THE TELEPHONE AND THE PEDIATRICIAN

by Jeff Cersonsky, MD, FAAP

How soon can I expect my pediatrician (or the covering doctor) to respond to my call to the answering service after hours?

When my dad first practiced pediatrics, beepers were not even invented.  He would have to leave the phone number of his present location with the answering service.  He also didn't have a car phone and the EMS (911) service did not exist.  Times have changed, but I share with my dad the same goal: The best care possible for the child. 

To this end, we now use electronic aids.  However, the system for after-hours calls is not perfect, because the elements involved (telephones, answering services, pagers, and doctors) are not perfect.  Though we strive for perfection, the goal is never 100 percent obtained.  However, a parent who understands the system can help us to answer her concerns.  Here are some pointers for parents who call:

1.  If it's an absolute emergency (e.g. heavy bleeding, a child has stopped breathing or is having severe trouble breathing, a severe injury, a seizure, or loss of consciousness), call 911.  The EMS system is in place for just such an emergency.  They will respond immediately.  After you call the EMS and they have the situation under control, call your pediatrician so that they can be aware of the situation.

2.  If, on the other hand, it's a problem you are not particularly troubled by and are sure that it can wait until the next day, it's best to wait and call your pediatrician the next morning.  In responding to your call, the doctor might have to keep a parent waiting who does have an urgent matter.

3.  The doctor will talk with you about the nature of your problem.  Using the information you give him, the decision will be made as to the appropriate course of action.  I will frequently arrange to meet patients in my office at night.  Other times, a first slot appointment the next morning is best.  Sometimes, a visit to the pediatric emergency room is necessary.

4.  If your schedule requires that you get a call back in a certain time frame (you have to pick up your other child from dance class, for instance), tell the answering service so the doctor knows your time constraints.

5.  If you call the number and get no answer, hang up and try again.  You might have misdialed or the phone company and/or call forwarding might have misrouted the call.

6.  If you get a busy signal or a recorded message, try to be patient.  There are only a finite number of lines going into the office or answering service, and they can get all tied up at once.

7.  If you get a busy signal several times, call the phone company.  There might be something wrong with the line. I put the answering service's direct line in my office information booklet should there continue to be a problem with the line that is supposed to be forwarded to the answering service.

8.  Be patient with the person answering at the answering service.  They do a very good job of trying to get important information from you to your doctor.  Frequently, I will get several calls at once from the answering service, and I call patients back in order based on the urgency of the problems.

9.  If you feel it's a relative emergency, tell the answering service.  For instance, belly pain is usually not an urgent matter, unless you really suspect it's appendicitis.  Most pediatricians have an emergency code that the answering service can beep them on.

10.  If the doctor does not call back within a reasonable amount of time (that amount will vary with the type of problem), CALL AGAIN.  Several things can go wrong to delay a call-back: the answering service may have misheard the phone number so the doctor is trying to call you on the wrong number, your phone might be off the hook or otherwise not working, a page sent to the doctor did not get through because of a "dead zone" for the beeper, the doctor might be involved with an emergency that inhibits him from returning phone calls, the message was given as a non-urgent message when it should have been urgent, or simple human error occurs.

11.  Once you do call, please try to stay off the line.  It is frustrating to receive an urgent message and be unable to get through to the family.

12.  If you have anonymous call blocking with your caller ID, disable it by dialing "*87" (or 1187 from a rotary phone).  Most doctors understandably have caller ID blocks on their home phones so they can't get through to you if you have not disabled this feature.  I've found that many people do not even know they have this blocking feature.

13.  Understand that the doctor you talk to might be a different one than you are used to.  We all tend to do things a little differently, so the advice you get might vary from doctor to doctor.  If it's a chronic problem, it might better wait until the next weekday so you can speak with the doctor who is most familiar with your child. 

14.  I have found that it is very difficult to properly prescribe over the phone for children.  Without seeing them, diagnosing the problem and treating it is rarely possible.  If a prescription is called in, the problem might not be addressed, unnecessary side-effects can occur, and other problems might be missed.  Most careful doctors will rarely prescribe antibiotics and other powerful medications over the phone.

After-hours calls are an important segment of any pediatrician's practice.  Working together with the parent, we can make this a useful tool and give the best possible care to your child.