Phone Consultations: Should Doctors Give Their Cellphone Numbers To Their Patients?
January 27th, 2010 by Prudence
Image Source: Cartoonstock
In a manner of speaking, Filipinos have long embraced the mobile lifestyle. Most students have cellphones now, whether a college freshman or a gradeschooler, and they usually keep it in their pockets, waiting for call from parents or bus service so they could be picked up. Most become queasy when they’re already away from home and they find out they’ve left their cellphones behind. Long gone are the days when friends chat over phone about the day’s happenings; now they’d chat over YM or skype or have a barrage of text exchanges. Even the neighborhood’s basurero can be seen toying with his cellphone while resting from his work.
And this lifestyle has permeated almost all aspects of the society. Fitness clubs would request for members’ cellphone numbers so they could send them SMS regarding new promotions/contests. Some radio shows have adopted SMS for “text”-in contest votes or song requests. Hell, it has even invaded the banking business, in which one can request a brief bank account statement.
So, it wasn’t long when Filipinos realized that they can use this new technology to further enhance communication with their medical doctors (though delivery of health care via telephone have long been used, since 1876, when Alexander Graham Bell recorded his first telephone call asking help after he spilled sulphuric acid on himself)
In my years of practice, I’ve frequently encountered patients who do consultations over SMS. These are some examples of such messages:
1) ”Doc, I have cough. 3 days na. What do I take?”
2) ”This is X, friend of Y, he gave me your number. I have urinalysis test, can you tell me what this means?”
3) ”Si Lolo ayaw gumising. Parang maputla. Ano kaya nangyari?”
The most common message would be Case #1. The problem I have with it is that people assume that when there’s cough, there’s an automatic corresponding medication to take. I think if people will take notice, doctors do ask a lot of questions during consultations. How long has he had cough? Was it productive of sputum? What color was the phlegm? Did he have fever? Is there anyone in the house who’s had cough for a long time? There could be more questions, depending upon the answers derived from earlier questions. And certainly, some patients do find this quite annoying, not realizing that history-taking is part of the process of diagnosing an illness. Thus, the problem I find with SMS consultations is that proper history-taking is hindered.
Case #2 is something that I get often too. A bit harmless but can be a bit frustrating, especially when I realize that the person asking the question has not actually followed up with the doctor who requested for the test. Progress in management of illnesses have been slow due to patients who have not come back for follow-up or have resorted to doctor-shopping. On the other hand, this is a practice that is done sometimes by some patients and are welcomed by their doctors, but only if: 1) doctors already know the patient’s medical history well enough to make a sound judgment; and 2) it is done with respect for both the patient’s and doctor’s private lives.
Case #3 is perhaps the worst SMS consult I’ve got. It actually came from a cousin, whom for reasons that I don’t understand, preferred to send me an SMS rather than call directly to tell me that our grandfather is unconscious. I mean, why waste precious minutes typing away an electronic message when he could have had told me the same information in a matter of seconds by simply pushing the call button? And, not to discount the fact that the situation itself is an immediate emergency that would have warranted an trip to the ER ASAP, no questions asked. It might have been panic on his part. However, this is the kind of situations that average people should already know how to manage: seek immediate medical help. And SMS-ing will not give you that.
So, what did I do to my cousin who texted me that? I immediately called his number, told him to get Lolo into the car, drive to the nearest hospital and I’ll meet him there. It’s an advice that could have been delivered several minutes earlier, IF only he had called instead of sending an SMS.
As for the question of whether a doctor should give his cellphone number to his patients or not, I’d say it’s an option for the doctor whether he’d give his cellphone number (and which cellphone number). But for the sake of better patient management and doctor-patient relationship, it is preferable to give it. Some studies have shown that patients feel highly satisfied and reassured that they can contact their doctors whenever the need arises. It has even cut down the number of unnecessary trips to the emergency room (unfortunately, we still don’t have a local study on this yet, as far as I know).
However, with this privilege also comes responsibilities. Patients do have duties too, as suggested by Evans in his article published in Journal of Medical Ethics, “Do patients have duties?”
Here are some suggestions:
1) As patients do have the right to seek medical care, doctors, too, have the right to healthcare. And healthcare includes having some sleep whenever time permits them to. There are doctors who go on 24-hours duties, like resident physicians. After that 24-hours duty, they don’t go home but usually have to stay in the hospital to give help to those in duty for that day, at least, during office hours (and so the duty isn’t actually just 24 hours but 36 hours). And so finally, after that 36-hours shift and he finally gets home, the last thing he’ll want to deal with while he’s in the process of catching a long-awaited sleeptime is someone calling in the middle of the night asking him to interpret some lab results. Though doctors have a duty to take care of their patients, patients should also realize that doctors are human too. If it is not an emergency, then try to inquire those questions during normal waking times.
2) In conjunction with #1, please learn how to identify common emergency situations. This is both for the benefit of the patient and the doctor. There are clinical situations that require doctors to see patients physically to be able to diagnose correctly. Doctors have been trained to rely on a good history and physical examination to make diagnosis. So, please don’t expect your doctors to be able to diagnose your illness based on “an abdomen that is aching all over” and unrelieved by intake of “a small, white, round tablet” sent thru SMS. If there is high-grade fever, difficulty breathing, severe abdominal pain, chest pain, shortness of breath, or unresponsiveness, then definitely it’s an emergency. Go to the nearest hospital and tell your doctor that you’re there or you could just let the hospital staff to do it for you.
3) If you really need to speak with your doctor because of pressing matters, then list those questions down so that when you’re able to reach your doctor, you’d remember all those questions. It is time-saving both for you and your doctor.
4) Please do not give out your doctor’s cellphone number to someone else, unless you have asked his permission to do so. There may be some reason why he’d rather have you know his number but not somebody else. And I think it is also common courtesy to be asking permission before giving out such important information.
5) Usually, phone consultations are time-constrained. It would be better if a follow-up appointment to the doctor’s clinic is arranged after a phone consultation has been done, just so that both the patient and the doctor can review their progress over the treatment regimen.
I believe, in the near future, Filipinos would also begin to utilize the email system as a means of communicating with their doctors. Video conferences discussing progress in treatment wouldn’t be a far-fetched idea too. But no matter what kind of technology will be used, ethical rules should always be observed. As doctors are duty-bound to take care of their patients, patients do have the duty to take care of their own health by being well-informed and to be respectful that their doctors do have rights too.
January 27, 2010 at 2:19 am
We are in the Information Technology Age…
January 27, 2010 at 3:41 am
Should Doctors Give Their Cellphone Numbers To Their Patients?
No for legal purpose. Only during clinic hours but it should be an office cell phone number not MD’s personal cellphone number. The answering staff must be able to spot the right issue or clinical complains that warrants the emergency need to get the Physician on the phone. An automated answering machine or an automated text respond messaging may facilitate the process. In the Philippines, mamatay ka na sa emergency pa lang. am i right or wrong? I’m talking about the majority of hospitals in the country. Philippines lacks walk in clinics with 24 hour service.
In the modern world of managing a healthcare business, the business and the professionals have the highest responsibility to cater their clients/patients. “Customer is always right” should be a standard vision and mission for any service provider. A policy and procedure manual in handling calls after clinic hours must be written.
My question:
Why will the patient call after hours anyway? it must be an emergency , right? If the patients were educated in the first place of normal hours of clinic operation and the appropriate time to call then the patient may be able to manage his/her time on when to call? or what is considered an emergency. Ethics must come from the professionals primarily and not from the patients who can be totally clueless of their own physical health. That’s why they need doctors.
In my experience as a consultant in healthcare, many doctors are good in patient care but managing the office and other business operation especially CRM is beyond a physician’s scope of practice.
On email system, sure on a checklist basis of patient’s history but on a new onset of complains, an email can pose a liability to the physician if physician’s advice thru email is wrong.
My advice: Register all new patients , educate all client’s/patients to call MD during business hours on other complains. A monthly reminder or quarterly routine check up is advisable for on going clients.
Physician or physicians group can open a walk in clinic with 24 hours service. Internal Med or General Med. It’s a business niche.
January 27, 2010 at 4:12 am
in addition, referral and marketing still lacking in this country… family friends should be educated not to give out a doctors number when a potential client is already complaining of ACUTE pain or some other ACUTE symptoms.
In my observation, many people are scared of seeing their doctors because of cost, transportation problem and denial. In the US, many doctors advertise free consultation only on a limited time purpose ( but for marketing and luring new clients- for competition of attracting new patients. The US however have 90% insured and the rest are 100% federally funded healthcare benefit)
In a poor country like Philippines where majority don’t have health insurance and the government so corrupt lacking budget for healthcare subsidies, a good samaritan doctor can empower the people thru an outreach program or a medical mission to educate the poor. Doctors may asked assistance from drug companies and local drug store to make things happen. Or a good samaritan doctors may ask legislators for a budget especially on initial consultation fee. Many of my doctor friends back in CEBU are doing plenty of outreach program. Free and genuinely coming from the heart. Their speeches include their normal business hours and TIME not available.
hope this help…
January 27, 2010 at 2:08 pm
leytenian,
For $25.00 Dollars an hour, you’re hired…!
January 29, 2010 at 10:58 pm
“Why will the patient call after hours anyway? it must be an emergency , right?”
- Ah, that is actually not true. As I’ve said, there are patients who call after hours just because. There’s even someone who called me up at night just because he watched something on TV regarding H1N1 and he called because it worried him. Is it an emergency? Definitely no. The point is, not all patients who call after office hours are consulting because of an emergency.
“If the patients were educated in the first place of normal hours of clinic operation and the appropriate time to call then the patient may be able to manage his/her time on when to call? or what is considered an emergency. Ethics must come from the professionals primarily and not from the patients who can be totally clueless of their own physical health. That’s why they need doctors.”
- So, patients shouldn’t practice ethics? Yes, there are patients who are clueless, but they shouldn’t be. Average people are expected to at least have some common sense. And partly, some “gut feeling” that there’s something “wrong” with their bodies that needed immediate attention. One just cannot allow patients to be clueless. It’s an insult to intelligence and it’s just plain irresponsible. Doctors can help in the education. But unless you have a personal doctor who can guide you all the time, then it’s already up to the individual whether he’d be interested in his own healthcare or not. It is especially frustrating for doctors who have patients who do not want to exert effort to get well.
“In my experience as a consultant in healthcare, many doctors are good in patient care but managing the office and other business operation especially CRM is beyond a physician’s scope of practice.”
- Ah, but that is, perhaps, something that can be blamed on the setup of medical education, especially in this country. Most doctors learn it the hard way, when they’re already starting their practice.
“Physician or physicians group can open a walk in clinic with 24 hours service. Internal Med or General Med. It’s a business niche.”
- yes, good point. Especially now that there is an increasing number of people who do not work the regular 8-5 shift. But, of course, the setup is a walk-in clinic. That’s different from an emergency room setting.
January 31, 2010 at 4:10 am
i agree with you but what if the people are totally clueless and irresponsible. Many cannot afford of having a personal doctor. The poor has no access to information and who to call. Those people who watch TV and asked about HINI? are people who don’t know where to get this information.
I know your time is focused on patient care and delivery of quality healthcare. My question, who is then responsible to educate all these clueless people ( let’s just assume majority are). This question will connect to the rule of public health services finance by the government. I believe that the primary responsibility should be coming from a public entity.- department of health.
thanks again..
January 27, 2010 at 6:58 am
With Filipinos’ inclination to self medicate phone consultations are iffy at best. While the patient himself making call may be properly diagnosed and councekked chances are he’ll pass on that medical advise to friends suffering similar symptoms but…
January 29, 2010 at 11:01 pm
Re: passing on medical advice, yeah, I noticed that too. Sadly, sometimes, they believe the friend’s advice more than that of their doctor’s. It could be dangerous, you know.
January 27, 2010 at 7:38 am
this is great for patients with established relationships with the docs, so that the docs know their history, etc…
January 29, 2010 at 11:04 pm
Yes, and I should emphasize the part “for patients with established relationships with their docs”. For first time consultations and for new symptoms or problems, definitely a no-no.
January 27, 2010 at 7:59 am
My US-trained view sees the whole arena of medical care in the Philippines as loosey goosey. I recall vividly my wandering the streets of Olongapo at 2 in the morning desperately looking for supplies for my wife’s emergency c-section at various street pharmacies. The hospital does not stock such supplies and the patient must provide same.
And hospitals kidnap patients if they cannot pay their bills. Holding them captive, not letting them out, and running the bill higher, until such bills are paid.
I cannot get an appointment with a doctor. The don’t do them, evidently feeling my time is not as important as theirs, so I can just wait.
Cell phones are a way to break through the idiocy, so let it be.
Joe
January 27, 2010 at 8:38 am
i see your point Joe. doctors should then publicized their cell phone numbers to potential patients in good faith.
browsing now on philippines department of health , it says on its front page that its sending medical workers to Haiti. what’s the difference between Haiti and Philippines? i mean they both are poor country requiring a lot of help. people are children are malnourished lacking toilet facilities. clicking further on health policies and laws, there is a republic ACT 7883 – AN ACT GRANTING BENEFITS AND INCENTIVES TO ACCREDIT BARANGAY HEALTH WORKERS AND FOR OTHER PURPOSES.
It seems like the people do not know who to call or txt in case of emergency at barangay or township level.
January 27, 2010 at 8:44 am
just explaining the role of public health entity and private physician. yeah there’s hope. supply for c section can be readily available, BUT… definitely I will not deliver my baby in Philippines. I might just die from blood loss. ciao..
January 27, 2010 at 1:27 pm
Welcome to FV Prudence, we are indeed lucky to have such a perspective from your field.. Thank you!
February 1, 2010 at 11:16 pm
Thanks Nick!
January 27, 2010 at 2:18 pm
Actually good physicians do give out their mobile phone numbers to patients whose management may need immediate access or medical attention. But I doubt if it would be prudent for a doctor to give his/her patients his/her number. And the question is much much related to
Should professors give their mobile phone numbers to their students?
Yes if it would be of great help in student welfare in limited circumstances. For instance if you are supervising students in off campus locations (OJT sites, field courses etc), then you need to provide them with your contact number. I don’t give my number to the
I believe patients and students should be made well aware that the giving out mobile numbers is a professional trust and the same courtesy must be extended. In have never had any student yet that has abused this courtesy.
January 27, 2010 at 4:27 pm
Sorry that should have read
“I don’t give my number just to any student”
January 29, 2010 at 11:06 pm
“I believe patients and students should be made well aware that the giving out mobile numbers is a professional trust and the same courtesy must be extended.”
- Same with doctors and patients. Sadly, though, some patients tend to forget this courtesy.
“In have never had any student yet that has abused this courtesy.”
- Good for you.
January 31, 2010 at 4:53 am
but who want to connect to his professor after classhours?
January 27, 2010 at 10:45 pm
no abuse of doctor-patient relationship if only doctors can explain well (re: condition, treatment, and what to expect) and patients will understood well.
giving out mobile numbers (i am pretty sure docs have different numbers for private or public use) is just a form of security blanket to be used in case of emergencies and in setting clinic appointments. consults (be it in a form of SMS or voice call), i am pretty sure also, are a rarity and mostly on a case-to-case basis such as a communication between a trusted doctor and a very loyal patient.
i should know…my doctor-friend (a surgeon*) has his mobile number printed on his business card and his patients and would-be patients are happy (esp. those who are in the province)…even my doctor is happy for no amount of abuse happened since the GSM was introduced in the Philippines!
my doctor-friend said he can only count with his fingers those patients who were somewhat annoying to him…caucasians mostly (language barrier, perhaps? or are they just a worrisome lot?). generally, my friend added, his patients are respectful of his privacy.
moreover, my friend avoids texting the diagnosis and/or prescriptions/instructions (if ever there is a RARE need to respond to consults)…voice calls are utilized mostly. this is a deterrence for abuse esp. in preventing medical malpractice and text-forwarding.
so, as a reply…SHOULD doctors give their cellphone numbers to their patients? i believe the answer should be NO, however, they MAY give their numbers if they are prepared to entertain consults by cellphone AND if they are prepared to handle patients that could pester** them.
—–
*possibly this will depend on one’s specialty or perhaps on the doctor’s age
**toxic patients, as my friend described some of them
January 27, 2010 at 10:54 pm
…will understand well…
January 30, 2010 at 12:41 am
My doctor gave me his number. I called him because i needed a referral and his office was not open. He was upset because he said it was not an emergency. I felt bad , but it is an emergency to me because I would have missed a day of work if I did not get this done. I can not afford it. Insurance companies make everything so complicated.
January 31, 2010 at 3:37 am
Dra. Prudence,
There are two factors of having your Doctor’s cell number.
• Good to know that you’re able to connect with your Doctor during business hours. Specially, when an emergency arise.
• The frustrating part, of course, is during the time of need. Because you have misplaced them. LOL!
Welcome Dra. Prudence.
It’s good to know, that often times we commentator’s need to be thrown somewhere in left field. Rather than being subjected into politics itself.
February 1, 2010 at 11:23 pm
Thanks. I think my purpose in here is to point to other interesting destinations outside the “hotspots” which would be so deeply engrossing.
February 1, 2010 at 11:26 pm
Ooopppsss…that should have read “which could be so deeply engrossing”
January 31, 2010 at 3:58 am
Yes welcome Dra Prudence. Please ignore if I may disagree. keep blogging. Share your experiences in Philippine healthcare setting. Ignore those who disagree and agree. Just blog and make no answer unless it is an emergency. lol. thank you
February 1, 2010 at 11:33 pm
Thanks too. Doesn’t matter to me if people will agree or disagree. I write and I let others comment. And then comment on their comments. And the cycle repeats itself. That’s the fun and important part actually…the interaction.
The post is nothing without the comments area.
Re: emergency calls, unfortunately I do get easily awakened by a ringing phone (and unfortunately, deaf to a ringing alarm clock). I’ve learned to consider every call as an emergency.
January 31, 2010 at 4:47 am
i would keep 2 (or even 3) mobile phones. i would give it to my secretary at times when i am suppose to sleep and never to bother me, yes, bother me at designated time.
nice to hear that you are an atheist (a doctor with one less superstition). at least, you wont resort to prayers while curing people.
February 1, 2010 at 11:41 pm
Hmmm…that reminded me of the few times when relatives of dying patients seemed puzzled that I did not offer them prayers. Some food for thought. And perhaps, sparks of the beginning of a new blog post as well.