Calling the doctor after hours

Of course, patients are entitled to medical care around the clock. You would not expect to show up at 2:00 a.m. at an emergency room to find a “Closed” sign. If you are having chest pain on a weekend, and you call your doctor's office, you should expect a prompt response from a living and breathing medical doctor. Patients are aware that when they call the doctor at night, that they are unlikely to reach their own doctor. Similarly, when a patient is admitted to the hospital, they will likely be attended to by a hospitalist, not the primary care physician. Such is the reality of medical practice today.

Here are 3 types of after hour calls that merit mentioning.
1. One of my partner's patients calls me because the diarrhea is still not better and it's been more than 3 months. While I completely understand the frustrated patient's rationale for calling, there's not much I can do in these circumstances. It is generally not helpful to call a doctor at night to discuss chronic medical complaints, as you will likely not reach your own physician. For example, if you have been having nausea for months, and have had several diagnostic tests and tried different medications, it is doubtful that a covering physician on the phone at night who does not know you will crack the case.
2. The radiology department calls me at night to give a reading. Here's how this works when one of my partner's patients undergoes an evening radiologic test. ”Dr. Kirsch. a patient you have never heard of who left the hospital a half hour ago had a CAT scan of the abdomen. The radiologist suspects mild diverticulitis. Good luck, doctor and have a nice evening!” What this means, of course, is that the radiology department has “checked off a box” that I have been notified and is now in the clear. It is now my responsibility at 11:00 p.m. to sort through this. When I call the patient and can't reach him, how well do you think I sleep that night? I don't have a solution here, but clearly, this is not ideal medical care.
3. A hospital nurse calls me at night to approve a patient's discharge. This is always a killer. It's generally 1 of my partner's patients whom I have never seen. He may have had a complicated hospital course that involved multiple consultants. There is an extensive medication list. The patient still has stomach pain, which the medical team can't explain. If I give the nurse the green light on sending the patient home, then I am accepting full responsibility for this decision even though I have never laid a hand on him. How you would suggest I respond to the nurse in this situation?

Yes, our practice is available to our patients at every hour. But, some hours are more equal than others. It's challenging enough to take care of patients we know well. How can we take care of patients we have never seen?

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.