keagirl gives an example of an inappropriate call:
Do patients think that on-call physicians stay up all night long by the phone in clinic, eagerly awaiting the next page? (and for free for that matter since we don’t bill for any of our telephone calls). Do they not realize that when calling late at night, you are waking someone who has a full work schedule the next day, and that it has better be an emergent, or at least urgent situation.
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{ 11 comments }
Actually, I have asked patients who call in the middle of the night with inane questions, that very question…”Do you think I’m up all night.” Almost all believe that I am up all night when all call and did not think that they were waking me up. So I try to educate my patients in the office about this. Still last night I got a call at 4 AM from one of my patients who was in the ER (I did not send her) and in the middle of being seen who didn’t like what the ER doc wanted to do ( a pelvic exam)….sigh
Storkdoc
Most Clinics/HMOas etc will screen the calls and then relay them to the oncall Doc.
Most patients don’t know what
“urgent” means and sometimes will call, when they shouldn’t and other times, will wait, until it’s too late.
The HMOs do not provide any screening or call center for me, and if they did, the patient would still dial my number. I have an answering service, but that is staffed by operators.
I once had a patient call me around 1AM, with some complaint (I can’t remember what) asking if I could call something into the pharmacy so he could pick it up in the morning.
I don’t know if this is feasible, but I think a system where a credit card # is obtained by the answering svc & charged by the minute would be appropriate.
After all, as many non-medical bloggers on these sites would say, “being a doctor is just another job, nothing more, nothing less” and one should be compensated adequately for their time, just like e.g. lawyers.
I think about $75 per fifteen minutes would be appropriate. That’d certainly cut down on bogus calls in the middle of the night.
This is one of the huge changes in medical practice over the last 20 years. In the 80’s, I never got inappropriate after hours calls. Most were unnecessary from my perspective but the patient didn’t have the knowledge base to know that until they talked to me.
By 2000, it was unbearable. I think the big HMO contract and moving from solo to a big clinic were a large part of it. I got calls in the middle of the night to schedule appointments. I got calls after hours asking me to reconsider long-term therapy of chronic conditions–and got shocked responses when I pointed out that I was at home (or church, or shopping) and didn’t have their chart in front of me and so could not possible address such a thing. Refill requests began to flow in at all hours–and often when previous Rx were still valid and active.
I no longer take call. I will never take call for an institution again. Maybe if I go solo, where I can anticipate some mutual consideration (or maybe not–my state board doesn’t require it). But is clear that if you are part of an institution, you are expected to be 100% all the time just like the water that comes out of the faucet–you are not respected as a human being who just happens to have a calling and a profession, but still a human who deserves consideration and respect of your person.
When I was a doc doing my military time I got a call 0530 sunday morning from a dude wanting to know his cholesterol results.
From that day I decided I would never have an office practice and went into an ER residency.
Now I try and guard the PCP/specialist’s sleep unless it is a true emergency. No, your doctor is not going to be here at 3am. No, I will not call him.
anon 7:31 –
THANK YOU!
I have no problem calling anybody at anytime for anything. If I’m up all night seeing your patients while you’re asleep snuggling with your significant other, the least you can do is wake up and call me back so I can put your name on the chart as “Dr. Soandso notified.”
That way, when your patient cries to you about the mean ER doc not admitting them, you can’t weasel out and throw it back at me by claiming that you weren’t notified. Or if they have a spot on their chest x ray or an INR that’s a bit high, and they decide not to follow up as I recommended, the ball is in your court.
Get it?
“when your patient cries to you about the mean ER doc not admitting them, you can’t weasel out and throw it back at me”
I NEVER downtalk another doctor to my patients, even though these days patients often ask for validation that another doctor they saw treated them poorly. This is bad practice & only hurts everybody.
I explain to patients that it often isn’t necessary to be “notified” of a slightly elevated INR at 3am if the PATIENT takes some responsibility and follows up as instructed.
Remember, working in the ER means doing a shift and then it’s over, whereas the primary might get woken up on a tuesday night 3 times in the middle of the night, only to have a regular work day the next day.
Sometimes, the ball needs to be in the PATIENT’S court. The prevailing mentality otherwise nowadays is pitting doctor against doctor, and unduly validates the lack of personal responsibility among patients, & ultimately hurts doctors & patients alike by ruining access. That, in turn, overcrowds ERs!
Scalpel
Thanks for reminding me why I could never work in an ER. 50% of what you do is little more than CYA. You wonder why the rep of many ER docs is little more than triage nurse?
scalpel, is it too much to ask you wait 3 hours until 6 AM? At least then my son has already woken me up.
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