Wrong Number: The Joys of Being on Call

Physician's Money Digest, August 2007, Volume 14, Issue 8

This special feature serves as a forum for our physician-readers to share their stories. We welcome tales from your practice, financial planning, personal life, and adventures. Please limit articles to 1000 words and send photos if possible. Send submissions to Attn: Lisa A. Tomaszewski, Ascend Media Healthcare, 103 College Road East, 3rd Floor, Princeton, NJ 08540 or ltomaszewski@ ascendmedia.com.

Recently, I faced the biggest ongoing challenge of my professional career: the dreaded weekend when I take emergency phone calls for myself and the other doctors in my call group. I persist in believing that I am only taking calls for medical problems of some urgency, problems that cannot wait until Monday. On weekdays, my dedicated, but haggard, staff talk to patients who call, determining the severity of their issues. They do a pretty good job defending me from the crazy way many patients approach their health problems. On the weekend, however, I have to do this for myself, and I have to do it with patients who belong to the other doctors in my call group. Worst of all, I have to do it for 2 full days and 3 full nights.

Ringing Off the Hook

The night part is very interesting in itself. During weekdays, I seldom get a call in the middle of the night. On weekends, for some reason, patients don’t seem to make a clear distinction between sleeping hours and nonsleeping hours. The weekend seems to be one long "day" to them. Something may be bothering them all week, but suddenly they will feel a burning urge to call at 3 AM. One patient called to talk about his wife's ongoing problems, because he hadn't had time to have this little chat with me earlier in the week. Another called to ask about changing baby formulas. The grocery store wouldn’t be open until the next morning, but he needed to know now. Apparently, if they were up with the baby, I should be, too.

One of my biggest challenges is understanding why patients consider an emergency as anything that they don't want to wait until Monday, or even daylight. They want lab reports. They want advice on whether to get a flu shot. They want to know what that green cough medicine was their doctor recommended 3 years ago. They want their medicines— that they only seem to know by color—refilled. And, of course, they are not satisfied with a few pills to get them through the weekend. They're not going to pay a "full" copay for less than a "full" prescription.

He's Not in Right Now

A related challenge is that, when I call a phone number after being paged, the person answering the phone is almost never the person who paged me. Sometimes it is a teen who answers the phone with a "Yeah" or a "What?" That there is an important call expected and that there is an emergency going on in the house is beyond them. Eventually, I persuade them to find the sick person, and from the amount of time they are gone, the house must be a mansion.

Sometimes a man answers the phone, and says, "Here, I’ll let you talk to my wife." Funny, he's the one with the problem, but he somehow cannot talk. I imagine him sitting in the background like a king who cannot be expected to do his own talking, while his servant/wife explains his symptoms. Sometimes, if the person having the emergency is a teen, I have to talk to the mother, because the teen won't come to the phone (an interesting twist). The teen won't tell Mom exactly what the problem is either, so I have to ask the mother my questions, then she yells them down the hall, listens for the answer, then relays the answer to me. Example: "My daughter Susie has a cough." "Does she have a fever?" "SUSIE, DO YOU HAVE A FEVER?" "NO." "No," "Is she bringing up any sputum?" "SUSIE, ARE YOU BRINGING UP ANY SPUTUM?" "YES." "Yes." Well, I don't need to go on, but it can, interminably.

Sometimes the person having the problem is not available at the number when I call. "Hello, this is Dr. Constan." "Hello, this is Mrs. Smith, I’m calling about my mother, Mrs. Jones, and she wants to know what to do about her abdominal pain." "Could you please put her on the line so that I can talk to her?"

"She’s not here, she went shopping."

"Oh."

Sometimes the person doesn't answer, at all. I’ve called back promptly, yet "there's no one home." What gives? They call back later to fill me in on what happened at the ER, like I need to know. They had called me then decided it wasn't necessary to talk to me, they wanted to go to the ER anyway. Then, why did you call? Sometimes when I call back, I get a busy signal. How does that happen? You page a doctor then tie up the line so I can't call back! I imagine that you figure you should first seek advice from the doctor then seek advice from all your friends and relatives, whomever you can get on the line. Later you say to yourself, "I wonder why that darned doctor never called me back."

Technical Difficulties

The advent of Caller ID has produced its own set of challenges. The person pages me, leaves their number, but when I call them, they won't answer the phone because they don't recognize the number displayed by the Caller ID. I imagine them standing by the phone, staring at the number, and reasoning: "Now, I’m having a serious emergency here, but I don't want to take the chance of answering this call and having to talk to a telemarketer. What do I do? Best not take the chance." Later: "I wonder why that darned doctor never called me back."

If I talk to an answering machine, I usually offer that the patient can call me back later if they still need help. One lady called me back and told me that she was home when I called, heard me leaving the message on her machine, but couldn't come to the phone because she was doing her vacuuming. How has outrageous fortune relegated my services below those of a vacuum cleaner?

Although all the above challenges tend to wear on me toward the end of the weekend, I try to be professional and caring about each call (just ask my family). It’s my job to stay the course with no laurel wreath expected on Monday morning. It was a surprise and joy to me recently when, at a party, I was introduced to a nice young couple. "You're Dr. Constan! We called you 2 years ago about our sick child. You were so helpful. We've always appreciated what you did for us." The challenge of weekend call should have more such awards.