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Dr. Darrell White's Personal Blog

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Time, Freedom, and Medical Emergencies

A message heard while calling to speak with a colleague at 5:01 on a Thursday afternoon: “Thank you for calling Waterworld Eye, a division of World-Class Hospital. Our office is closed. Our office hours are Monday through Friday 8:00 AM until 5:00 PM. If this is an emergency please hang up and dial 911, or go directly to the emergency room. This system does not take messages.” Something like that.

This is what has come to.This is how World-Class Hospital, held out as the beacon of hope, the shining example that all in medicine should follow, this is how they deal with emergency patients who are in need of specialty help. The same institution that took out a full-page newspaper ad touting  “same–day appointments” is not available to see emergency eye visits after 5:00 PM or on the weekends. This is the type of system that our federal government believes will bring better health care to all Americans.

Brings a tear to the eye, don’t it?

About a week ago my wife and I celebrated our 25th Wedding Anniversary. A part of our “gift” to ourselves was a four-day weekend, four days without any plans to visit the offices of Skyvision Centers, and four days where my partners would answer as many of the emergency calls that they were qualified to handle. My partners are optometrists, eye doctors who are trained in vision care, and at least in the state of Ohio eye doctors who are also trained and qualified to take care of medical diseases of the eye. I am an ophthalmologist, an M.D. I went to medical school, did a medical internship, and then did a residency in ophthalmology. I am trained in vision care, the care of medical diseases of the eye, and I am trained to perform eye surgery as well. As such even though my partners were the first line of “on-call”, and even though I was “off–duty” for my four-day Anniversary weekend, I still had to be available for any emergencies that might require my additional training, my special skills.

On Monday evening, day three of our four day anniversary gift, I sat next to Beth while finishing the last of the “Girl with the Dragon Tattoo” books. We enjoyed a magnificent dinner of lamb chops and all the fixings, accompanied by one of those rare finds at the wine store: a $20 Cabernet that tasted like 100 bucks! The bottle was still one third full; it sat just behind me next to my empty Reidel goblet. “You know what I miss,” I said. “When my face is already numb, I miss the freedom of being able to have another glass. Another glass of joy, another glass of goodness.”

Now, I’ve always taken ER call. Every practice I have ever been part of has always had doctors available to see emergency patients, pretty much 24–7, 365. No “nurse on call”, no call 911 or go to the emergency room. Nope, I have always worked in a place where an eye doctor was available to see you if it was truly an emergency. Makes sense, don’t you think? The eye is a pretty specialized area, so specialized that we actually have super–specialists who concentrate either on the front or the back half of the eye! Think about that… and organ roughly the size of a large marble that is so complex and whose care is so complicated that it has to be divided in half! Call 911 for this?!

I left my original Cleveland practice some 5 1/2 years ago to start Skyvision. Suffice it to say that it was not an easy or clean break. No, it was all kinds of messy and ugly, with very hard and uncompromising business and legal stuff before, during, and after. And yet, with all of the inconvenience, and all of the bad blood, and all of the hardships that we and I endured as Skyvision Center started from scratch, the only thing that really affected me, the only thing that really hurt, was when I was ousted from my emergency call coverage group because I left the other practice. That one hurt, and continues to hurt. (If anyone involved in my prior practice or in that call group decision reads my blog, and I certainly would if I were them, the score on this one is definitely you 1–Darrell 0).

Why is that, exactly? Why should such a seemingly minor part of an otherwise very hard experience be the only thing that hurt? Well, it’s rather simple and rather complex. You see, everything about the way we handled emergency calls in my previous practice, and everything about the way the other practices involved in our call coverage group handled emergency calls was exactly correct. Everyone, and I mean EVERYONE involved, routinely and regularly took the high road. Everyone answered patienT calls. Everyone went in to see a patient who had a true emergency, seven days a week, at all hours of the day or night. Emergencies, true emergencies, do not respect either the calendar or the clock.

Now some folks certainly abused our collective goodwill, calling after hours or on the weekend and manufacturing an emergency simply because it was more convenient for them as patients to come in during non–office hours. But this was really more the exception than the rule; all of our patients respected our personal time and personal space, and demonstrated their respect and gratitude for our collective availability by calling only when they had a real problem. (As far as I know, all of the doctors in all of the practices in that call group continue to do just this.)

So who’s right? Are we, the private ophthalmologists and optometrists who take the phone calls from our emergency patients and see them when it is necessary, are we right? Or is it Waterworld Eyecare and World-Class Hospital, and by extension our federal government and “health care reform”, dial 911 or go to the ER? Are they right.  Let me tell you a story and I’ll let you decide.

Just before my four day weekend I got a call at 10:40 at night, 20 minutes after I had retired for the evening. The father of my patient, a 10-year-old girl with a extremely high glasses prescription, had torn her contact lens when she was trying to remove it for the evening. Half of the contact lens ended up in the sink, and half of the contact lens was still in her eye, stuck way up underneath her eyelid and unreachable by either  young Maria and her parents. My phone was right next to my bed, 2 feet from my pillow as it is every night. I answered the phone, spoke with the father, got dressed and went to the office to remove the other half of the offending contact lens. Didn’t even really give any thought to any other options, to tell you the truth. What if they had been patients at Waterworld I? “Hang up and call 911, or go to the emergency room.” Your call.

So on that Monday night, day three of my four day weekend, wine in the bottle, glass empty, face not yet numb… I sighed, turned the page, and continued to read.

7 Responses to “Time, Freedom, and Medical Emergencies”

  1. September 16th, 2010 at 12:03 pm

    darrellwhite says:

    I should note that the eye call group is not the only private specialty group that takes emergency call after hours and on the weekend. There is a very large group of orthopedic surgeons who not only answer the phones for their own patients, but they also provide coverage for 3 local hospital emergency rooms.

    Likewise, there are two Ear, Nose, and Throat groups that take emergency calls after hours, and any number of primary care doctors who do as well.

    The unifying characteristic of all of THESE groups is that they are private practice groups or doctors who work directly for their patients rather than for an institution.

    Something to think about, I believe, as we proceed with healthcare “reform”.

  2. September 19th, 2010 at 11:18 am

    Jen says:

    I hate being told to call 911. Luckily, we have urgent care centers here that are open till 9 and I have been known to call the pediatrician’s office at 3am and had the doctor call me back. Didn’t realize that if I get a doctor with a ‘call 911’ message that it means I should be hunting around for a practice that doesn’t do that. Good to know.

  3. September 19th, 2010 at 4:58 pm

    darrellwhite says:

    It’s a bit more complex than that, Jen, but if your doc or his/her group cover, and REALLY cover by seeing and talking to patients directly, how can that NOT be better care? It’s maddening that all of the “command and control” BS from DC is pushing a “command and control” center as the panacea…it ain’t.

  4. September 23rd, 2010 at 8:55 am

    Sales jobs website tailored for only sales jobs says:

    Great post.

  5. September 26th, 2010 at 7:27 pm

    mactavish insurance says:

    Great read! I want to see a follow up to this topic!?

    Sincere Regards

  6. November 4th, 2010 at 11:23 pm

    meladerm says:

    Great post about this. I’m surprised to see someone so educated in the matter.

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