Do you share direct contact information with patients?

I gave  a patient my cell phone number today.  I have been toying with the idea for a while and talking to various other physicians about how they handle it.  We have a 24/7 chain of coverage so that a patient can call at any time of the day or night and reach a pulmonary/critical care physician.  But not necessarily their physician, because, like everyone else, even doctors get days off.  It’s not that we’re not constantly semi-available.  I’ve had a surgeon call me back about a patient while he was in Switzerland for a meeting.  More recently one of my colleagues went away on vacation in Europe.  He asked me to cover his patients while away, yet he kept answering email questions from our clinic nurse about a variety of patient related issues.  He was hardly unavailable.  But direct patient questions to your cell? That’s a bit different.

I asked some other doctors what they did.  A breast cancer surgeon in Mississippi said he routinely gives his patients his cell phone, and still, instead of calling him, they will drive hours to the emergency department.

“I didn’t want to bother you,” they’d tell him.

“I went to a meeting and all the dermatologists said they gave their patients their cell phones.  I thought ‘if it’s good enough for the dermatologists, it’s good enough for me,’” he said.

An oncologist who has practiced all over the country, though, perhaps significantly, started practicing in a small town where he was also a volunteer firefighter, said he has been giving his patients his cell phone for the entirety of his career.

“8 times out of 10, I’m glad they called me!” he said.  “It saves time and I could direct the care, instead of them just going to the ED where they get back x-rays for their back pain.”  (Back x-rays being close to useless when evaluating back pain in a cancer patient.)

All the physicians who do this assured me that in the decades that they have been sharing their direct contact information with patients, they have had few abuse it.  “I could count the number of patients on one hand!” they each said repeatedly.

And yet, the vast majority of physicians I talked to were as horrified at the idea of their patients having their cell phones as I was!  I trained in Boston, and the intensity of care there, as well as the patient population is quite different from what I’ve found elsewhere.  When I was an intern, an excellent intern in my class switched to pathology.

“Why?” I asked, shaken, for if this stellar doctor couldn’t make it through the first year of residency, then what did that say for the rest of us?

It was a lot of things he said, it always is, but he also noted that he had made the mistake of calling a patient back with his cell phone without blocking the number.  That patient then proceeded to call him at all hours of the day and night demanding prescription pain medicine.  We all shuddered.

“We share ‘donor call’,” one cardiologist told me and I knew exactly what he meant.  At other institutions, as well, people who have donated particularly large sums of money have access to the cell phone of a cardiologist in that system.  Of course, theoretically, the rest of us, mere mortals, also have access to a physician 24/7 — it is via the answering service that has the call schedule for our doctors.  As someone who is part of that chain, I can testify that, at least in our practices, it does not get overused.  I haven’t had anyone call me at 1am to complain of constipation for 8 hrs, as one doctor in Boston experienced, nor the patients who would deliberately call at 5:30pm knowing that after hours they’d reach the on call physician directly, rather than relying on the clinic staff to pass messages to their doctor.

And yet. I gave a patient my cell phone to call me back regarding test results and while we still played a bit of phone tag, it was more effective than multiple messages via the clinic phone line, or the answering service have been in the past.  I started telling the clinic nurse to give select patients my cell phone number, and none have called me.  The one who did call, reached me via the answering service and was apologetic for not calling my cell phone number because she couldn’t find it, she said.

“I texted my doctor to ask him about my medication and drinking,” a patient said today.

“You texted him? You have each other’s cell phones?” I said.

Yes, apparently.  The patient sometimes asks a quick question over text and generally gets a quick reply back.  He doesn’t text late at night, though not always strictly during business hours, which is probably just as well.  It  may well be that 7pm is a better time for the doctor to reply than 3pm, depending on the work day.  He doesn’t ask complicated or urgent questions over texts.

“I figure if I’m that sick or it’s that urgent, I shouldn’t be texting you but should be coming to be seen,” he said.  “I try to be considerate, doctors are busy so I don’t want to abuse the privilege,” he said.

I might be ready to take the plunge, but still, I’d like to know if it would make any difference in my patient’s health.  Other well-meaning interventions, like a large VA study that assigned patients to education and a case manager that could follow up with them over the phone was closed early for surprisingly increased mortality in the intervention arm.     And so, I am planning on routinely sharing my cell phone with a subset of my clinic patients to see if I can improve their outcomes and their health.

Denitza Blagev is a pulmonary physician who blogs at mybetterdoctor.

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