When You Really Need Your Doctor…and She’s in Fiji

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.

The scariest call I ever got was from the father of a young patient.

“Hi, it’s Mr. D,” he said cheerily, when I returned the call. “Everything’s fine here, but I’m just calling to see if Mary can take Motrin for her headache.” A simple enough question. But I had no idea who Mary was. I could so easily have said, “Sure, that sounds good,” and been done. But wait: Why was this man taking the trouble to call a doctor at 11 p.m. to find out if Motrin was OK?

After asking series of questions, I learned that Mary was very sick indeed, the headache was probably due to out-of-control blood pressure, and she needed hospitalization and careful monitoring before things got better.

I’ve missed things too, I know, when trying to take care of patients I don’t know well. During residency, at night, we each covered a large number of hospitalized patients. It was difficult to check on everything, and I sometimes didn’t make it to see every patient on the list. I remember handing the lists back to their owners in the morning, ashamed that I hadn’t seen the results of a test that could have been critical.

Now I think I’ve become more conservative, ordering more tests and checking the chart more carefully when I see a patient for another doctor. I guess that’s the part of covering where the person I’m covering may be myself. It’s hard to strike the right balance.

You can help us out with this. Next time you need to call a doctor at off hours, remember: The doctor who calls you back may not know your story. Explain who you are, what medicines you take, what’s been happening, and why you’re worried. You’ll be helping us help you.