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On Being a Doctor |

I Can't Be Bothered

Faith Fitzgerald, MD
[+] Article and Author Information

From the University of California, Davis, Sacramento, CA 95817.


Requests for Single Reprints: Faith Fitzgerald, MD, University of California, Davis, 4150 V Street, Suite 2400, Sacramento, CA 95817; e-mail, faith.fitzgerald@ucdmc.ucdavis.edu.


Ann Intern Med. 2008;148(4):317-318. doi:10.7326/0003-4819-148-4-200802190-00013
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When I get a telephone call from a patient, it always begins with the same words: “I hate to bother you, but … .”

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I Know How to Bother Them
Posted on February 19, 2008
William C (III) Waters
MS Center of Atlanta
Conflict of Interest: None Declared

Faith, Loved your commentary as always. This is the era, not of communication, but of electronic insularity.

For some 10 years the doctors at our institution all have cell phones and I KNOW THE NUMBERS. They know colleagues must have their secret numbers or they will be isolated.

I can't be bothered with landlines, beepers, faxes, or emails.

Warm regards

Bill Waters

Conflict of Interest:

None declared

I'm Glad You Called
Posted on February 20, 2008
Jack G. Beaird
Woodlake Clinic
Conflict of Interest: None Declared

Dr. Fitzgerald's experiences with trying to reach a physician are much the same as those my patients used to have when they tried to reach me. About five years ago the problem was so bad that I started giving my patients my cell phone number.

The number is not printed on my card or in any of our clinic literature. I make a point of hand writing the number on a notepad, telling my patients to keep it in a safe place, and to use it if they ever are having serious trouble and need to reach me quickly. I remind them to use the regular clinic number for refills, appointments and routine matters.

I was afraid of being overwhelmed, but the experience has been nothing like what I dreaded. Invariably the patient and their family members express astonishment that I would give them this number. Now that I have been doing this a while, some will say, I heard you were going to give me your cell number, but I did not believe it. They all tell me they would not dream of bothering me unless it is truly urgent. And then they thank me, and carefully store the slip of paper in their wallet or purse.

I have not studied this formally, but I average about 10 to 15 patient calls a week on my cell. No one has ever called me after midnight or before 0600. About once every two weeks, someone will forget and call about a mundane issue. I redirect them to the appropriate clinic number but tell them to be sure and keep the number for urgent issues.

Almost all of the calls are important in some way or another. One of my younger patients died unexpectedly at home. Her father did not know what to do and called me. A patient with dementia became acutely agitated. His wife was frightened and called me. A patient with COPD developed fever and shortness of breath and called.

Some patients I ask to call 911. Some I reassure and tell to call me if the problem does not clear up as it seems like it will. Others I arrange to see in the clinic the next morning.

None of the calls are very long, not over 5 minutes. None have been especially difficult. I know the person calling well and can either solve the problem on the phone or tell them how to get the further assessment and treatment they need. It is not hard work.

Maybe this won't work for other docs. None of my partners have started giving out their numbers. Maybe it only works for me because I'm a geriatrician in a stable midwest community. My patients are mostly self- reliant old folks who truly do not want to bother anyone. Maybe it only works because I see my patients often for regular management of their chronic problems, so they are seeing me often enough to deal with most of their issues at scheduled visits. Maybe it only works because I work with the best nurse I've ever known, and she anticipates and heads off so many problems.

But, for what ever reasons, it does work for my patients and for me. Being available in this way is reassuring to my patients and has made me realize that I can trust them, just as they trust me.

At the end of each patient call I try to remember to say: "I'm glad you called, it was important". And it is true, I am glad they had the number and that they called. It makes me feel like I've done a little bit to make a huge complicated impersonal medical system a little more human, a little kinder, a little more caring.

Jack Beaird MD Internal Medicine and Geriatrics Woodlake Clinic Richfield, MN

Conflict of Interest:

None declared

I can and should be bothered!
Posted on February 20, 2008
Renu Weiss
The Banyan, www.thebanyan.org
Conflict of Interest: None Declared

Hi Faith,

Loved the no-nonsense article.

As you know, I take care of the destitute in India. When one of my patients has to be evaluated by another physician, I consider it good fortune to get a call from her/him after said evaluation. Several doctors are good enough to do that; as with your other correspondent, many of us have each others' cell phone numbers and it is easy to tell at a glance who is calling and how valuable the call is. For the calling physician, as well, it is nice to reach a medical colleague, give a concise update, and essentially safely pass the care back to the other physician.

Such ease of communication can only benefit the patient. The designers of the phone system you waded (so patiently! I would have lasted 2-1/2 minutes at max) through appear to have forgotten that. Too bad.

My cell phone has become as important as my stethoscope.

Keep on keepin' on,

Renu Weiss

Conflict of Interest:

None declared

The Bothering System!
Posted on February 21, 2008
Osama S.M. Amin
Baghdad Teaching Hospital, Department of Neurology, Baghdad, Iraq
Conflict of Interest: None Declared

Thanks to Dr.Faith...

Honestly, I was so impressed by Dr. Fitzgerald's article. I don't know if it is a mere coincidence! This morning, our department's secretary gave me a call saying that we will meet at 1.00 PM and ended her phone call by saying "stick to the schedule!"

Just before reading the article, I had received a phone call from one of my new patients who seemed to be very embarrassed; "pardon me doctor and please forgive me for bothering you at this time, but I think the pharmacist had given me the wrong medication. I don't know what to do!" said the man.

He was more polite than our secretary!

I agree with Dr. Beaird in respect to giving our personal cell phone number, but in my country, everyone should know others' mobile's number. In Iraq, the landlines suffer a lot as an aftermath of the war, sectarian violence, terrorism, and financial corruption. That's why we depend "heavily" on cellular phones for communications. However, some patients or their relatives may actually abuse this bonus. What to do to get rid of this? Nothing, as the benefit definitely outweighs the bothering call! Yes, it is our work; ignoring an irritated patient or a confused resident would be the bothering thing.

Regards

O. Amin

Conflict of Interest:

None declared

The bothering system: A politically incorrect response
Posted on February 29, 2008
Edward J. Volpintesta
No Affiliation
Conflict of Interest: None Declared

I admire the author's dedication,fortitude, and her derived satisfaction in making herself available by cell phone to her patients.

As a busy primary care doctor in private practice I would not be able to do it. Being available by cell phone would add too great a degree of electonic omnipresence.

My day is already full of distractions and interruptions that a multitude of sources send my way. They don't all hit me at once or on the same day, but enough of them combine on any given day to distract and interrupt me.

Phone calls from patients and their families, small emergencies, large emergencies, filling out drug store fax-requests for refills, reading and sending back visiting nurse forms and home health care agency reports, hassling with an HMO over a drug not on their formulary, calls from hospitalists; reading X-ray, CAT scans and other imaging reports and deciding on a course of action and getting back to the patient (the incidentalomas are especially a nuisance), going over stress tests and echocardiograms; reviewing laboratory reports and deciding whether or not to repeat that elevated calcium, replete that low potassium, or treat more aggressively that high triglyceride and calling the patient, responding to a request from Medicare ,HEDIS or an HMO for a chart review, writing out work absence notes, fitting in that extra patient when the schedule is already overloaded, these are some of the "bothers" that all primary care doctors undergo everyday.

It may be politically incorrect, but my time off is precious. I am wary of losing what little free time I have; distractions and interruptions are the modus operandi in the office but I prefer not to have them on my time off. In order to give my patients the compassionate and competent care they require,I need to recharge my emotional reserves and the answering service for over thiry years as been doing just fine.

Conflict of Interest:

None declared

Nurses need ready access, too
Posted on February 27, 2008
Charles R Felton
Porsmouth Regional Hospital
Conflict of Interest: None Declared

For hospitalized patients, nurses catch my mistakes, are my eyes and ears, provide valuable perspective and thoughts, and are an essential part of the health care team. In addition to other physicians and patients, I want nurses to be able to readily reach me.

Conflict of Interest:

None declared

Using technology to reduce bother
Posted on March 18, 2008
Ashish Sitapara
University of Pennsylvania
Conflict of Interest: None Declared

"Bothering" is not a form of casual interaction in today's pseudoefficient modern medical practice. When I started my private practice a few months ago, Signature Medicine, I was advised by paid consultants to use telephone trees to screen/filter calls and increase overall efficiency and productivity. I chose not to. In fact, I give my cell phone number out freely to patients. I use text messaging between colleagues (in fact I choose many of my specialists I refer to because they read and send text messages). I use email to get in touch with people. And when I still can't get in touch with someone, I get angry.

As a resident, I use to worry about bothering the attending. As a patient, I still worry about bothering own my doctor. It's not that I shouldn't bother him. But I sympathize, and empathize for him. He has to see 30 patients a day, deal with daily interference from insurane companies who refuse to pay for care, increasing overhead, increasing liabiltiy, prior-pre authorizations, and ultimately below cost reimbursement or flat denial.

With him going home to his children at 10pm every night, how can I in good conscious "bother" him? My answer to my patients...just email, text, or call me. I'll always make time for them, as soon as I get a moment to catch my own breath.

Conflict of Interest:

None declared

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