Urgent Case And I Can’t Get In Touch With The Doctor: What Do I Do?
Covering physicians should always be available, especially in the event of an urgent case. However, when you begin radiology practice you will find that 24-hour physician availability is a pipe dream. In fact, several times a week I encounter situations when I cannot reach a physician, let alone a nurse. Fortunately, most of the time I just want to make sure that the physician receives a piece of nonurgent information. So, if I wait a day or two to contact the physician, no harm will come to the patient.
But then, every once in a while we read an urgent case that can potentially represent the difference between life or death. Perhaps, you find a spontaneous pneumothorax in a patient with mild chest pain. Or, maybe you see an impending aortic rupture in a patient with heartburn. Regardless, good medicine and the law dictate that we need to communicate these urgent results rapidly so the patient can get properly treated.
So, what do you do when you cannot get in touch with a physician and you have an urgent case? Do you yell down the hallway? Do you stomp your feet? Or, do you send smoke signals via the hospital generator? You can do any of these fun activities if you want to. (Sure would release a lot of stress!) But, today I am going to go into more effective ways of making sure that the patient receives the appropriate care when you cannot reach the covering physician. In order to introduce this topic, I will give you a few real-world scenarios and instruct you on what my colleagues and I would have done.
Call The Patient Or Patient’s Caretaker Directly
These are the sorts of cases that tend to occur at the very end of the day. For me, the last episode I can remember occurred when I just looked at the last outpatient case of the day at one of our imaging centers. I can recall looking at the last abdominal CT scan at about 8:30 PM on a late shift, and seeing oral contrast density framing several bowel loops on a CT scan. Then suddenly, the anticipation of going home shifted to dread. I knew that I would be lucky if I could reach anyone to let them know this patient had a bowel perforation. And, right I was…
As you would expect, I called multiple times to reach the physician covering the patient. But, to no avail. All I got back was a ringing telephone. What would you do next? Well, I did the most logical thing. Simply, I called the patient’s house and reached the wife of the patient. I told them to immediately get checked out at the local emergency department.
Fortunately for the patient, everything turned out alright. But, if I would have continued to call and wait for a physician to pick up, the patient could have died. Sometimes, you just have to call the patient directly!
Send A Certified Letter
Other times, you may make a finding that is very important but not quite as urgent. Maybe, you discovered cancer on a mammogram. Again, you try to reach the covering physician. But, it does not work out all too well. At this point, you still need to make sure you directly contact a covering physician or patient. Otherwise, you can be liable if the patient did not follow appropriate treatment. But, you also have another option if you can’t get in touch with the physician or patient. You can make sure to send a certified letter to the address on record.
Certified letters serve as official documentation that you have made a good faith effort to reach the patient after the initial communication has failed. At least, you can make sure you have performed your own due diligence.
Call The Cops/Dial 911
In other situations, the consequences of not getting to the patient in time can be dire. Let’s say you detected a subarachnoid hemorrhage on an outpatient at 9 pm in an imaging facility, but the imaging center completed the case in the early afternoon. And, again, you cannot get through to the doctor or patient. One radical technique to overcome this issue: Call the police and dial 911. Theoretically, if you have a suspicion that the patient may be at risk of life or limb, the police have the authority to knock down the door and make sure that the patient receives appropriate care. Fortunately for me, I have never had to resort to this option. But, I know of other radiologists who have.
Final Thoughts About Communicating An Urgent Case When The Doctor Is Not Available
Usually, when you have the will to get through to a covering physician or patient, there is a way. Sometimes, you need to take more extreme tactics into your own hands. Remember… It’s for quality patient care. So, don’t give up. Rather, make sure to follow through. Because otherwise, you risk not only the patient’s well being but your own career as well!