In a message dated 6/11/2000 9:55:36 AM Central Daylight Time, writes: > This might seem a silly question to the list members in the US, but please > indulge my ignorance (trained in the UK/NHS, now working in Australia): > Do the patients/parents have to pay for the "right" of contacting you at > home, or is this available to all and sundry? > > Dr Janil Puthucheary MRCPCH > Registrar > New South Wales neonatal and paediatric Emergency Transfer Service > NETS, www.nets.org.au There are not many things that will get pediatricians talking (or complaining) more than phone calls, day or night. The Pediatric Research in Office Settings(PROS) section of the AAP is looking into doing a study on phone calls. Now I will qualify this by saying I practice in a group of 6 pediatricians in a major metro area. There is a "Barton Schmitt" style after-hours service in the city that we don't utilize. We have 2-4 nurses answering the phone, giving advice, booking appointments, handling scripts, and sometimes pulling their hair out at any given time during office hours. We also don't put our phones on service during "lunch" like so many practices are want to do. The doc on call handles all the calls after 6PM. Over the years, I have seen increased use of the phone in pediatric practice. For the most part it has been for the good. We still offer this service without additional charge 24 hours a day, 365 days a year. During the day, our nurses handle most of the calls. Of course this is a big help to us and those who made appointments for their children. No one seems to want to sit in an exam room while the doc talks on the phone. In between patients we review notes, answer questions from the nurses, and return some phone calls. We don't charge for calls after hours, basically because it isn't the usual practice and we don't charge for calls during the day. Most calls are short, appropriate, and assist the parent in caring for their child and relieving anxiety. Now a few are less enjoyable but not all of my day is a piece of cake either. When I get irritated with a call it is more dependent on where my head is than the exact content of the call. If I smile and answer the question the call is ALWAYS shorter than if I don't. Why don't we use the after-hours nurse call service: 1) No one in the group feels strongly that their life is ruined by being on call and talking to parents. 2) The service is expensive on a per call charge. Every study I have seen shows that afterhour calls increase when a call service is used. Not the way we want to go. Now, I don't want get into a discussion why it is ok for the pediatcian to pay for after-hours calls but not the patient or insurance company. 3) We still have to review the faxed documentation and file it in the chart the next day. Personally, it is just as easy to deal with it then vs the next morning when I have other things to do. 4) We give all our patients an Owner's Manual and we often refer to the information in the office and phone calls. Why, it saves the family time to check the book for the dose of tylenol vs waiting for the doc to call. 5) Most of our patients really appreciate that we call them and actually thank us. I think it gives us a competitive advantage. For those that don't appreciate our service, well, there are plenty of practices in Tulsa that use the after-hours service which may better meet their needs. 6) Some of my best chuckles come from these calls. Things that I like to refer to as National Inquirer headlines such as "9 MONTH OLD INFANT SO STRONG THAT MOTHER IS UNABLE TO CHECK AN AXILLARY TEMPERATURE. DOCTOR AMAZED AND SAYS HE HAS NEVER SEEN ANYTHING LIKE THIS" Dumb, maybe. btw: I am on call this weekend. :-)) J. W. Hendricks, MD Tulsa, OK