A recently posted article in the Postgraduate Medical Journal discussed potential physician liability associated with being on call and having after-hours patient calls handled by third-party telephone answering services. Telephone answering services provide a link between a physician and their patients when the office is closed. Physicians must recognize possible risks associated with the physician-patient relationship and some aspects relating to the Emergency Medical Treatment and Labor Act. In the physician-patient relationship, the provider has an obligation to maintain communication as needed.
An answering service helps to be sure that patient emergencies are responded to in a timely fashion. The service is essentially acting as an agent of the physician. Physicians facing claims of negligence are tasked with defending that they maintained the appropriate level of standards in care. When an answering service is an intermediary, the physician may ultimately need to defend the actions of these operators. Answering service providers should be properly chosen, trained and monitored regularly. Common problems involve operators not sending critical messages to the doctor immediately, failing to make appropriate documentation, or sending inaccurate data (like the wrong patient phone number) to the doctor.
Professional After-Hours Call Centers
A recent American Association of Pediatrics article discussed call centers that are staffed with registered nurses and other clinical professionals that offer much more than the clerical skills among those working in answering services. The staff is able to better evaluate the nature of the calls and assess the proper course of action. Although the service is more costly, physicians are likely to benefit from a reduced number of calls.
If a lawsuit were to surface, the physician will need to prove that they responded to the patient in a period of time that was reasonable based on current care standards. The physician has a duty to reach the patient and have documentation to defend a claim of negligence. Answering services should have call recording and the time automatically documented.
When a physician speaks with a patient after-hours in response to an answering service call it is important to enter the details into the patient's medical records. If the answering service is unable to reach the doctor in a reasonable time frame, they should be instructed to forward patients to 911 or direct them to visit the emergency room.
Potentially Important Calls
Those fielding patient calls after-hours should be trained to recognize possibly critical signs such as:
- If the caller believes the situation is urgent
- When the operator believes that the patient's situation may be an emergency based on the nature of their complaint or frame of mind
- Multiple calls regarding the same issue are received
- Situations involving infants
Calls should be answered by a live operator—an answering machine does not suffice. The answering service should have multiple ways of contacting the physician such as mobile phone, e-mail, landline, etc. Operators should not feel as though their priority is to deflect your calls. Consider bilingual operators if needed for the base of patients. Patients should not be placed on hold for excessive lengths of time. Doctors may initiate calls posing as a patient to evaluate performance.