Overnight phone call

Home Practice Management Overnight phone call

  • Rando Rando 
    Status: Physician
    Posts: 204
    Joined: 01/08/2016

    At the risk of this sounding like a “I walked barefoot through the snow uphill to school” post, in my first practice and also in my 3rd year of residency not only did we take patient calls, if they needed to be seen we were expected to go see them either with a house call or in the ER.   HMO’s were coming in heavy and we were expected to take care of as much as possible ourselves.

    My situation now is a bit different than most here.  I’m a solo FP and I take call for my patients 24/7, even when I’m out of town.  I have been in call-sharing arrangements and honestly I prefer the way I do now.  It’s much easier to handle patients that you know than to handle patients of other doctors.  Since the advent of hospitalists call is not that big of a deal.

    I will say one thing that has changed is that patients are much more likely just to go the ER these days than they are to call me first.  It’s like they have been conditioned that’s just the thing to do, and a lot of that is the nurse’s help lines the insurance companies and large groups have set up.  They almost always just tell patients to go to the ER.

    #227746 Reply
    Avatar GPGP 
    Status: Physician
    Posts: 202
    Joined: 05/02/2017

    In my group docs take call by specialty and app’s do not take call (not in their contract. However one doc actually felt they somehow lacked the qualifications for home call- which I truly do not get. They can be PCP’s or see our patients after all).

    I was solo and did my own call for 2 years. A pain but you knew the people as rando said. Now, most of the calls fall into a) critical labs b) people who waited until 505 to talk to the doc c) silliness that could wait. 10% of my calls are legit ones where people need help deciding what to do.

    #227767 Reply
    Liked by Lordosis
    Avatar Eye3md 
    Status: Physician
    Posts: 80
    Joined: 12/01/2017

    It doesn’t matter if it’s one call at night, or you are up all night operating, docs are used and abused for this “noble” duty we have to provide on call coverage for patients and hospitals.

    The HUGE majority of after hours calls are absolute nonsense that could wait until normal business hours. I do ophthalmology now but I worked ER while in residency. We would also take calls from the offices of local primary care docs since they all shared time being the local ER doc as well (when a moonlighting doc was not available). Even back then, the majority of the calls were BS…..I need a refill, I think Little Johnny has a fever, my chest started hurting a month ago so do you think it’s a heart attack. As someone else said, patients would call because they didn’t have to wait and knew they’d get directly through to a doc.

    No one is looking out for the sanity of the doc so you are damn right I care about how it impacts my life.  Quality of care is important but you get to a point, when you are 55, and you’ve been woken up at 2:00AM for a BS call, where you just don’t really give a damn if that patient goes to the ER or does whatever. Especially if you know you have a crazy busy schedule the next day, and there’ll be very little chance you can try to recover from this insult to your sleep (health). In a perfect world, there’d be a system to pay a bunch of specialty specific docs to sit around and take calls or see patients at all hours of the night. That’ll never happen so it’s just us providing that service now.

    #228071 Reply
    Avatar Tim 
    Status: Accountant
    Posts: 3337
    Joined: 09/18/2018

    So it seems it’s a huge PITA for md’s and any type of nursing solution overloads ED so ………..?
    When is the best time to get sick if everyone is booed up for a month or two?
    I wish I knew so I could schedule being sick. Maybe that’s why every doc I know just tells me to call their office and drinks my beer and eats my burgers.

    Actually, thank you all for helping when needed. I realize it’s a lot of false alarms, but it is appreciated.

    #228209 Reply
    Lordosis Lordosis 
    Status: Physician
    Posts: 2165
    Joined: 02/11/2019

    I don’t like when I hear about other primary doctors referring people to the emergency room or urgent Care during business hours. it is very infrequently that I ever have to do so and it is only when I don’t think they are appropriate for my level of care and need emergency care. Almost always I can make room in my schedule to squeeze in another patient or two to avoid them having to go elsewhere for an acute visit. However I frequently see other primary docs shuttle these patients off elsewhere and that is just a burden for everybody. One patient switched to me because reportedly it took three weeks to see his physician for an acute issue. Obviously that is not sustainable.
    it is correct that patients to wait to call the alarm call to actually speak with the doctor. I’ve seen several patients who called in because their doctor has not answered questions after multiple phone call attempts and the messages are just sitting in their inbox. I do not understand why people just don’t deal with the issue rather than letting it sit and pile up and make people angry. It just makes more work for all of us.

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

    #228216 Reply
    Liked by Zaphod
    Avatar MaxPower 
    Status: Physician
    Posts: 372
    Joined: 02/22/2016

    I, too, would rather deal with the issue when it arises, and not necessarily in the middle of the night or after hours. But the fact is that the office is only open about 9-10 hours a day (8-5 or so), five days a week. So statistically, more things are going to come up after hours than during business hours.

    Probably 95% of the post op calls could be solved by telling the patients to take their pain meds when and as prescribed, to elevate and ice their operative extremity, and to loosen the bandage. Those are things that any decent clinic nurse worth her/his salt could tell a patient, thus avoiding a phone call to a physician in the middle of the night. The other 5% that are legitimate issues could then be referred on to the on call doc. But since for some reason doctors aren’t paid for after hours clinic call and nurses would have to be, the calls get sent directly to the physician.

    The part about working patients in who call during the day is a two-edged sword. If I don’t leave spots in my schedule for same day add ons, then patients who have been scheduled for weeks get delayed or their appointments by cut shorter to accommodate for the higher patient volume. But if you leave spots open and no one uses them then you give up revenue generating spots for nothing, and patients have to wait longer to get an appointment.

    Our hospital system opened a (poorly run) orthopedic urgent care, so many of the patients who called in could be funneled there during the day, avoiding some of the exorbitant ER charges, but then be sent to the specialist as needed for urgent or surgical issues. Don’t most places have urgent cares that these patients could be sent to during urgent care hours, which are usually more than standard office hours?

    #228219 Reply
    Liked by q-school
    Zaphod Zaphod 
    Status: Physician, Small Business Owner
    Posts: 6335
    Joined: 01/12/2016

    Dont forget that for the majority of problems that are called about they are not at all serious, and your patients are doing things during business hours as well. I feel a large part of when called is simply when they have the time, or they are just bored it seems (these post dinner no point question calls).

    #228222 Reply
    Avatar MaxPower 
    Status: Physician
    Posts: 372
    Joined: 02/22/2016

    True, @zaphod. Which means if they can wait to call until it’s convenient for them, that it probably really isn’t an issue that warrants a phone call to the doctor anyway.

    #228229 Reply
    Liked by Zaphod

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