May 21, 2009

The Telephone Paradox -- Follow Up

When I wrote the post called The Telephone Paradox, I thought it would be interesting to my readers. Mostly, I think, these are parents and parents of patients of mine. I know that at least a few other doctors read some of the pieces. Since I'm a member of a private listserv focusing on telemedicine through the American Academy of Pediatrics, I let the administrator know about the post in case it would be of interest to colleagues.

In that post, I noted my experience in giving my patients open, unlimited access to calling me any time, at home, on weekends, or at night. I found that the number of phone calls I received actually went down, and the ones I did get were all appropriate and important.

I was not prepared for what happened.

Some responses were flatly doubtful. Many doctors commented that they absolutely knew that my observations were in error, and that I must have a very unusual practice if all kinds of wacky people weren't calling me through the night for foolish reasons. They didn't quite say that I made it all up, but they clearly thought that was a possibility. The most hostile comment came from someone who worked at a for-profit call center. She claimed that waking up doctors in the middle of the night was extremely dangerous because they were likely to make hazardous errors in judgment. She said that people with genuinely sick children would not call when they should because they'd be intimidated by the fact the doctor himself would be answering the phone.

But there were a surprising number of comments noting similar experiences to mine. Typically doctors from small practices, they, too, thought they were the only ones with this experience. These doctors said that they rarely, if ever, were bothered unnecessarily. Patients were respectful of their time and sleep, and they were glad to get the calls they did get.

I redoubled my efforts to search the medical literature. This has never been studied. So while I can discuss my personal experience, and others their experiences, I have nothing to report as supported by statistics.

What I believe is that I have stumbled upon a great example of conventional wisdom. Everybody, including the most exalted experts, believes the world is flat. They are so sure of it that they don't want to send out an expedition to the edge to find out for sure. Why bother when they already know the truth. Yet I, in my little boat, have sailed to where the edge was supposed to be and it's not there at all. So I found out there is a whole industry of for-profit call centers, with people who make a living working in them and managing them. Their purpose is to relieve doctors of the burden of patient calls, a burden that is strongly supported by conventional wisdom.

I made a decision to try and avoid alienating my colleagues (at least for this--I've got some whoppers in the pipeline), and didn't argue with any of them. I had my say in the post, and I thought it was a good idea to let others comment as they might. It gradually became clear that there are no data supporting anything that was said. The person who claimed that patients would be intimidated by calling the doctor had a particularly difficult task if she were ever asked to prove that somehow the medical care of a patient would be improved with less communication with their own doctor. Though I have no data either, at least I have my own genuine experience, and others have had the same experience. Those that have not had this experience have never tried giving out their home phone number, so they believe their experience confirms the conventional wisdom. Since they've never tried it any other way, I don't think it really does.

My readers and my patients know that I question dogma about, well, everything. At least my patients can call me.

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