The headline sounds very obnoxious right? Working in the UK during my specialization was an insight into what the life of a doctor should ideally be. When I clock into work, I know I am on call. You are handed the beep and it runs your life. Immediately it rings you have to call back and attend to that emergency.
We also had a department phone line where the resident on cover called back patients who had issues to direct them to their GPs, advise them, change appointments, or refer to the emergency.
Once the day ended and I handed over that beep, I could go home without thinking about the hospital, because someone else was on cover. Patients’ had access to advise and care and the doctor also got to go home, read on assignments, prepare for the next day and hopefully have some family time.
Unfortunately, that’s not the case in Ghana and probably most developing countries. Beeps are not available; hospital lines don’t work or are not existent. What does the patient do when he or she is in a crisis? The GP system doesn’t work well at all.
Reality is, in some cases a patient might meet an emergency question or concern that has to be answered. If you are a doctor and you become concernedand you give you private number out after a while. You want your patient to be able to get access to the right care in case of an emergency, so with trepidation you still give it out. With stern warnings not to call unnecessarily. (Oh doc! I promise I won’t call you unless it is necessary).
Now examine this scenario. The patient to doctor ratio in Ghana is one doctor to 8000 patients, imagine that you gave your number to only 25percent of clients that’s 2000, imagine only 25percent chose to call that’s 500 patients outside regular work. If you hold your clinic from 8am to 5pm and receive calls and texts from patients thereon after when does it end? Even after midnight. Day in and day out.
The problems with phone consults:
Now let me tell you what happens next in 50percent of cases. Ring ring! Doc I was just calling to say thank you.
Ring Ring! Doc I saw this advert for some herbal drug on radio can I take that instead? Ring Ring! Doc are you asleep? (it is 2am!) I couldn’t eat today can it be malaria? Ring ring! Doc I have missed you.
Calling to ask advice about people you haven’t seen; what medicine do I give my father his blood pressure is 210/120?”, “My child just drank something from a bottle in the garage. What should I give?” and “Doc I have been having stomach pains, what should I take?” All could clearly be medical emergencies and should not be treated over text or on the phone.
Facebook and Whatsapp: your inbox is full of religious messages from patients and you can’t sift through to find the urgent messages.
Phone consults has a high risk of misdiagnosis and inadequate management, stomach pain can mean anything from peptic ulcer to a pelvic infection. Substandard care is delivered via telephone, if I am busy and responding to you, I am more likely to miss vital information you say.
Clients think once they call, you have to pick immediately, forgetting that at work that day my responsibility is to the client in front of me. They also deserve my outmost care and attention.
There is no compensation for this extra workload (try calling a lawyer and see the bill!)
Using phones and social media can put patients’ confidential data out in the open and in some countries that can easily ruin your HIPAA compliance and make you vulnerable to large fines.
Even strangers end up with your number! Patient Asomasi gives the phone number to two friends and those two friends give the number to other friends and so on.
Potential intrusions on private time with loved ones or family.It should be fair to say that when a doctor is off-duty they are off-everything. No clinics. No hospital rounds. No emergency calls. No patients. A doctor needs to rest and do regular person activities just like everyone else.
So what is the best way to handle this?
Of course, ideally not to give your number out at all, hospitals should make work lines available. But we know that would not happen soon.
So dear clients:
Don’t be offended if a doctor refuses to give their private number out. For those who are lucky, please keep the calls to genuine emergencies.
No, no, we don’t need those generic messages on Facebook or WhatsApp (I personally will block you once you abuse this after I send you’re a courteous message to desist twice). I am not here to save my soul, but to help heal you.
We love you just as you love us, let’s appreciate each other. Don’t wait till Christmas and send 100s of messages to make up. If that emergency didn’t make you call or seek help in the daytime it can wait the night.
Calling at 2am instead of going to the hospital is not helping you. First seek the nearest help then call. Hospitals are 24 hours. In an emergency a doctor without examining the patient cannot give an accurate diagnosis through phone.
Clients tend to trust and regard the doctor who gives their number as more caring. If the patient is a high risk patient, it is for your own peace of mind and the clients’ better long term care to give out your number.
If a doctor gives their personal phone number out, they should set out rules on when they should or should not call or text. If you set boundaries and provided alternate accessibility options, most patients will understand and direct concerns to the appropriate level of care at a reasonable time of day.
Be careful not to breach confidentiality issues.
A second phone line can make it easy to set boundaries while still increasing overall access for your patients. You could, for instance, configure things so that calls to your personal number ring through at all times, while calls to your “practice” line go straight to voicemail and don’t interrupt you until you’re ready for them.
So Doc, Can I have your number?