In my last post, I wrote about trying to practice medicine solely by telephone. This week I’m going to the opposite extreme.
In a recent Sermo.com post, a doctor commented about how he NEVER deals with patients by phone under any circumstances. He uses his answering service as a go-between, with two options:
• Call back tomorrow.
• If this is an emergency, I will meet you right now at my office (if I can find a chaperone) or at the emergency department (if I can’t).
He was critical of doctors who do anything by phone, mainly on the grounds of potential legal liability and lack of reimbursement for such. On paper, this is a great, if not commendable, view. In reality, it won’t work for the vast majority of us.
I don’t like getting calls after hours, but they’re a fact of life in this business. Being in solo practice, I have the advantage of knowing my patients. My charts are only as far away as my MacBook (a relatively modern benefit).
Obviously, I’m not going to try to manage acute or serious things by phone, and have sent my share of patients to the ED. But I’d rather be called for a refill on an empty bottle of antiseizure medication by a patient than by an emergency physician seeing him for a missed-medication car wreck.
If one of my patients has a seizure (or other acute neurologic change) I’d rather know about it sooner than later. It’s easy to come to a decision and type up a quick note to document it. I’m not saying you should manage everything by phone, but refusing to manage anything by phone, especially in a patient who is well known to you, is just silly.
Yes, phone calls have legal liability, but so does everything else we do. Just like an office visit, you document it carefully. Even refusing to take phone calls and sending everyone to the ED has some degree of liability. It’s also going to cost you in the long run, from patients sick of being routed there for every call. They’ll leave your practice, and likely complain to your referring sources about you.
"We don't get paid to answer after-hours phone calls." So what? We also don’t get paid to write scripts for 90-day mail-in supplies, renew physical therapy, or order a follow-up MRI for a meningioma. Time is money, and dealing with phone calls can help. A simple question that could have been answered by phone will likely take up the same amount of schedule time as a more complex case that not only pays at a higher level, but needs to see you more.
Most doctors (I hope) have their own physicians. Have you ever called yours with a question after hours? If so, how would you have felt if they said "just go to the ED"?
No one likes getting calls after hours. But being able to tell what can (and can’t) be handled by phone is part of what we do. And part of providing good patient care.