Contrary to what my wife and colleagues think, it is not all about me. Well yes, I do get lonely sitting at my desk late at night, when my wife is busy, and the long-ago-moved-away kids are not available and there is nothing running on NASCAR. Nonetheless, it is not really about my needs. I am talking, of course, about why I give patients my cell phone number.
It is printed on my card and I emphasize it during office visits. “If you need me, call.” I remind them that when you are lying on the floor with crushing chest pain, the correct number is 911. PLEASE, do not leave life and death messages on my voice mail. Call the office. Call the rescue squad. Call another doctor. Nonetheless, in general, my job is to help, so feel free to reach out and touch me.
Not that I am warm and fuzzy with out-of-the-blue calls from patients I have not seen in years, with a new, non-urgent message. “I saw in the Times today, that coffee prevents liver cancer … what about decaf?” Or the elderly spinster who calls, every couple of days, to review bowel, bladder and bunion. Admittedly, I do not get much pleasure reviewing vitamin recommendations at 11:18 on a Saturday eve. “Can you combine B12, biotin and grapefruit? All at once? Really?”
While these are easy, social and efficient, they can raise doubt regarding my open-phone policy. Fortunately, they are rare and well balanced by the positive intervention of rapid direct contact. Truth be told, patients and families are respectful and perceive my number as a life-line privilege.
There are several types of calls which have great value. There is the patient six days into chemo with the fever of 102.8, or the gentleman with maroon stool or the woman with breast cancer who notes a suddenly swollen leg and dyspnea. Easy. Do not pass go; Do not collect $200; Do go to the ER. We will see you there.
Then there are the “I left an urgent message with the office, but you didn’t call back,” or the “can you repeat the plan to my sister,” or “I have a “_____” (fill in as indicated), what should I do?” I rarely get the dreaded “refill my medication” call and truthfully it is often a screen for a deeper question and conversation. “Can you order oxycodone” may equal “is hospice appropriate?”
The call which has the most value is the one which says, in effect, “Doc, I am really scared, can you help me?” Why is this call so important? Because, fighting fear and danger is why I went into medicine in the first place… The opportunity and honor to be there when “s**t” really hits the fan. That is what it means to be a healer.
Tony called me this morning, while I was waiting for a plane at Logan. He had a CT scan on Friday to restage his disease. At home, alone even with family by his side, seconds were minutes were hours and, in many ways, felt like a lifetime. So, after rethinking a dozen times, “Do I bother Dr. Salwitz, I am just being silly,” he called. I viewed the images on my IPad and reassured him the cancer was melting away. Is that incredibly cool, or what?
Now, some will say that I can replace this sort of direct, personal connection, with a high quality, compassionate front desk, triage nurse and answering service. A “screening” team would allow me to organize and focus on the task in front of me, without interruption. I am fortunate enough to also have that support. Despite best intentions I should not and cannot answer every call. I depend heavily on great teamwork, especially when I am seeing other patients.
However, when push comes to shove, when a patient really needs a doctor, really needs me, the cell phone contact fills a critical need. No delay. Instant answers. Rapid resolution. Dial, ring, answer, discuss, act. The patient gets great service. Disease and fear are on the run. I get closure and can move on. Wait a minute. I do my job quickly, easily and well, and do not have to deal with an infinite list of unanswered ”call backs?” Perhaps, it is all about me.