Sunday, August 25, 2019

Do Patients Like Weekend and After Hours Medical Care?

I have previously expressed how physicianss feel about treating patients that they do not know in a prior post, which readers are invited to review.  This post is the other side of the story.   

Nowadays, patients are used to seeing physicians who are not their doctors.  Often, patients may be seeing a nurse practitioner, a highly trained professional for their medical care, instead of a physician.  A generation ago, patients nearly always saw their own physician, including if a patient was hospitalized. Imagine that, your own primary care doctor sees you in the hospital, an event that occurred when dinosaurs roamed freely.

The medical universe has changed.  Hospitalists care for most hospitalized patients, which in my view, has vastly improved the quality of hospital medical care.  It is commonplace for patients who need to be seen right away in the office, to see a doctor who is available, who may not be the physician of record.  Pregnant women today often see many obstetricians in the group since it is unlikely that the patient’s designated obstetrician will be on-call on D-day.  One of Cleveland’s corporate medical giants boasts that they offer ‘same day appointments’, which is true if a patient is willing to see a medical professional several zip codes away, not the patient's actual doctor.

In the olden days, one doctor did it all.

Understandably, if you call your physician after hours or on the weekend, you will most likely connect with one of your doctor’s partners.  This is why it is not advisable to call the emergency on-call physician 9 pm for a conversation about your chronic arthritis.

Patients are now used to seeing strangers prescribing their medications and ordering their diagnostic tests.  Hospitalized patients may be treated by several physicians they do not know. They have adjusted as best they can, but there are obstacles and drawbacks to this medical care paradigm.
  • It is unsettling for patients to be confronting several medical professionals for their care.  Similarly, if you are reading 4 or 5 books at once, are you really able to keep the separate stories straight in your mind?
  • There is unavoidable loss of continuity when there are multiple physicians at the table.  Hospitalists do a great job.  But, do we really think that all of the nuanced knowledge and objective data can be seamlessly transmitted to your primary care physician whom you will see after you are discharged?
  • What if different primary care physicians who are seeing the same patient have different opinions?  Who does the patient believe?
  • Even in the computerized era, it’s astonishing how often new physicians do not have easy access other physician’s medical records.  Does the weekend physician consultant who is seeing you in the hospital know that another doctor already ordered an ultrasound of the gallbladder a few months ago across town?
  • When there are too many physicians involved in a single patient’s care, medical testing and costs tend to increase, which does not increase medical quality.  In my experience, a new doctor is more inclined to order a medical tes, than to advise watchful waiting, a strategy that the doctor who knows the patient well would more likely rely on.  For example, if I see a patient I know for years with the same stomach pain, I may react differently than another gastroenterologist seeing him for the first time. 
Oftentimes, patients and physicians meet as strangers.  This reality creates many challenges.  Both sides need to be understanding.


3 comments:

G-31 Toastmasters said...

It's complicated, for sure! I was blessed to have the same brilliant, kind, wonderful PCP for nearly thirty years. My husband had the same PCP. Through all manner of job & insurance changes, we managed to keep him. His practice, grew, changed, morphed into one piece of a mega-practice, and we got to keep him. It was a true comfort to me that he'd known me at my best and my worst, as a newlywed, and later as a mom of four. When he retired I chose his NP as my new PCP because she knows me almost as well.

I'm so grateful that the mega-practice has 365 Care. I trust it. That's my first choice for examination and treatment off-hours or for mid-day Work injuries (unless I'm in an ambulance and have no choice.)

This weekend I went to Mega-Practice 365 Care for an eye infection that turned out to be only a blocked tear duct. Some will call that a wasteful use of precious medical resources. But I work in a school with students who have very complex needs and I cannot afford to miss a day after a holiday weekend because of delay in treating what could be nasty. I figured "new school, new germs", angry red eye + pain means I should get treatment before it gets worse. To be honest, I called both of my eye doctors first.

I was very grateful for the kind doctor (a stranger to me) who examined my eye and told me I don't need antibiotics, but just a warm compresses and artificial tears. I hope he doesn't think I was silly and over-reactive. From my view, I was looking at a 3-day holiday weekend and the biggest weight was put on "Must Be Well By Tuesday When All Students Return".

Thanks for "e-listening".

For what it's worth, the regular doctor at Mega-Practice 365 Care sees me too often. Last year I had ten Worker's Comp injuries. Yes, ten. My students are strong and active.

Michael Kirsch, M.D. said...

Thx for your comment. I think that 24/7 care is coming, I don't meet ER visits. Virtual physician visits have already started. I think folks will be able to 'visit' with a medical professional at any time and from any place.

G-31 Toastmasters said...

Then none of you will EVER get any sleep! Laugh!

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