Sunday, December 14, 2008

Early a.m. calls

Ordinarily I'm up by 6:30 a.m. I recognize, however, that patient problems don't follow my schedule, even my more leisurely Saturday morning agenda. I also know that nagging problems have a way of seeming more urgent through the wee hours of the morning, so that which is not an emergency (say the discomfort of a bladder infection) can move a patient to place a call to me at oh-dark thirty.

That said, here's the gist of my conversation with a patient of one of my call partners at 6:30 yesterday morning:

Pt: I've had an irregular heart beat on and off for two weeks now.

Me: Is it worse this morning? Are you having shortness of breath or chest pain?

Pt: No. It's just been on my mind and I thought I'd run it by someone.

Turns out this fellow is quite the work-out fiend, feels fine when he works out without any sensation of skipped beats (typical of benign premature contractions), and I think he just wanted reassurance before he went off to his early morning work-out. I was tempted to berate him a bit for his timing (I know some people call off-hours because they know they'll get right through to the doctor), but I held my tongue as he was not my patient.

Would I have been justified in schooling him on after-hours etiquette?


JeanMac said...

Oh my gosh! you give out your number - what a saint. Our MD has an answering service which transfers the call to MD on call - one should never call in the wee hours - go to emerg.

Midlife Midwife said...

Nope...just call him back at 3 a.m. and ask him if his heart is skipping beats again. :-)

femail doc said...

JM: Heavens no, I've got voice mail service that calls me but doesn't, alas, screen calls nor hold them 'til civilized hours.

MM: I like your thinking. Sounds like you've been there if not done that. I have to tell you your story of the young girl who gave birth to Katie who responded so to your singing K-k-k-katie to the baby has stayed with me.

Ruth said...

In Ontario we have a free provincial service called TeleHealth. A nurse is available 24 hours a day for phone consultations. I called once in the wee hours of the morning when our daughter was writhing with colicky abdominal pain. The nurse talked to her and asked screening questions, calming her somewhat. She did advise an emergency room visit and faxed her information ahead to the hospital so we got very fast service. I could never reach a doctor as easily as you can be reached. And that is likely a good thing! (btw, dx... constipation. rx...lactalose)

Mauigirl said...

Some people just don't have the brains they were born with!

My doctor is part of RelayHealth so if I get an anxiety-ridden moment at some ungodly hour I could e-mail her through the service. (It does say to call if you think it's an emergency of course. But it doesn't sound like this guy's problem was an emergency!)

Dr S. said...

Yes, yes! Most definitely this patient needed an education in Dr/patient after hours etiquette.

We are not superheroes we need sleep and food to function, like other human beings.

I work as a community service hospital on the ganglands in Cape Town, and we have patients brought in by the AMBULANCE at three am for "weakness" that has been present for months. Luckily for me, our nurses don't let them through to see me before giving them a great tongue lashing for their non-emergency after hours visit.

I love those nurses.