25 to an 11D2. Ultimately sending an ambulance lights and siren to a person with a sore throat, when an ambulance should have driven over with no lights or siren to the pt locate.

    If the pt was having trouble breathing it should have been determined earlier in the call interrogation, and coded as an 06C or 26C – card 11 should only be used for CHOKING calls, that is why it is called the CHOKING card, not the 'I have a sore throat, and can't swallow without it hurts' card.

    (Okay, I sound a little b!tchy here, but this is the prime reason why EMS responding crews dislike Dispatch and think we do a horrible job.)

  12. There’s a big problem with offering advice over the phone, whether you’re a nurse at a call center, or the ER nurse who has one of these type of calls on the line. The problem is that lawyer in his fancy car, ready to chase that ambulance. If, as a nurse, you advise a patient to treat at home, and that a trip to the ER is not necessary, and that patient develops any kind of worsening of his condition, a complication of his condition or God forbid, dies, the first call is to the lawyer. The default to “Call 911″ or “Come in the ER if you are not comfortable at home.” is directly because of this fear of being sued. Phone triage and its cousins are made exceptionally difficult by the fear of the law suit, and the position has become one of extreme caution on the part of nurses answering phones on Nurse Lines and in ERs all over. I wish it wasn’t this way, but I think that hospitals and other health care providers live in fear of the patient or his close kin getting on the witness stand and saying, “Well, the nurse said I didn’t have to come in,” or “The nurse said not to call 911.”

  13. There's a big problem with offering advice over the phone, whether you're a nurse at a call center, or the ER nurse who has one of these type of calls on the line. The problem is that lawyer in his fancy car, ready to chase that ambulance. If, as a nurse, you advise a patient to treat at home, and that a trip to the ER is not necessary, and that patient develops any kind of worsening of his condition, a complication of his condition or God forbid, dies, the first call is to the lawyer. The default to “Call 911″ or “Come in the ER if you are not comfortable at home.” is directly because of this fear of being sued. Phone triage and its cousins are made exceptionally difficult by the fear of the law suit, and the position has become one of extreme caution on the part of nurses answering phones on Nurse Lines and in ERs all over. I wish it wasn't this way, but I think that hospitals and other health care providers live in fear of the patient or his close kin getting on the witness stand and saying, “Well, the nurse said I didn't have to come in,” or “The nurse said not to call 911.”

  14. I would love to give honest advice! However, honest advice might get me sued up to my eyeballs. As an ER nurse, when I receive calls from patients asking if they should come to the ER, if it is a situation where it is not clear cut that they definitely should come in, I try to put the decision back in the patient's hands by giving them information and alternatives. I have to tell you I hate these calls. You always wonder a) did you get the full story from the patient so your decision making was informed? b) does the patient have the intelligence and common sense to take good medical advice and use it sensibly.

    Don't be too hard on telephone nurses. They are trying to make a decision based on limited and possibly corrupted data.

  15. imo, dial a nurse lines are a waste of good resources and nurses who should be doing direct patient care in hospitals or offices instead of sitting by the phone. I called one once for advice on how to deal with my asthma (got some stupid asthma packet in the mail and it had the nurse line on it with a “for more information call….1800 we r dumb” and got told essentially the same thing, that i should just go to my doctor, or call 911 when i wasnt even having an emergency. Then when i implored the nurse as to her advice…. she basically told me that they really CANT give out medical advice over the phone and are trained to basically tell people get help from your doctor or the ER. So calling those lines are NOT going to get anywhere except to overburden a system that is already falling on its knees because its taxed so much.

  16. imo, dial a nurse lines are a waste of good resources and nurses who should be doing direct patient care in hospitals or offices instead of sitting by the phone. I called one once for advice on how to deal with my asthma (got some stupid asthma packet in the mail and it had the nurse line on it with a “for more information call….1800 we r dumb” and got told essentially the same thing, that i should just go to my doctor, or call 911 when i wasnt even having an emergency. Then when i implored the nurse as to her advice…. she basically told me that they really CANT give out medical advice over the phone and are trained to basically tell people get help from your doctor or the ER. So calling those lines are NOT going to get anywhere except to overburden a system that is already falling on its knees because its taxed so much.

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