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Overnight phone call

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  • hatton1 hatton1 
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    For many years in solo practice I paid a nurse to take the calls.  The nurses liked the extra money and I liked the sleep.  Now that I work for a large hospital the NPs take patient calls.

    #227394 Reply
    Lordosis Lordosis 
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    Joined: 02/11/2019

    My employer recently instituted a nurse triage line. It has decreased the calls we get. My clinic’s group is similar size with similar call schedule to OP’s but part of a much larger organization. I can say it’s nice but at the same time we’ve lost RN support in the clinic. I’d much rather have an RN every day at work which helps get me home faster daily than cutting the number of calls down a little for my home call.

    I believe my employer billed it as a provider satisfier as well as patient satisfier as a wider pool of RNs get back to pages or answer a phone faster than we can. Really, I think we were the only large organization without such coverage so we were playing catch-up. I’d take the angle of helping docs, helping pts with less wait time, etc etc.

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    Yeah I noticed that most other groups have it too.  That is kind of why I am interested.  I have been here 4 years so I am one of the newer docs.  I feel like we have a lot of “This is the way we always done it”  mentality here.  I think the fact that we have to take call is off putting to new recruits when there is a no call and higher paid group 30 min away.

     

    It is an annoyance to take call but If I had to pay for it I would not hire it out.  But if I did not have to that is a different story.

    “Never let your sense of morals prevent you from doing what is right.”

    #227399 Reply
    Liked by Tim
    Zaphod Zaphod 
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    Joined: 01/12/2016

    Medicolegally anything other than a clarifying question, you can see how the organization may start to lean on coming to ER, its really the only way to make sure. I wish it werent true, but its really just the environment and nature of the work.

    #227400 Reply
    q-school q-school 
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    In 2019, it is silly for an attending physician to field BS calls in the middle of the night and then work the next day. Either someone else fields the call or the on-call doc gets the next day off to rest.

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    could not agree more.  however, much (most?) of the time, the thing that is keeping on call doc working the next day is the doctor, not necessarily some administrator or hospital.

    we have the nurse line.  it decreases our calls but it doesn’t seem by much.  the algorithms always end with contact physician if questions remain, which they always do.

    the nurses always seem inclined to send the patient to the ED in the end.

    #227402 Reply
    Avatar Dilaudidopenia 
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    Status: Physician
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    Joined: 05/22/2016

    Maybe the overnight ER doc would field the phone calls :p

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    Ill do it for $100 / call

    #227519 Reply
    Avatar Bmac 
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    Joined: 10/21/2017

    This is such a classic example of how nobody likes call. I’m sure surgical and other specialists would consider q20 and 3 weekends a year phone call a dream come true. But there seems to be no amount or intensity of call that is not onerous.

    #227536 Reply
    Liked by Tim, Eye3md, EndoRobert
    Avatar Panscan 
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    Joined: 03/18/2017

    If the nurse line always sends the patient to the ed then I’m not sure the point of the nurse line. Thats why this is all messed up. It’s basically doctors saying I am OK with substandard care for quality of life.

    The whole point of calling someone is to be told no you’re fine or it can wait until tomorrow, see us in the office. A clear emergency would probably be obvious and not relevant to the discussion. Someone with crushing chest pain probably isn’t calling their pcp, they are just going to Ed.

    You’re adding value by avoiding needless Ed visits, preventing peolle from having needless scans which discover incidental findings that are likely bs and we have to follow for too long result in more bs scans and patient concerns. It’s a vicious cycle that is ideal to avoid.

    It is a huge problem in our system that the ed is so overutilized. We need to incentivize systems that prevent that, not encourage.

    #227584 Reply
    CordMcNally CordMcNally 
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    If the nurse line always sends the patient to the ed then I’m not sure the point of the nurse line. Thats why this is all messed up. It’s basically doctors saying I am OK with substandard care for quality of life.

    The whole point of calling someone is to be told no you’re fine or it can wait until tomorrow, see us in the office. A clear emergency would probably be obvious and not relevant to the discussion. Someone with crushing chest pain probably isn’t calling their pcp, they are just going to Ed.

    You’re adding value by avoiding needless Ed visits, preventing peolle from having needless scans which discover incidental findings that are likely bs and we have to follow for too long result in more bs scans and patient concerns. It’s a vicious cycle that is ideal to avoid.

    It is a huge problem in our system that the ed is so overutilized. We need to incentivize systems that prevent that, not encourage.

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    The hospital sees it as providing a service to the community. Unfortunately, because of the medicolegal environment that we’re in, we’re likely not doing the people that call in any favors.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #227589 Reply
    Avatar SValleyMD 
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    Panscan- I’m curious to hear how your current call schedule is structured? Sounds like you’re able to still find value in the service you’re providing your patients which is admirable.

    #227630 Reply
    Liked by nfldoc, Eye3md
    Zaphod Zaphod 
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    Joined: 01/12/2016

    If the nurse line always sends the patient to the ed then I’m not sure the point of the nurse line. Thats why this is all messed up. It’s basically doctors saying I am OK with substandard care for quality of life.

    The whole point of calling someone is to be told no you’re fine or it can wait until tomorrow, see us in the office. A clear emergency would probably be obvious and not relevant to the discussion. Someone with crushing chest pain probably isn’t calling their pcp, they are just going to Ed.

    You’re adding value by avoiding needless Ed visits, preventing peolle from having needless scans which discover incidental findings that are likely bs and we have to follow for too long result in more bs scans and patient concerns. It’s a vicious cycle that is ideal to avoid.

    It is a huge problem in our system that the ed is so overutilized. We need to incentivize systems that prevent that, not encourage.

    Click to expand…

    True, but its easier to miss and dismiss things over the phone and you cant examine people, etc…all kinds of things you may one day end up on the witness stand defending yourself and the choices you made for. Trust me, its not pleasant and over utilizing the ED just doesnt matter anymore at that point. I have zero problem and our practice now basically frankly tells people the second they, “well also theres x…” to just go to the ED as we cant fully assess otherwise”.

    #227634 Reply
    Lordosis Lordosis 
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    Status: Physician
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    Especially when these are people you never met. When I am lucky enough to get one of my own patients it is much easier.

    “Never let your sense of morals prevent you from doing what is right.”

    #227641 Reply
    Avatar MaxPower 
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    Status: Physician
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    Joined: 02/22/2016

    It’s super rich having someone who never in their life takes overnight calls from patients, a radiologist, lecture us on the appropriateness of having a nurse take phone calls over night instead of doctors.

    In my experience taking about 10 years of these calls, about 15-20% of them are legitimate questions to be calling a doctor about in the middle of the night. And these are mostly dealing with post-op pain control. A majority of the questions could be handled by a nurse or PA, and most of those could wait until regular business hours.

    #227643 Reply
    Avatar Panscan 
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    Splash Refinancing Bonus

    Get calls from patients every single day and overnight sometimes. About results, symptoms with a recent procedure, etc.

    #227650 Reply
    Liked by Vagabond MD
    Avatar SValleyMD 
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    Status: Physician
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    Agree maxPower…

    The other funny thing is when we use to take these calls we had a bunch of patients wait until after hours to call because they knew they could speak directly with a doc at that time..

    But the vast majority of calls were obviously nonsense. Seems like our nurse triage is doing fine. I can’t remember the last time they (rN) called me.

    Ultimately vagabond is correct… in this day and age a non shift worker should never be waking up to take these calls..

    #227666 Reply
    Avatar Dilaudidopenia 
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    As an EM doc who thankfully never has to deal with this…wait…literally as I’m typing this I realized that I DO deal with this as I get all the (mostly) shi**y referrals, it seems like unless you have your own nurses / midlevels who you train to do this, paying for this “service” is not worth it.  I can’t see how a general nurse triage line staffed with people who don’t know you or your practice could be of any value.  I agree that specialized docs for post-op and other specific things like onc should be available for legitimate issues.  Most (>90%) adult and pediatric primary care issues can wait till morning.  I can’t tell you how much BS pediatric fever I saw overnight at my last shop.

    #227669 Reply
    Liked by Rando

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