I get a lot of phone calls every day. After seeing all my patients and writing all my notes, I then sit down at the end of the day and return anywhere from 5-15 messages. This means that when all of the staff leaves and the door is locked, I am sitting down to do another half day of work over the phone.
Trying to diagnose and treat patients over the phone is one of the most difficult things that I have to do. I cannot see the patient, so I am depending on you, the parent, to give me an accurate representation of not only what is happening, but also exactly what your child looks like right now. I decided to write this blog to help some of you understand what the call looks like from my side and why I give the advice I give, and how you can help me to help your children.
Daytime calls during office hours – I have a policy of answering all of my phone calls by the end of the day. That means that before I go home, I am going to call you back, but this is going to be when I have time between patients, and sometimes at lunch time. If I have a really busy day when I am running from room to room, this may mean that I will not call you back until the office has already closed for the day. Rest assured, I will call you back, but it may be when I get a chance and not at a specific time since I have to see the scheduled patients at the time they scheduled and I don't want to keep them waiting. For this reason, I cannot always honor requests that I call you back “between 1 pm and 1:30 pm” or “after 5:30 pm”. If you need a specific time, please come for an appointment. If not, I will call when I can, but I don't want to make my patient who is scheduled for a 1 pm appointment with me wait because I am on the phone. If you will not be available by phone during the day, please use the patient portal and I can email you. I do sometimes have people call first thing in the morning and then get concerned if they have not received a prompt call back. I will call you back, I promise, but sometimes there is just not a lot of time between patients. If it is an urgent issue, I will call you back at my first opportunity, but if not, I will call when I get a chance and certainly by the end of the day, but I consider patients with scheduled appointments a priority over phone calls as I am always trying very hard to stay on time so I don't inconvenience everyone.
Lunchtime calls – At lunchtime (between 12 pm and 1 pm) our phones flip off for lunch. This gives all the staff and the doctor a chance to eat. Because physicians are required to be available 24/7, our phone messaging system gives the option of paging the doctor during that time if you have a question that cannot safely wait until we reopen at 1 pm. This means that if you page the doctor during lunch at 12:40 pm, you are saying that your child has a medical issue of such urgency that it cannot safely wait for 20 minutes. If that is truly the case, by all means, page the doctor, but few issues of that kind of urgency can be taken care of over the phone. If your child is experiencing trouble breathing, excessive bleeding, etc, please call 911. If you just want to say that you are cancelling your appointment for 1 pm or are running late for your appointment later that day, you don't need to page the doctor. Just call us at 1 pm.
After hours calls – After hours calls are the calls that occur outside of regular office hours, typically in the evenings and on the weekends. Because I am a solo doctor, I am on call 24 hrs a day, 365 days of the year. I will call you back if you need help! But there are also some great resources for obtaining good information and advice for some more common non-urgent issues available over the internet. The best one in my opinion is www.healthychildren.org. This is the official website of the American Academy of Pediatrics. There is a link from my website (click on Sick Child”) directly to their Symptom Checker page. On this page, you just type in the symptom, such as “fever” or “vomiting” and it provides excellent advice on what to do and even in what situations you should page the doctor or proceed to the ER. I highly suggest that you take a look at this site if you have a question. Answers for over 99% of the questions for which I get paged can be found beautifully explained on this website.
Lastly, a few helpful tips on how to help me get an accurate picture about what is happening to your child when I can’t see them:
Try not to exaggerate - When I talk to parents on the phone, most are very good about telling me the story of what happened. I can usually find out pretty easily how many times a child threw up, how they fell, etc. What is very difficult for parents is describing how their child looks now. First off, I advise that you never exaggerate. I think parents often feel bad about having to page me, so they want to impress upon me that their child really is sick and that they aren’t calling for no reason. So they describe their child as “really really sick”, “will barely open her eyes” and tell me “she has only had a drop to drink all day”. If that is really accurate, yes, please tell me that. But if your child is actually just watching a movie instead of playing with her toys, don’t describe her as almost unconscious. If she has had 10 ounces of formula this morning as opposed to her usual 13 ounces, don’t describe her as having “only had a drop”. I take you absolutely at your word since I can’t see her and what is going to happen is that I am going to end up telling you to take her to the ER, perhaps unnecessarily.
Take his/her temperature – I am probably going to ask if your child has a fever. Please take his/her temperature with a thermometer before you call, and don’t depend on touch to determine a fever. It is notoriously inaccurate.
Don’t expect a prescription – I do not prescribe medications for children without seeing them. Without a physical exam, I have a very hard time doing more than guessing at a diagnosis over the phone. If your child is having ear pain, yes, it is very possible that they have an ear infection, but I will send you to urgent care or the ER if it can’t wait until we reopen. This is not because I want to inconvenience you, I just want to make your that your child has the most accurate and best medical care possible. I don’t want to put them on amoxicillin for what sounded like an ear infection on the phone, but turned out to be a peritonsillar abscess, something any doctor would have known right away if they had just looked at them.
I can’t diagnose rashes over the phone – Ever! Rashes all sound the same on the phone –red and bumpy. It could be hives, poison ivy, chicken pox, anything! Please make an appointment if you have a rash.
Okay, I hope this helps! Phone calls are tough for everyone, but maybe this will make them just a little easier.
No matter why you are coming to the doctor, whether it is for a well check that was scheduled months ago, or for an unexpected sick visit your child needs in an hour, you want the same thing that we want---to get in, get your child the care he or she needs, and to get out with the least possible trauma and in a timely fashion. Here are tips to help everything to go as smoothly as possible with the fewest possible surprises.
1. The New Patient - if you are a new patient, you will have to fill out some forms. We know it's a pain, but it has to be done! You can save yourself some time by printing them out from the "Forms" section of our website, filling them out at home, and then bringing them in with you, along with your insurance card. I can't even tell you how much faster this will get you into an exam room, and back home where you want to be.
2. The Established Patient - we have your information, so no paperwork! But we will ask you to verify that nothing has changed. We kindly ask you to REALLY think about that question. I cannot tell you how many times we have tried to call people just a day or two after their appointment to tell them about lab results, or to check on the condition of their child only to find out that every single number we have is a non-working number, they no longer work for that employer and their address is also not correct. Right after they told us that nothing has changed. If anything has changed in the past 2 years, please make sure we have the right information. The health of your child could depend on it. I can't tell you that they are positive for strep throat on their throat culture if I can't find you. Also, please make sure we have your correct insurance. It will save you the hassle of receiving bills for the full amount of the visit after your inactive insurance company has rejected our claim.
3. The Check Up - if your child is scheduled for a check up, you can save even more time by filling out the developmental forms in advance! These are absolutely required at the 9 month, 18 month and 24 month check ups, but we would appreciate it if you would fill them out at every check up until age 6 years. The forms ask detailed developmental questions that can help us find even very minor developmental issues that could improve with early treatment. Just go to www.chadis.com, and fill them out. The invitation code is our phone number: 4105829434, and then they will be emailed directly to us before your visit. If you did fill them out, let the doctor know at the beginning of the visit, so we can pull them up (and before we start asking you the whole list of developmental questions, making you go through it all over again!).
4. The Unexpected Sick Visit - I understand that it is tempting to ask the office to have the doctor just see your other child since she happens to be here with you and she just started sniffling in the car. You already have an appointment for one child, so what's the big deal about adding on one more? The issue is that the doctor has a very set schedule which blocks the amount of time that is needed for every appointment. When we squeeze another child in where no appointment time exists, it means that the doctor will be 10 minutes late for every appointment after you. And even if it's "just a cold" and you think "it will only take the doctor a minute", the truth is that we are required to document everything. Vital signs need to be taken, a full history and exam done and a full note typed up to document everything. It takes more than a minute, I assure you. If your other child truly needs to be seen, please try to notify us ahead of time instead of when you walk into the office. We may need to change your appointment time to a time where we can accomodate the extra appointment.
5. The Walk In - we do not accept walk in patients. This is for the same reason as stated above. It will delay every appointment after you which is not fair to the patients with scheduled appointments. Please call before you come. If your child needs an urgent sick appointment, we will never turn you away and we will give you an appointment today, but we will give you a time to come in so you and your child can wait in the comfort of your own home instead of in the waiting room.
6. The Waiting Room - It's time, you are called back to the exam room! Hopefully you have not been waiting long, but now 2 of your 3 children do not want to come. You are tempted to leave them in the waiting room where they are quietly playing with toys. We understand, it is easier to leave them be than to take them with you, but we kindly ask that if they are under the age of 10 years, to please take them with you. Our staff cannot keep an eye on them for you while answering phones and taking copays, and our door opens right out onto a small porch and then the parking lot. The door also can be opened with a little push from small hands, no turning of the knob necessary. Even when they do not try to leave the office, we have had children running up and down the halls, running into open exam rooms and playing with expensive equipment unsupervised. And you might not realize it, because you are in an exam room with your little one and the door is closed. We ask that you please keep an eye on all of your children.
7. The Copay/Bill - you are done and your little one got shots and you just want to get them back home. But please stop at the front desk before you go. You are required to pay all copays at the time of the visit and if you have an existing bill, that will be due as well. We usually advise that you make your next well check appointment before leaving as well, so that you can get the best possible choice of times and dates. If you would rather, we would be happy to take care of all these issues at the check-in, so you won't be delayed on your way out.
We thank you so very much for choosing East West Pediatrics. We hope this helps make your visit a smoother one!
Welcome to the Blog of East West Pediatrics
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