March 28, 1997

Telephone Medicine

It is because we have begun to act like merchants, and in many instances to observe the same hours, that the public expects us to be regulated by the same restraints.

John L. McClenahan, M.D. 1961

For most of my adult life, the physicians I dealt with were accessible by phone. All of them set aside a certain amount of time to talk to their patients on the telephone. I would phone the office them and be told that "The doctor will call you back." And he always did. When I had small children, I would describe the problem and often his advice was to deal with the fever and call him back in the morning if the child wasn't better. Sometimes it was "Bring her to the office," or "meet me in the emergency room at Children's Hospital at..." or "Bring her to the office tomorrow at..." I can't adequately describe what a great mind reliever it was to have a doctor available by phone.

To have a doctor available when I had a problem was something that I took for granted. I didn't realize that there would come a time when this was no longer so. The last physician I had who was available to his patients by phone was the surgeon Hugh Curtis -and he retired. The new brand of physician seems to believe that his patients should be available to him at his convenience.

My last evening phone experience was with a recorded message that said to call again in the morning, and if it was an emergency to go to the local hospital emergency room. I am fairly knowledgeable in matters medical. How does a message like this impact on someone who knows nothing about medicine? Or worse yet, how does it impinge on someone who has no means of getting to the hospital or who is quite far from the hospital. I am particularly concerned about parents of small children. Their worry must be immense.

I have heard people lament the use of the emergency room for things that weren't real emergencies. What choices do people have? How does the average parent know whether his child has something that can wait, or something that is a true medical emergency? With careful questioning, a skilled physician can often distinguish between a possible appendicitis and a simple bellyache; or a virus infection from a possible meningitis. He usually knows whether a child should be seen immediately or if it can wait.

Every parent has had the experience of seeing his child mildly ill at 4 p.m. He figures that he can wait until morning to call the doctor. Then, at 11 p.m. the kids temperature goes to 105 and the child seems severely ill. It is then that he needs his physician, and if a doctor is unavailable, what good is he?

The modern doctor has at his disposal tools which his predecessor could only dream about. Medicine can now perform some genuine miracles; yet the esteem in which the physician is held has dropped. I attribute this, in part, to the fact that many modern physicians are no longer available to their patients when they need them most.

I am occasionally called by an acquaintance who is worried sick about something that could be dealt with by a physician in a two minute phone call -if he was available. With two recent problems, I was able to relieve that person's mind; always with the caution to check with their doctor. In one case, the advice was "You get to a doctor immediately!"

Usually a knowledgeable nurse can do the job, but often the person you talk to at the doctor's office is a clerk who knows little or nothing about medicine.

There is now a good deal of talk about using nurses to deal with patients, rather than physicians. While it is probably true that a person may sometimes be better off with a skilled nurse than with a poor physician, that is not what the patient is paying for. To charge someone for an office visit, which presumes the attention of a physician, and then have the patient see a nurse seems to me to be blatantly fraudulent.

One great curse of medical insurance is the prevailing attitude that the patient is not paying for the service; the insurance company is. Being treated like second-class citizens used to be a common complaint of the so-called "charity cases." Now everyone can experience that frustration.

Much of the suffering in illness is caused by worrying. Much of the worrying can be relieved by a physician taking some time to explain things to his patient. Physicians talking to patients was not too common in the past. It seems to me that it is becoming rare.

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