Blog | Wednesday, March 16, 2016

Emergency on-call physician policy, a doctor dissents


I am known by my patients and friends for my calm, imperturbable manner. Yes, I am equipped with the full range of human emotions, but few folks have ever seen me raise my voice or demonstrate bulging next veins. I am not suggesting this is a virtue or a character flaw, but is just the way I am wired.

Sure, I get irritated and frustrated with the absurdities of life, as we all do. For those who cannot relate here, may I suggest calling any airline carrier to discuss changing your ticket reservation. If that fails, then have a go at reaching out for tech support when your home internet goes ‘poof’!

Last week, I did become irritated when I was notified 1 evening about a patient's abnormal blood test result. I was on-call for our gastroenterology group, so I would be the designated physician to notify with concerning test results. Why, then, was I miffed?

Our community hospital uses a “new and improved” system for notifying physicians after hours of significantly abnormal test results. The hospital loves it. I hate it. Here's how it works.

First, I receive a text message notifying me that a patient has a CRITICAL TEST RESULT. I am then directed to call a 10-digit phone number, when I will be greeted by a robotic menu system. After enduring this labyrinth, I will be directed to insert a long series of numbers, a code which will lead to either a non-human voice announcing an abnormal lab value, or to a radiologist's dictation of a CAT scan report or some other X-ray study. The hospital is happy as once I complete the process, their system indicates that the physician has heard the message and now bears full responsibility. They are in the clear. Here's some of my objections.
• The initial text message often arrives when I am driving. Attempting this process while driving would be suicidal.
• The messages announcing the abnormalities are not given with any patient contact information or medical details. While the hospital is happy, I then have the fun and excitement of trying to find the patient's phone number, not easy to do at 9 p.m. When I can't reach the individual, it guarantees a night of insomnia for me.
• Try listening to any radiologist's dictation. I've done this many times and often cannot ascertain which language is being spoken.

I called the lab director and begged to be removed from this automated system. I argued that, while it satisfied the hospital's documentation police, it was not serving patients or doctors well. If a test result is CRITICAL, then I want to be called by a living and breathing human being. The 2 of us will have what is called a conversation, providing me with sufficient knowledge so that I will be reasonably equipped when I reach out for the patient. I may want, for example, to hear results of prior tests, so that I will understand the current results in context. Get the point here?

The lab director couldn't promise to release me from electronic bondage. Throughout the medical profession, I witness the duel between documentation and doctoring. Guess who's winning.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.