after-hours availability
On Call: An Option or an Obligation?
It's 1 a.m. and a patient has an emergency. How will you make sure that help is on the way?
BY GLENN S. CORBIN, O.D., Reading, Pa.

During a medical emergency, it's comforting to call your physician's office to find that he (or a physician who's covering the practice) is accessible. Often the "emergency" may be something that can be resolved or addressed by a return telephone call alone. Other times, however, it requires a visit to the doctor's office for a personal evaluation.

Regardless, having a physician return your call promptly can save time, money, aggravation and possibly your life. Optometrists have the same responsibility to patients.

I'm all too often disheartened when I phone a colleague after hours only to get endless ringing, an answering machine that offers no emergency service to call, an answering machine that gives the doctor's home or cell phone number, which may have a second voice mail, or a message to call the local ophthalmologist or to go to the nearest emergency room (ER). I've heard them all and believe that we owe our patients more because as the primary eyecare professionals, we care about our patients and their well being.

Let them know you care

We can argue that a "non-therapeutic" practice doesn't need after-hours coverage. I disagree. At the least, probably 20% of our after-hour "emergency" calls relate to contact lens wear. How about the inexperienced contact lens wearer who can't remove his lens, scratches his cornea in the process or develops an acute red, painful eye? Now frightened, this patient needs to reach his optometrist. Do we want him to defer care, visit another provider or go to the ER where eye care is the least learned skill?

Consider the missed opportunities to gain new patients who seek emergency eye care after hours. These patients could become profitable established patients. The message to your patients when you're on call 24/7 is clear: You care about them.

Where is the burden?

Our three-doctor practice services thousands of patients yearly and averages two or three "after-hours" calls each week. Most require only a return phone call to assess the problem and to provide suggestions for palliative care and/or reassurance.

My patients never forget that return call or my visit to the office after hours to treat them. We rotate being on call among our group and have arranged with another local optometric practice to cover for us when we're not available. This reciprocal arrangement ensures that our patients aren't forced to go to our unwanted competition or to an M.D. practice or the ER. Do our patients perceive these after hours providers to be more caring than we are because they're available for them, even though they're treating them by default? I hope not, but the only way to avoid this is to be available after hours.

Some technical advice

Optometrists can solve the after-hours challenge by contracting with an answering service. The service can reach you any time by pager or cell phone wherever you are, without patients having access to your personal numbers. To save costs, you could set up a voice mail system at the answering service so that the answering service only answers in a true emergency.

Upon picking up, our voice mail automatically offers the option to press 0 if a patient has a medical eye emergency. After that announcement, the message reviews office hours and lets the caller access various voice mailboxes. My staff retrieves these messages every morning before opening the office.

The only time the answering service needs to pick up a call is when the caller presses "0" for a medical eye emergency. In this case, the service documents a brief description of the problem and contacts the doctor on call. This process limits the answering service fees and offers patients numerous opportunities to communicate with us. Because many callers only wish to know our office hours, they never need to speak to an answering service operator directly.

On average, we spend $75 each month for this service and easily get a return on our investment with a single emergency office visit.

We owe it to our patients

Whether it's a sudden onset of flashes or floaters, loss of vision or an allergic reaction to the medication you prescribed that day, we owe it to our patients to be available for them after hours. This, my colleagues, is not an option; it is an obligation.

Dr. Corbin is in private practice. He serves on the Adjunct Faculty at The Pennsylvania College of Optometry and lectures nationally.