Pediatrician’s Journal––

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. The system for after-hours calls is not perfect, however, because the elements involved (telephones, answering services, pagers, and doctors) are not perfect. Though we strive for perfection, the goal is never obtained 100 percent of the time. Parents who understand the system can, however, help us to answer their concerns. Here are some pointers for parents who call:

1. If it is 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 is a problem you are not particularly troubled by and are sure that it can wait until the next day, it is best to wait and call your pediatrician the next morning. In responding to your call, the doctor might have to keep a patient waiting who does have an urgent matter.

3. The doctor will talk with you about the nature of your problem. Using the information you provide, 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 school, 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 you speak with 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 is a relative emergency, please tell the answering service. For instance, belly pain is usually not an urgent matter, unless you suspect it is appendicitis. Most pediatricians have an emergency code on which the answering service can beep them.

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: a. The answering service may have misheard the phone number so the doctor is trying to call you on the wrong number; b. Your phone might be off the hook or otherwise not working; c. A page sent to the doctor did not get through because of a “dead zone” for the beeper; d. The doctor might be involved with an emergency that inhibits him or her from returning phone calls; e. The message was given as a nonurgent message when it should have been urgent; or f. A simple human error occurred.

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 and cannot get through to you if you have not disabled this feature. I have 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 is a chronic problem that is not immediately serious, it might better wait until the next weekday so you can speak with the doctor who is most familiar with your child.

14. Diagnosing the problem and treating it without seeing the patient is generally not good medicine. If a prescription is called in without seeing the child, the problem might not be addressed, unnecessary side effects can occur, and other problems might be missed. I will advise over-the-counter medications over the phone when appropriate, but rarely will I call in a prescription without seeing the patient. Most careful doctors will rarely prescribe antibiotics and other powerful medications over the phone. (Antibiotics are the most frequently prescribed medicine, which makes some people feel they are “no big deal”. Antibiotics are powerful medicines and their overuse is directly responsible for the very scary situation we now face with some bacteria that are resistant to most, if not all, antibiotics.)

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.

(Note: Most of the questions used in my articles are derived from questions I am asked in my practice. I welcome questions from readers, which can be sent to my email address at jmcsdii@erols.com or to my office at 30 Quaker Farms Road, Southbury, CT 06488. I cannot respond to all questions nor give medical direction for specific children, but can give helpful general advice.}