Sunday, February 14, 2016

Emergency On-Call Physician Policy - A Doctor Dissents

I am known by my patients and friends for my calm, imperturbable manner.  Yes, I am equipped with the full range of human emotions, but few folks have ever seen me raise my voice or demonstrate bulging next veins.  I am not suggesting this is a virtue or a character flaw, but is just the way I am wired.

Sure, I get irritated and frustrated with the absurdities of life, as we all do.   For those who cannot relate here, may I suggest calling any airline carrier to discuss changing your ticket reservation.  If that fails,  then have a go at reaching out for tech support when your home internet goes ‘poof’!

Last week, I did become irritated when I was notified one evening about a patient’s abnormal blood test result.  I was on-call for our gastroenterology group, so I would be the designated physician to notify with concerning test results.  Why, then, was I miffed?

Our community hospital uses a ‘new and improved’ system for notifying physicians after hours of significantly abnormal test results.  The hospital loves it.  I hate it.  Here’s how it works.

First, I receive a text message notifying me that a patient has a CRITICAL TEST RESULT.  I am then directed to call a 10 digit phone number, when I will be greeted by a robotic menu system.  After enduring this labyrinth, I will be directed to insert a long series of numbers, a code which will lead to either a non-human voice announcing an abnormal lab value, or to a radiologist’s dictation of a CAT scan report or some other x-ray study.  The hospital is happy as once I complete the process, their system indicates that the physician has heard the message and now bears full responsibility.  They are in the clear.  Here’s some of my objections.
  • The initial text message often arrives when I am driving.   Attempting this process while driving would be suicidal.
  • The messages announcing the abnormalities are not given with any patient contact information or medical details.  While the hospital is happy, I then have the fun and excitement of trying to find the patient’s phone number, not easy to do at 9 pm.  When I can’t reach the individual, it guarantees a night of insomnia for me.
  • Try listening to any radiologist’s dictation.   I’ve done this many times and often cannot ascertain which language is being spoken. 

I called the lab director and begged to be removed from this automated system.  I argued that, while it satisfied the hospital’s documentation police, it was not serving patients or doctors well.  If a test result is CRITICAL, then I want to be called by a living and breathing human being.  The two of us will have what is called a conversation, providing me with sufficient knowledge so that I will be reasonably equipped when I reach out for the patient.  I may want, for example, to hear results of prior tests, so that I will understand the current results in context.  Get the point here?

The lab director couldn’t promise to release me from electronic bondage.  Throughout the medical profession, I witness the duel between documentation and doctoring.  Guess who’s winning.

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