J R Soc Med 2001;94:290-291
© 2001 Royal Society of Medicine
Off-the-cuff cellular phone consultations in a family practice
Roni Peleg MD
Department of Family Medicine, Ben-Gurion University, POB 653,
Beer-Sheva, Israel 84105. E-mail: ayapeleg@bgumail.bgu.ac.il
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SUMMARY
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In Israel the public tends to make use of informal medicine
alongside
organized health services, and cellular phones now
allow contact with
physicians at almost any time or place. For
three months in 1999 a family
physician documented all consultations
on medical subjects conducted by
cellular phone, the phone being
available 24 hours a day. There were 94
cellular phone medical
consultations, of mean duration 5.8 min (range 2-18).
Only 11
took place over the weekend, and 63 took place while the clinic
was
open. The most common reasons for consultation were advice
on treatment (29%)
and a second opinion (28%). In 48 cases the
consultation was for a close
relative rather than the caller.
In 42 cases the request for consultation came
while the physician
was busy with other patients.
The results of this small personal study confirm that the practice of
informal consultations now extends to the cellular phone. Technologies of this
sort demand new rules of conduct, if we are to avoid the various hazards of
off-the-cuff medicine.
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INTRODUCTION
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In the section of the journal
Postgraduate Medicine in which
physicians
relate events of interest that occurred in the course of their
work,
Dr Eric Anderson, a family physician from San Diego, recounted
a story
that was first published in the
BMJ in the
1950s
1. A
doctor was
driving his car when, suddenly, a young boy riding
a bicycle appeared in front
of him. The doctor swerved to avoid
a collision, the car slid to the side of
the road and crashed
through a fence into a garden, where the ride ended. The
doctor
sat there, with water pouring from the car's radiator, sweat
from his
forehead and blood from his chin, and with a broken
tooth that cut his lip.
Out came the home-owner, who recognized
the driver as his own physician.
‘Ah, doctor,’ said
he, bending over the shaken man and wrenching
his white knuckles
off the steering wheel, ‘there you are! Dear me. But
as
long as you're here, I'd like you to check my wife. She's got
this strange
rash, you see...’.
Weingarten reported 198 ‘off-the-cuff’ consultations between
general practitioners and patients that occurred over six months at social
gatherings, at chance meetings, and in medical settings outside the regular
practice2. Hallway,
off-the-cuff, curbside medicine is widely
practised3, and in
the same way doctors consult each other informally about patients, to general
benefit4,5.
E-mail is now used by family physicians and consultants for similar
purposes6.
In the era of ever increasing use of cellular telephones, contact can be
made with physicians at almost any time and place. The aim of the present
study was to characterize informal consultations by cellular phone, from the
personal perspective of a family physician.
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METHODS
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Israel has compulsory national health insurance, and I work
for the General
Health Service, which provides for about 65%
of the population. Much as in the
UK, patients are registered
and see the general practitioner (GP) by
appointment. GPs do
little work beyond the clinic, and outside office hours
patients
use the emergency services. There is no financial or other incentive
to
making oneself available at all times.
Over three months in 1999 all consultations on medical subjects conducted
by cellular phone were documented. The phone was available 24 hours a day
during the study period.
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RESULTS
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During the 91-day study period there were 94 cellular phone
calls for
medical consultation (mean 1.03/day). The mean duration
of calls was 5.8 min
(range 2-18). In 3 cases the call was for
two unrelated medical problems. 57
callers were women (61%).
Only 11 calls were received at weekends. 63 were
made when the
caller's clinic was open; only one was made between midnight
and
8 a.m. The reasons for the calls are presented in
Table 1 and the characteristics
of the callers in
Table 2. 48
calls
related to persons other than the caller. 42 were answered while
the
physician was treating other patients in the clinic, 20
when he was at home
and 17 when he was driving with the cellular
phone hooked into the car. During
the entire study period no
messages asking for medical consultations were left
on the cellular-phone
answering machine.
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DISCUSSION
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The Israeli public, much like that of the USA, tends to make
use of
informal medicine as well as the organized public health
services
1,2,3,4,5,6,7,8.
The
results of the present small personal study confirm that informal
consultations
now extend to the cellular phone.
Doctors are taught to document all medical encounters, and the lack of
documentation inherent in a cellular phone consultation generates anxiety.
What if some complication should arise? This kind of encounter has other
drawbacks: it interrupts other patients' appointments, wastes their time in
the clinic and disrupts the appointment schedule. There is also a potential
conflict of interest whereby the physician is paid to work for a particular
healthcare organization but provides consultations during working hours to
people who are not insured by that organization. The timing of the calls
received by me—67% during working hours—suggests that in many
cases the caller was simply trying to avoid the inconvenience of coming to the
clinic. Most requests came either from my extended family or from my circle of
friends, but some were from professional colleagues and medical students.
Clearly, for a person with a high-pressure lifestyle, an off-the-cuff cellular
phone consultation is an appealing option. From a social and personal
standpoint, I am glad that the cellular phone makes medical consultations so
readily available. Whether physicians in other medical disciplines or other
healthcare systems will be equally positive I cannot say. What is clear,
however, is that technologies such as e-mail and the cellular phone demand new
rules of conduct to help avoid the legal, economic and other hazards that
arise from such off-the-cuff consultations.
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