Almost every phone call I receive when on call that comes from a junior I don’t know follows the infuriating “sbar” mnemonic. They give me the situation, then the background, their assessment and then we come to an agreed recommendation. You can read about it here.
This is a real conversation with minimal changes made to protect confidentiality.
“Hi I have a 76 year old lady here with diarrhoea and abdominal pain. She came into the hospital, ummmm, 7 weeks ago with a fractured neck of femur and that was fixed, I think but then she was diagnosed with some sort of cancer, ummm, she’s quite unwell, I think it is a lymphoma and she had chemo I think and an operation on her groin maybe and then she seems to have been well. But then she got a DVT, which she needed a filter for, and then she had a chest infection, she’s in a lot of pain….”l
This woman was unwell with ischaemic gut, she had a low blood pressure and was in a bad way.
Nowhere in the SBAR is there scope to override the endless and irrelevant to drivel, which is not relevant in deciding whether or not I am coming to see her.
Too much Background and not enough Assessment, cut to “Hi we have a really unwell woman here and you need to come and see her now”.
I’m old fashioned, I see everyone that is referred to me, unlike the new younger trainees who like to give telephone advice based on the SBAR. My advice is don’t ever do that, it’s shoddy medicine and indefensible medico legally as there is often no record in the notes of what they said to you and what you said.
I let this person ramble on with the tedious SBAR story, we still hadn’t reached the point of the story about the hypotension. I interrupted them “listen, you sound worried about this lady, do you want me to come now?”. The poor junior on the other end of the phone was delighted “oh yes please, she’s not well, do you want her 10 digits?”.
The ability to give a concise and relevant history is a skill that comes with time and practice and watching others. Most newly qualified doctors don’t have it, those who do tend to lose the ability under pressure.
Hospitals have changed and we have more and more out of hours care delivered by people who don’t know the patients they are covering. We need to instil confidence in juniors to phone up a registrar or consultant and say “I need you to come now. This person is really sick”, not give them stupid protocols for referring things, SBAR has a place but it is not in the referral of the critically ill.