On call tonight. Someone calls, tells their story and I make a recommendation for home action, we clarify the plan and agree on it. I call the ER at the hospital closest to the patient to let them know that my patient may be coming. I speak with ER physician, letting him know something unique about my patient in the context of sharing clinical information. I ask ER physician if they are seeing similar patients with these symptoms. He notes that he's seen four tonight and he'll take care of my patient. I am pleased.
Another calller with concerns about their adolescent child. I ask some questions after listening to the mother's observations of her teen the last few days. I need to clarify the level of intensity of the illness and the threat to the patient's life, parts, ability to go to school tomorrow, need for follow-up, etc. Does he need to be seen tonight or tomorrow? Is he safe? If tonight, which ER or urgent care are we suggesting? If tomorrow, do I have a specific time to offer an appointment?
Sign of the times: both callers left a cell phone number on our answering system. One of them didn't answer, so I left a message that I would call back in 3 minutes. I called back in 3 minutes- no answer again, so I left another message. In 3 minutes, when I called again, they answered, so we conversed about the situation with the illness.
Sometimes when I'm on call, people will call our number, leave their message on the voice mail and forget to leave their number. Sometimes one of us will lose phone contact due to holes in the phone coverage. Lots of interesting cell phone situations occur.
Sometimes the caller is trying to convince a very sick loved one to go to the ER late in the night. Often we can be of help by talking to the sick person and informing them of our relationship with the ER doctors, providing a little continuity message to the patient and transferring the patients trust to the emergency department physician and staff.
The advent of videophones could make night call more effective in those situations in which the patient has a viewable problem, like a rash. Technology will help us to be more and more effective, leaving more time for patient interactions on night call.