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Answer the phone, resident

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Bernice Clark |
Answer the phone'See you in a month for a check up, in the meantime give me a call if there are any problems.' And our patient is released from the hospital. A few days later the phone call arrived, but doctor's hands are full and it's on you, dear resident, to answer the phone.


If you are working in general practice that means that you will be answering questions asked by patients who already were in the hospital and need an advice. While diagnosing disease and recognizing symptoms as life-threatening it's a benefit to have a patient in front of you, but in this case you must rely on your knowledge and sometimes on your instincts. Why?

Firstly, because some patients don't follow doctor's order and secondly, a person on the phone could be scared (a family member on the phone) or unsure does she/he need your help at all, and it will be hard for you to understand what exactly is the problem and without having the right facts it is very hard to give the right advice. In the other hand, some patients will be waiting for too long before they make a call.

Think about answering the phone like on triage: first things first, and you will do it right.

But, first let's see a few questions asked by patients to get a feeling what to expect:

"I was fine after the surgery but now I have high temperature."

"I think I took wrong pills."

"I forgot to take my pills last night and I took two pills half an hour ago and now I feel dizzy and have blurred vision."

"You said my daughter can play with other children and I just noticed she has some red, blotchy skin rash. She started to cough, has runny nose, inflamed eyes, sore throat, and fever. My neighbour said it's allergic reaction to medication she takes. Should we come? Our car is broken but we can take a bus, we can be there in 30-40 minutes max."

"My husband was working in the field, not long, maybe 2 or 3 hours, and now his heart is beating very fast and hard."

"Hello. You said I can call. My leg is hurting me and it's a bit swollen. Well, I had a surgery but my buddies came to my place and they talk me into playing some tennis. I swear I was in the game for only one set paying extreme attention to my leg (as you said), I was standing at one place - almost not moving. I just want to ask: it will pass, right?"

"Sorry for bothering you, you said she'll be fine and my wife says it's nothing, but she's pale in her face. You know, our children came and she was in the kitchen making pasta and we all see she's having trouble breathing and now I'm not feeling well either, but you said she'll be fine."

As you can see there will be a range of questions and you must treat all of them with the same attention. When you are on the phone you are a doctor and your judgement can save someone's life. Or you may kill somebody. But above all you must make a decision. Questioning and doubts are bad. Making decisions is good.

Although you may expect to get questions related to patient's previous staying in the hospital, have in mind that behind some of them can be some completely new disease, either well hidden while the patient was in the hospital or one that patient got after she/he was sent home.

So, maximal focus, concentration all the time and you are on the horse. The first thing you must know is which medical conditions are life-threatening.

Those are:

1. Sudden loss of consciousness
That's tricky, because it can be either not a big deal or the end of a journey. You will be amazed how many times someone will call in panic "My husband felt down! He's not moving!", only to discover that he is plain drunk, totally unrelated to his previous visit to the hospital. But then again, as you know, cardiac arrest usually starts with - unconsciousness. So, this is a condition that requires attention.

2. Chest pain
Remember this: Never ever ignore a patient who is complaining about chest pain! Some data shows that chest pain is one of the most overlooked medical emergencies. Don't be a part of the statistic. Maybe a person on the phone would try to minimize patient's feeling of chest pain because of fear, but since she/he is already on the phone ask for more details. Start your questions with the pain in arms (ask especially for the left arm), ask about breathing, sweating and nausea.

Pay special attention to two situations: the pain started around 2AM or 3AM and it awakes the person, usually an older person. Or, a middle age man feels the chest pain after exercising. The both situations are good signs of an incoming heart attack.

3. Weakness on one side
It can be nothing more than a pinched nerve, but it can also mean - stroke. Especially if the other side is fine. If that is the case then Big Ben in your head must make a noise like it is New Year.

4. Shortness of breath
Shortness of breath in combination with chest pain means just one thing: the patient must call ER. No driving to doctor, no "I'll call my wife", no "OK, I'll take taxi" - tell patient to call ER and say "I am having a heart attack!" With a bit of panic if possible. In one percent of cases you will be wrong and ER staff will yell at you because they went out for no reason, but in 99 percent you will save someone's life. Shortness of breath alone - but lasting for days - looks like a chronic illness and you just send the patient to his doctor.

5. Seizure
If patient had a seizure or is having a seizure, see first is the seizure connected with his previous staying in the hospital because of epilepsy or some brain damage. Some seizures are of cardiac nature, some have endocrine causes and only about 25 percent of people who have a seizure have epilepsy.

Yes, sometimes you will make it easy, sometimes hard, but you must try to correct the mistake. If you make a wrong one, try to make things better, but you MUST make a decision. If you are in doubt don't ask senior service - just send the caller to his general practice.

And for the end, take a closer look at that mother's question one more time and think about what your answer would be. Practice answering the phone among yourselves and soon you will feel no fear or doubt about decisions you have to make.

Contributed by: Abraham Eisenstein, M.D.

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