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Phone calls MIA

April 2011

We are increasingly seeing patients who (due to insurance restrictions) have to change doctors while they are still sick enough to require inpatient care.

The first time Dr. Othercare gets told to give us a patient by the case manager, he calls us and we are nice. The second time he calls, we are in a hurry and just go to see the patient without even talking to him.

The third time he says, “Oh, the heck with the phone call,” and just writes an order to transfer care with NO call to the doctor who is expected to assume primary responsibility for this patient’s care. The fifth or sixth time it happens, the hospitalist is never even told about the transfer at all–but the patient develops midnight pulmonary edema, and everybody blames the hospitalist for greedily snatching business away from poor Dr. Othercare.

When we were residents and had lots of back-up and redundancy in our staffing, this may have worked out OK. That’s because somebody would always “find” the patient before anything bad happened. But it is not always clear to the nurses whom to call and which hospitalist service should be taking care of a patient. And they do not keep track of whether somebody is writing a note every day.

We want to be liked, we want to be helpful to our colleagues, we want to be good team players. And often we don’t really need that doctor-to-doctor phone call, so why should we be sticky about insisting on it for every single transfer?

Because sooner or later one or more of our patients is going to get in serious trouble because that phone call never took place. And the transferring doctor is going to say, “But the hospitalists are always really nice about taking these patients! How was I supposed to know they wanted me to call?!”