Picture this scenario. It is 2 a.m., and you get a phone call from a doctor at an outside hospital not associated with your residency. The doctor asks about a patient previously admitted under one of the radiology faculty at your institution. This faculty member also has privileges at another site, but your residency program is not affiliated with this other imaging center. He prompts you to try to contact the faculty member to do the procedure at the other hospital. If you comply with the phone call demands, it will take time away from reading cases while you take call. What do you do?
Many of you may have encountered a situation such as this one. And, you might think there is a simple answer. Of course, you should help out a fellow clinician in need, right? But, in fact, many issues should come into play before making this final decision. So, let’s go through these factors and come up with a balanced answer to this question. Let’s tackle this problem from three different angles: patient care, the hospital/residency perspective, and the financial/legal perspective. Then, we will come up with a final conclusion on how to deal with this scenario.
The Patient Care Perspective
From a patient care perspective, as long as you can verify that the physician calling is truly a physician, helping out a fellow clinician could potentially benefit the patient the clinician is calling about. However, while trying to get in touch with your radiologist, you are distracted from the work you have at hand. You may be delaying all the CT scans, ultrasounds, and more that need to get read at nighttime. So, in terms of patient care, answering the phone call may at best be a wash in terms of fulfilling your duties.
The Hospital/Residency Perspective
On the other hand, you are also providing a service to an outside doctor, not in your job description. You are supposed to be taking care of patients at your institution, not other sites. Moreover, the hospital and the federal government pays you to take care of patients at this site. Answering the phone call for the convenience of an outside attending is outside your job purview.
Additionally, from the residency perspective, taking extraneous phone calls is not helping you in your training. Nor does this phone call count as service duty. Therefore, taking this phone and performing this service runs counter to what you should be doing at nighttime.
The Financial/Legal Perspective
Your malpractice insurance does not cover you if you are taking care of patients outside the institution. Let’s say you can’t get in touch with the faculty member to take care of this patient. But, you have promised to get in touch with him. Now, in a sense, you are taking responsibility for a case outside your institution. You have some obligation toward the doctor that called, the patient that needs care, and the faculty member that you need to call. If something goes wrong with these entities’ connections, the law can hold you partially liable theoretically. And, the residency does not insure you for that!
What To Do With The Outside Phone Call?
You have one reason to respond to this outside physician’s request (“to be helpful”), and you have multiple additional patient care, residency, and financial/legal reasons not to get involved. So, what is the best course of action? Based on these reasons, you need to make it the hospital’s responsibility to get the doctor’s information. Refer the doctor to the operator or the help desk!
In a perfect world, we can help out everyone. But, there are costs and benefits to everything we do. Sometimes, initially, the seemingly most logical and straightforward answers are not the best!