Monday, April 14, 2008

When You Really Need Your Doctor...and She's in Fiji

How to get great medical care from the doctor on call (from a doctor on call)
by Dena Rifkin, MD

A couple of my colleagues were out of town this week, so I’ve been taking care of some of their patients for them. This is known as covering, and we do it all the time: nights, weekends, holidays, vacations.

The days when doctors were on call 24 hours a day, seven days a week, are, by and large, gone with the horse-drawn ambulance and the once-ubiquitous black bag.

How does coverage work? Well, a lot depends on the system. Some practices cancel everything but urgent care while they are away. For others, the practice must continue—for instance, dialysis patients must come three times a week, every week. Some practices have electronic medical records that make it easy to look up old records if a patient calls in with a new problem.

The hospital where I work has an electronic-record system, and I can access it from home, which makes taking care of urgent calls much easier. But still, there are times when it’s pretty hard to figure out what’s going on when an unknown patient with a complicated history calls. Patients often call for reassurance about a new symptom—they don’t want to have to go to the ER (who would?). Sometimes we can provide that reassurance, and sometimes we can’t.
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