When I became a midwife, I knew that irregular work hours were part of the job. I don’t mind getting up in the middle of the night to support a woman in labor or help deliver a baby. It is also part of my job to answer emergency calls from patients, no matter the time of day or night.
However, my colleagues and I were recently discussing the growing number of non-emergent calls that we receive in the wee hours of the morning or on weekends. I estimate that on average, half of the off-hours calls I receive are non-emergent. I recently got a call at 2 AM from a patient who was having spotting a month after receiving her first Depo Provera shot. Spotting is a common side effect of Depo Provera, and hardly qualifies as an emergency.
Another growing trend is patients routinely using emergency rooms for primary care problems — a definite waste of resources. Part of this is due to the United States’ broken healthcare system, poor access to primary care and an increasing number of uninsured patients. But oftentimes, patients simply do not want to wait until their primary care office has an opening to see them. They want immediate attention for non-emergent issues.
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Have we become a society of such instant gratification that routine medical questions warrant a 2 AM phone call to a provider, or that a fever requires a trip to the ER?
Do patients not understand that providers take emergency phone calls during off-hours, but are not offering a 24/7 “Ask a Nurse” hotline?
Are we so crunched for time in the office that we are not properly educating patients on common side effects of medications and other basic information?
One group I do encourage to call about questions or concerns at any time is pregnant women, no matter what the time of day. Interestingly, I’ve found these patients are the least likely to call, even when they have genuine serious concerns, for fear of bothering the provider.
In my experience, answering services are not capable of triaging calls to determine if they warrant a provider call back. I’ve found that patients often exaggerate or even lie to the answering service in order to be called back.
There has to be a happy medium somewhere. I don’t want patients to be afraid to call off-hours for true emergencies, but being called at midnight for vaginitis is also unacceptable.
Should we start handing out instructions to every patient on when to seek emergency care and when it’s ok to wait? I’m not sure this would even ease this dilemma. If anyone has suggestions for a solution, please share it in the comments section.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.
