When a patient has been examined by you or another physician in the recent past, and little pathology was found, there is a tendency to be overly reassured by that examination. Each call must be treated in a "stand-alone" manner to be certain that new or worsening symptoms receive prompt attention. A common source of telephone liability occurs when physicians don't respond appropriately to a patient's complaints after a recent benign examination. Be wary when the patient is reported to "look much sicker" or "has much more pain" since the prior encounter.
Watch for "Hidden Agendas"
Whenever calls seem inappropriate for the time of day, the number of calls about a single symptom seem excessive, or the degree of anxiety exhibited by the parent is out of proportion for the problem, the real reason for the call may be different from the symptoms being presented. It is best to politely answer the parent's questions first, and then follow with a question like "You have called about this three times today. The symptoms don't sound serious to me. Is there something else I need to know?" The most important response from a parent is "I can't put my finger on what is wrong, but my child just isn't acting right and I really feel frightened by the way he looks."
Use Language that is Descriptive and Unambiguous
Because the child is not actually seen over the telephone, it is sometimes necessary to develop a specialized telephone language to evaluate the severity of illness. "Trouble breathing" can mean severe dyspnea or a stuffy nose. It is preferred to ask about "straining or working hard to breathe" or "pulling to get air in and out." Similarly, learning that a febrile child has a rash may not be helpful without knowing whether it looks like "bleeding or bruising under the skin" or whether it has the sudden appearance of "red freckles."
Protect Patient Confidentiality
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations apply to telephone calls between patients and medical staff. Conversations with and about patients (with pharmacies, other physicians, therapists, etc.) should be conducted in places where names and sensitive information will remain private. Be especially wary of answering requests for patient information from individuals who represent themselves as family members, insurance representatives, and helpful friends – especially following trauma. Before sharing information, you must be certain of the caller's identity and obtain the permission of the parent or legal guardian of the minor patient. Telephone messages left with persons other than the child's parent or legal guardian or on answering machines should be purposely vague but not cause undue anxiety.
Practice Good Medicine
This is the best but not infallible protection against malpractice actions. It is also very important to remain an ally and advocate for your patients and their families. Statements like "This sounds terrible. I don't understand why you didn't call me sooner" may be intended to let parents know that a poor outcome is not your fault. Instead – you might create parental guilt, making parents want to blame someone else – and your insensitivity might place you first on that list. A much better strategy is to express empathy with anxious parents' concerns. When you do, you are more likely to be rewarded with their loyalty and gratitude.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. This content is for informational purposes only. It is not intended to constitute financial or legal advice. A financial advisor or attorney should be consulted if financial or legal advice is desired.