Dealing with pushy patients on after-hours telephone triage

I just spent a 72-hour holiday weekend on call.  In my practice this entails making rounds at the hospital each day with the back-up physician, attending any vaginal births that occur and taking all phone calls that come through our answering service. The phone calls are usually the most challenging part of any weekend on-call shift.

I’m thrilled to be able take calls from home, and certainly there are urgent and emergent issues that need to be addressed during off hours. I’m more than happy to help with these problems in any way I can. 

The challenging part of taking weekend or nighttime phone calls is less about the medical issues and more about the attitude of the callers. Many patients seem to believe that I am sitting in the hospital or the office just waiting for them to call.  They expect me to have access to their charts, lab results and pharmacy phone numbers, regardless of the time of day or night.

Patients can become very irrational when you simply cannot help them. The most common trigger is hormonal birth control refills. Our office has a strict policy that we do not refill hormones during off hours. There are no true birth control emergencies. After calmly explaining this policy and recommending condoms or abstinence for the weekend, I’ve had women tell me that I will be to blame if they get pregnant!   

Patients sometimes want me to diagnose and treat their rash, bump, cough or bleeding over the phone. I’ve even had patients offer to text me a photo of their specific problem. Not being able to perform this service is one of the huge limitations of phone triage, so I often send people to the emergency room for evaluation. I understand that a visit to the ER can be lengthy, but I cannot treat a problem I cannot fully evaluate.

Any patient complaining of severe pain and requesting narcotics will also receive a referral to the ER. By law I cannot prescribe or refill narcotics over the phone.  Nor will I drive to a pharmacy to drop a prescription off.

As challenging as it can be, taking after-hours phone calls is a very serious and an important part of any health care provider’s job. I am polite, regardless of the time of day or night, and will listen and help in any way possible. I only wish that all of my patients could be respectful and aware of the limitations of telephone triage.