The Tired Doctor and Frivolous Phone Calls
An old joke:
The tired doctor was awakened by a phone call in the middle of the night.
"Please, you have to come right over," pleaded the distraught young mother. "My child has swallowed a contraceptive."
The physician dressed quickly; but before he could get out the door, the phone rang again.
"You don't have to come over after all," the woman said with a sigh of relief. "My husband just found another one."
Though this is just a joke, it does provide the lead-in for the discussion of frivolous calls to doctors and most disturbingly when the calls are at night. There is no doubt that often those calls which contribute to the establishment of a tired doctor are calls particularly at night that disturb the doctor’s sleep. The question is when is a phone call from a patient frivolous and when is it not? Are any phone calls to a physician “unworthy of serious attention”? If the answer is “yes” then one may ask: how can a physician evaluate a patient’s call? And finally, should patients themselves be responsible to screen their own call before placing it? Or if the patient makes the call, one should assume the call was already screened for importance. On the other hand, should every call received by the physician be taken seriously and some definitive action should be taken by the physician. I am not going to try to respond to these questions for you now but instead I would like to read the experience and views of physician and patient visitors to my blog. ..Maurice.
posted by Maurice Bernstein, M.D. @ 11:10:00 PM
9 comments
9 Comments:
I do not think there is enough patient (self)responsibility in our broken American health care system. Our immediate gratification culture has the expectation that everyone -- including physicians -- fix their problem now.
I was on call last night and got a couple of calls from people in our practice who have been sick for 2-3 weeks, but at 2am they got tired of dealing with it and called me for advice.
But, we've all heard a story in which the doc thought a late night call was "unworthy of serious attention," and had a bad outcome that night or the next day.
What's the answer? I look forward to other opinions on this topic.
Dr. A., I think that the issue of patient responsibility is one which has many facets, one of which is with regard to phone calls. The others have to do with being fully open to the physician regarding medical history, compliance with medical followup, testing and drug therapy and, in these days of patient autonomy, personal decision making after full education by the physician. Patients, along with their physicians, must participate actively in contributing to their better medical care. ..Maurice.
I agree with most of was said here, and I would never dream of waking my doctor at night. If it is a real emergency, I'll call an ambulance or go to the ER; if it is not - it can wait till morning. The only exception I can see is if I had surgery or something like and the doctor specifically asked me to call in specific cases. I am not sure if it is a matter of personal responsibility or just simple human decency: I don't want to be woken up at night, so I don't do it to others unless it is a real emergency. Really, I'll be fine with doctors charging extra (and cash) for off-hours phone consultation - this will reduce the number of calls to real emergencies (and shy people who don't like to bother others will be less reluctant to call if they have a real need).
I have to comment, however, on this line, even if it is off-topic:
in these days of patient autonomy, personal decision making after full education by the physician
Full education means presenting complete and honest information abouut risks and benefits of testing/drugs without omission, without downplaing the risks or "framing" of the information to make the benefit appear larger. I am yet to see a doctor who doesn't "frame" information when he/she talks about preventive care. Even when there is no risk of lawsuit - like on doctor's blogs or clinic websites I see quite a lot of "framing".
By framing I mean
a) using meaningless relative risk (reduction) numbers instead of absolute risk (reduction) or NNT.
b) using cumulative lifetime (up to 85) risk instead of 10-year risk
c) using meaningless data "so-many people die from this condition every year". How does this relate to my chance that a specific test/treatment will prolong my life?
d) completely "forgetting" to mention risks. How many doctors mention overdiagnosis and overtreatment when they talk about screening?
So unless doctors are honest with me, how can there be "shared decision making"? Does informed consent even apply to preventive care? Yes I know about the risks of lawsuits, but doctors do this even on their blogs and websites.
I'm sure our pediatrician laughed at me. I was (am still, until September) a first-time mom. My very fussy baby was constantly screaming or fussing or nursing (we had horrible nursing problems that probably caused a lot of the fussing and screaming). One night at about three weeks of age, he slept for more than three hours. And he was still sleeping. I, of course, was awake after forty-five minutes, as that was his usual sleep duration.
I was worried about him! He had never slept more than 60 minutes at a time. And I had not had more than 90 minutes of sleep at a time since our first night home from the hospital, so I probably wasn't thinking clearly.
As he slept peacefully on I grew more and more concerned and at 2 am called the pediatrician. He was very calm and respectful to me and gently explained that as they get older babies will often start to sleep longer and if he was breathing fine, I shouldn't worry or wake him.
I really felt awful called the doctor for nothing important, but I felt much better and was able to rest a bit myself before the baby woke in another hour (5 hours total sleep!).
He didn't sleep that long again until he was almost 8 months old.
I had chosen a doctor who was available by phone 24/7 and although I felt terrible for abusing the poor man, I was very grateful he was there to calm me down and was so kind to me.
I know you all will think it was silly and frivolous, but it didn't seem so to me. :)
In the ER it is amazing the number of people who come in and within 5 minutes say "did you call my doctor?" No- they are asleep, and your condition is being handled by the very competent physician at your bedside.
We also get (mostly chest pain patients) who immediately request that we call their cardiologist. No labs have been resulted, the EKG is unchanged, and they know that, but they want the specialist notified "just in case." Why? I truly don't get it.
Middle of the night phone calls would be the bane of my existence if I was a doc. Families want to feel that you truly care, and for some that means 24h call, regardless of arrangements made for a covering doc. God bless the physicians who stay compassionate and sane at 2am.
ER RN wrote:
"We also get (mostly chest pain patients) who immediately request that we call their cardiologist. No labs have been resulted, the EKG is unchanged, and they know that, but they want the specialist notified 'just in case.' Why? I truly don't get it."
I think an explanation is that the patient has much uncertainty in establishing confidence and understanding with an ER doc who has not as yet shown up or has not as yet established that kind of relationship which, the patient fearing the consequences of that chest pain, dearly needs. ..Maurice.
ER RN
I think the answer to you question is simple:
Imagine if you suddenly forgot *EVERYTHING* you know about medicine. Next, imagine that you start having chest pains and are whisked away to the emergency room of your local hospital.
You're wondering if you're going to still be alive in an hour. How clearly are you going to think in that situation?
I hope this doesn't sound too confrontational, but this type of attitude is the very thing that frustrates many patients. Patients in the emergency room are often a) in pain, possibly severe pain b) terrified c) almost completely ignorant of biology and medicine. If you don't understand why people in those circumstances might say or do things that -- to you -- seem dumb, then I honestly don't know what to say.
How often does that really happen?
Isn't the doctor the one creating the options? On-call shifts / answering service / e-mail?
I agree with the anonymous comment written at 4 am. Not only are the patients overcome by their fear and ignorance of medicine, but there is a total lack of confidence in emergency care at the ER.
Before any test results come in or any real evaluation is made, patients are unaware of how long the process will actually take and even how long they have to wait for a doctor to come in and take the blood tests, let alone when the tests will come back.
I have been to the emergency room before, and the lack of confidence is extremely important to the patient. It is not uncommon nor is it unreasonable for the patient to request more immediate attention, even if it means to waken their own doctor in the middle of the night.
Not even the ER can determine when the patient can and will be seen by a doctor.
LW
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