Dr. Stuppy has a great post up on Survivor Pediatrics that is worth
Tweeting and Facebooking.
Hello. This is Dr. Stuppy. I’m returning your call about…
That is how my phone calls start, then they take various turns. Some are
easy, some not so easy. I’d like to discuss what makes a phone call to the
doctor’s office more productive, so we can help you better. All examples
are entirely fictitious, made up of 12 + years of phone call experiences.
Many calls start off like this:
Hi. This is Mary Sue. My son has a rash and I want to know what to do.
Me: ????? I must ask many questions for more information.
Some callers don’t seem to know what to say, so they only answer direct
questions. How old is your son? When did the rash start? What does it look
like? Has it changed? Does it itch or hurt? Any other symptoms? What have
you used to treat it? Did that help? Has he had any new ingestions,
lotions, or creams? Does he have a history of allergies? Anyone else with a
rash that looks like this? On and on…
Or like this:
Hi. Thanks for calling back. My son Jack is 3 years old. Well, really his
birthday isn’t until next month, but he’s almost 3. He has had a fever for
2 days, maybe 3 days because he felt warm but he wasn’t acting funny or
sick that first day he felt warm. He actually was fussy last week, but I
don’t think he ever had a fever then. I was thinking maybe he didn’t sleep
well last week, but I don’t know why. I took his temperature and it was
100.3, that was on Tuesday around 7am. I gave Tylenol, and it went down to
97.9, but then 4 hours later it was back up to 99.7….
My thoughts so far: Get to the point.
Sorry, but that’s true. I care about my patients, but so far this phone
call has taken me quite a bit of time and I really know nothing except this
almost 3 year old has an elevated temperature (not even a true fever).
When parents call, they need to summarize with pertinent facts. While they
shouldn’t leave out important helpful information, they don’t need to
mention every time they took a temperature.
Much like the evening news: they can’t do a play by play of every football
game. There’s no time and it serves no purpose. A few highlights of the
game and the score. That works well. People get a pretty good idea of how
the game went.
It’s the same thing with phone calls to your doctor’s office or on call
provider. We have thousands of patients. Not all call the same day, but
during peak cold and flu season last year our office we took 50-90
calls/day (the highest numbers on Mondays). One phone nurse has 8 hours to
answer up to 90 calls in addition to filling out insurance forms and other
tasks. (We have great nurses that help out if they have time, but if the
phones are busy, I guarantee the office is busy too!)
They simply can’t spend 15 minutes chatting about every detail. That’s for
your friend and you to discuss over coffee.
After hour phone calls during the winter are also more frequent. It is not
uncommon for me to be on the phone with one parent and another call comes
in. This is at the same time I am trying to watch my son’s game or go to
the grocery store. I really don’t want to sit and chat. I don’t have time
for play by play action. Again, I really care about my patients, but I can
do a better job at answering your questions if you are clear and concise.
Things that help us help you over the phone:
1. Know what is going on. When a parent calls and the child is at
daycare or grandma’s so the caller doesn’t know details, we can’t really
help. Write down the pertinent facts to get them straight if you need to.
2. Start with your child’s full name and birth date. Include any
significant past history, such as your infant was born at 28 weeks
gestation, or your coughing 3 year old has a history of wheezing.
3. Give pertinent facts related to the concern.
4. If your child has a fever, give the number of days of fever, the
maximum temperature, and how it was taken. If you have given a fever
reducer, share that.
5. Briefly describe symptoms and what you have done to help them as well
as if your child responded or not to the treatment. Remember treatments are
not only medicines, but if you use a vaporizer or saline for a cold, or
have stopped dairy and used G2 for vomiting, let us know.
6. If your child has a rash, it is typically best for us to see the
rash, but if you call about a rash describe it in terms of location, color,
and size (many find it helpful to relate to common objects, such as
7. Note if there is a pattern to the symptoms, such as headache every
day after school or barky cough only at night.
8. Let us know any medications your child typically takes in addition to
ones you have tried for the current symptoms.
9. Leave out details that don’t help. Trends and generalizations work
well. If we want more details, we can always ask.
Examples of good call starters:
I am calling about Joe Smith, birth date 9.12.08. He has had a fever for 3
days, up to 101.3 under the arm. It comes down with ibuprofen, but is right
back up in 6 hours. He also has sore throat and headache. He’s drinking
well but not eating much for 3 days.
Sally Smith, birth date 9.12.11, has vomited 6 times in the past 12 hours.
If I give formula it immediately comes up. She is now dry heaving and
hasn’t had a wet diaper in 12 hours. She doesn’t have a fever but looks
tired and it is hard to wake her to drink. She doesn’t have diarrhea. Her
older brother had the stomach flu a few days ago but is now better.
John Smith, birth date 9.12.11, was in the NICU for 2 months due to
prematurity. He has been fussy all day and is now breathing fast and hard
and is not able to drink more than a few sucks at a time. He doesn’t have a
fever, but I’m really worried.
Things that cannot be done by our on call providers:
1. *Prior authorization for an ER or urgent care visit.* These must be
done during office hours, and most of the time our office is not involved.
These are typically done by the location at which your child is seen.
2. *“Allow” you to leave a busy ER.* It sounds silly, but I have had
many calls from the waiting room at ER/Urgent Cares with parents asking if
I think it okay that they leave due to a long wait. If you thought it
necessary to go in the first place, I would be open to a malpractice
lawsuit if I told you to go home without being seen. You should ask their
triage nurse who can make that assessment.
3. *Refill medications.* We typically expect that your child is seen
prior to most prescription refills for best medical care. If it is urgent
that your child have a refill, such as an inhaler, they should be seen to
evaluate the concern. There are exceptions to every rule, but don’t be
upset if the on call provider refuses to call out a prescription.
4. *Make a diagnosis.* We cannot see the ear, listen to the lungs, or
feel the belly over the phone. A physical exam (and sometimes labs or
radiology studies) are needed to make a diagnosis. If your doctor claims to
be able to diagnose by phone to call out prescriptions, I would suggest
that they are not doing the best of care.
Some things are best done with a visit for further evaluation.
1. *Difficulty breathing*. If a child is having difficulty breathing and
you don’t have treatments at home that work, he needs to be seen as soon as
2. *Dehydration*. An infant hasn’t urinated in 6-8 hours or an older
child hasn’t urinated in 12 hours might be dehydrated and should be seen as
soon as possible.
3. *Some fevers.* Temperature above 100.4F under the arm in an infant
under 3 months or under immunized child can be serious and should be seen
as soon as possible. Fevers lasting more than 3-5 days or with other
concerning symptoms require an evaluation.
4. *Uncontrollable pain.* If you have used standard pain relievers and
your child is still hurting, we cannot do anything by phone that will
improve the situation. A careful exam might find a treatable cause of pain.
5. *Most rashes.* Though these don’t necessarily need to be seen
emergently unless there are other concerns, rashes cannot be evaluated on
the phone and a physical exam is needed.
6. *Chronic problems.* CIf your child has been dealing with anything for
more than a few days, it might help to schedule a visit with your usual
7. *Diagnosis vs information.* If you want a diagnosis, we need to see
your child. We cannot tell if the ear is infected or if your child has
Strep based on symptoms alone. If you want advice of what to do with
symptoms, we can generally give advice. Remember that our website also has
most of this information too!
8. *Behavior problems.* These are best discussed with your usual
provider, not an on-call provider who doesn’t know your child. Most of
these build up over time and are not emergent issues.
9. *Injuries.* If your child has a moderate or severe head injury,
possible broken bone, laceration, or other injury symptoms they require
evaluation. Lacerations must be repaired as soon as possible, so don’t wait
until office hours the next day!
Help me help you! Let me know what else you need to know to be an educated
caller. I’d be happy to answer questions about when to call, what to ask,
and what to expect. If I left any questions unanswered, please ask!
*Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to
be able to help families keep their children healthy and she loves
watching entire families grow! Dr Stuppy is active on Facebook and puts a
more personal touch to pediatric topics on her
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