Physicians spend a lot of time counseling patients on the
phone. Often, these conversations occur
at night with patients we have never met before. When I am on-call in the
evenings or on the weekends, these are some typical phone calls I receive from
patients I have never met.
- I have a very bad stomach ache for the last hour.
- I started having rectal bleeding an hour ago.
- My wife tells me that my eyes are yellow.
- My chest is hurting. It feels different from my usual heartburn.
How do we manage patients with issues like those above? We get hundreds of calls like this every
year. Do we send every patient to the
emergency room just to play it safe? Do
we tell them to hang in there and to call their regular doctor when office
hours open? How can we be sure that a
simple stomach ache isn’t the first warning of appendicitis or some other
severe abdominal condition?
My After Hours Medical Equipment
Phone medicine relies on an entirely different skill set
than physicians use in the office or in the hospital. Consider these obstacles:
- We often don’t know the patient. The doctor who does know him may readily recognize that the complaint is benign.
- On a phone call, we cannot read body language to gauge a patient’s level of distress. Seasoned physicians get a gestalt feeling about a patient’s intensity of illness from simple observation.
- There is no opportunity to perform a physical examination.
- Prior medical records may not be available, although many electronic medical record systems to do permit remote access.
During my 3 years of internal medicine training and my 2
years of gastroenterology fellowship, I received not a whit of training in
phone medicine. This was a gaping
oversight in medical education considering how important these skills are to
practicing physicians. I use them every
day. I confess that during my first several
months on the job, there were many anxious moments for me as I fielded
phone calls from anxious and sick patients.
It would have been easier had my
educators given me a few pointers.
Understandably, patients who are calling physicians off
hours are not aware of the handicaps that these doctors face. Patients often seem to feel that even on a
phone call, we somehow have our full toolboxes available and can make diagnoses
or prescribe treatments. Consider the
following scenarios.
- Driving at night wearing sunglasses.
- Playing guitar with a broken string.
- Enjoying a movie without sound.
- Preparing a dinner party with only a saucepan available.
- Providing medical care to a stranger on the phone.
Want to discuss this further? Give me a call after hours.
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