A couple of years ago, while I was watching the new James Bond movie in the theatre, a physician called me an hour into the movie for a cardiac CT appointment. I had set my phone to Do Not Disturb (DND) and realized he had called only after the movie ended. I called back and he told me, “A patient needed a cardiac CT, but since you were not contactable, I have sent the patient to another centre.”
I was upset, “If I was not contactable, couldn’t you have called the centre directly or given the centre’s contact details to the patient, or asked the patient to make an appointment directly with the centre or just waited till I called back?”.
He said, “I don’t have any other number of yours”, which got me even more upset, because this is a physician who had been referring patients for the last 10 years and could easily have Googled for the landline number or told the patient he/we would get back. I asked him if it had been an emergency. He said no.
I told him, “So my worth to you is directly proportional to my ability to pick up the phone when you call?” He said, “Well, if you don’t pick up, then I don’t have a choice but to send to someone else who picks up.” I hung up, feeling small and commoditized.
After 30 years of practice, if my worth is based on how quickly I pick up the phone, then what is the point of having been in practice for this long? I can understand if it is an emergency as with a head injury or an ongoing stroke or an acute abdomen…at these times, you have to get the scan done at the earliest, with whoever is available nearby. But if it is not an emergency, what does it cost the referring doctor to wait? Many will tell the patient to wait, but many will just move on to the next available radiologist or pathologist or physician or surgeon, depending on who they can find to pick up the phone.
It is possible sometimes that the patient has a social emergency, is from out of town, cannot wait, is emotionally overwrought and wants to do the test immediately…then too it’s fine not to wait and to get the test done with whoever, whenever, though there are often consequences to this approach. I remember a friend’s 16-years old son who had a swelling over the leg for almost 2 weeks and then, when it wasn’t going away, went to show an orthopedic surgeon who advised an MRI, which led to complete panic and they went to a centre at 11 PM at night after they tried but could not get in touch with me and had the scan without the supervision of a radiologist. The tech did not bother to cover the top and bottom of the swelling and everything had to be repeated the next day.
Which as I have said, is all fine. If a patient is unwilling to wait for any reason, or if it is a true medical emergency, then the test may be done whenever wherever possible. But, if it is not a medical emergency, then that should be the patient’s choice, not the referring doctor’s.
In all other situations, how is my worth to a fellow doctor tied up to the speed with which I pick up the phone? Seriously? Is that my relevance? I remember another physician, whose secretary would call for an MRI appointment, typically sometime between 3 and 6 in the evening and the patient would be sent for an MRI only if I picked up the phone at the first instance. Even if I called back just 15 minutes later, the patient would have been sent somewhere else and I would be told very sweetly that the patient wanted to go somewhere else. After a few such calls, I just stopped picking up calls from that landline number.
I can understand when a doctor is starting out in practice and needs to be available at all times for patients and referring doctors, so as not to miss out on referrals. But after 30 years of practice, if I still have to work with the same scarcity mentality that the patient will go somewhere else if I don’t drop everything and pick up the phone the moment it rings, then I ask, “What was the point of all this?” After the age of 55, shouldn’t all doctors have garnered a little goodwill and respect that makes us worth a little more than just our ability to pick up the phone, or answer a WhatsApp immediately?
Patients usually don’t have a problem. If they have been told to see a particular doctor, and if the doctor does not pick up the phone or answer a WhatsApp right away, they will wait almost 95% of the times, unless it is a dire emergency. In any case, most doctors will get back within 24 hours, which is good enough for 95% of all medical issues. The challenge is with some of our brethren and colleagues who decide our worth based on our ability to pick up the phone and/or have ego issues if we don’t pick up the phone, especially if they are senior to us or have huge practices and believe they are doing us a favor by referring patients to us.
Some of you, especially those living abroad might say, “Why not use voicemail?” Voicemail in India remains an alien concept and is not worth the effort. What about forwarding the phone to a receptionist or secretary? Most people do not even wait till the end of the message played when the number is being forwarded…so that also rarely works.
The older I get, the less now I care. If I am sleeping, if I am with a friend chatting, if I am out with friends or family for a meal, if I am on vacation, I will put the phone on DND and I am done. If the referring doctor can wait, fine, if not, too bad. But, after more than a quarter century of practice, I will NOT have my life dictated or my worth decided on the basis of how fast I pick up the phone or answer a WhatsApp when a fellow physician or surgeon calls to refer a patient. I refuse to accept that what I have to offer is so commoditized that I make no difference to the final outcome except for how fast I pick up the phone or answer a message.
Anthony Burgess said, “One of the delights known to age, and beyond the grasp of youth, is that of Not Going”. I would change it to, “One of the delights known to age, and beyond the grasp of youth, is that of Not Being on Edge All the Time”.
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