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Phone Calls
November 20, 2016
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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.  So, 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.

  1. 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 necessarily when you want me to do so.  For this reason, I cannot 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 cannot make my patient who is scheduled for a 1 pm appointment with me wait because you want a call back at that time, nor can I stay at the office if I am done with work at 5:30 pm because you want a call after 6:30 pm.  If you will not be available by phone during the day, please use the patient portal and I can email you.  I also respectfully ask that patients/parents not call the office every hour complaining that “the doctor has not called me back”.  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.

  2. 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.

  3. 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:

 

  1.  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. 

  2. 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.

  3. 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.

  4. 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.

Comments:

Thank you
By Susan Coakley
March 01, 2017
I truly appreciate your willingness to call back (especially knowing that the responsibility is solely yours and is not shared with anyone else)!