What To Expect From The Pediatrician.

Children get sick, and parents have anxieties, at all times of the day and night. Most often the experienced parent knows when a problem is a real emergency and the child needs to be seen by a doctor without delay. But parents need time to acquire experience, and they need sources of information.
William Feldman, MD

How much "availability" should I expect?
Most parents, no matter how experienced and knowledgeable they are, will need to get in touch with their doctor sometime because their child has an acute problem. And that's when accessibility becomes crucial. Even during office hours, a very busy doctor may be hard to reach because the telephone is constantly in use. Many physicians get around this by having extra telephone lines, so parents can always get through.

Of course, the big problem with availability comes during nights, weekends, and holidays. We recently did a study of after-hours availability in four major Canadian cities. We made phone calls after office hours to doctors who look after children--family physicians and pediatricians--and took note of the messages left on their answering machines or voice mail. We classified a physician as available when the message said that the caller should leave a name and telephone number and that either this physician or the on-call (substitute) physician would reply shortly. When the message said that the office was closed and the patient should be taken to the nearest emergency room or walk-in clinic, we counted the physician as not available after hours.

We found quite a difference in the four cities. In one city, almost all the doctors were available; in another, about three-quarters were not available.

The benefit of phone calls
Physician availability gives parents a sense of security, and it's also important for other reasons. A telephone discussion between the parent and a physician solves the majority of after-hours problems; the physician gets enough information to decide whether the child needs to be seen at once, and in more than half the calls, the decision is that there is no need for a doctor to see the child. This not only saves money for the health-care system, but also spares the family a lot of trouble and lost time. Furthermore, each episode successfully handled with after-hours telephone consultation helps give parents the experience and knowledge they need to become less dependent on the health-care system.

24-hour availability?
No parent can expect a physician to be on call twenty-four hours a day, seven days a week. Years ago many physicians did practice this way, making housecalls, creating a special bond of caring between themselves and the families they served. Although they didn't have many effective treatments to offer, they demonstrated a helping mission that was in itself often therapeutic. Nowadays doctors have many effective treatments to offer, but until fairly recently medical schools concentrated on the curing, not the caring, aspects of being a doctor. That is now changing, as medical educators try to develop an appropriate balance of curing and caring in selecting and educating future doctors.

Most "available" doctors these days practise in on-call groups; this approach enables patients to obtain immediate advice, and doctors to have time for their personal lives. A physician who does not provide an afterhours on-call service, whose message is "Go to the emergency department," should not be your first choice.

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Tags: pediatrician

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