Risk Management

Who’s On Call?

Paul Weber, JD, OMIC Risk Manager

Digest, Summer, 2000

With the proliferation of cell phones, pagers, fax machines, and email, patients have come to expect their ophthalmologist to be available 24/7 whenever they have an urgent question or concern about their vision. This can present problems during weekends, holidays, vacations, or whenever the ophthalmologist is not available to take calls. So who else in the practice can take after hours calls from patients?

Q  Can my office staff be on call?

A  The simple answer is no. Non-physician office staff cannot “take call.” Only physicians can since being “on call,” by definition, means that a physician is ready and legally able to render medical/surgical care to patients on an urgent or emergent basis. This includes being able to see and treat patients in the office or emergency room and admitting them to a hospital if necessary.

Q  Can ophthalmic technicians answer calls from patients after hours?

A  Technicians can, and often do, take after hours calls from patients and answering services forwarding patient calls to them. This duty should only be assigned to staff members who have the knowledge to make critical decisions about the urgency of a patient’s condition and the experience to know when a patient should talk to or be seen by an ophthalmologist. Anytime a technician takes a patient’s call – whether it is at home after hours or in the office during business hours – there is the potential for claims of miscommunication or failure to communicate if the patient suffers an injury. Advise staff to document all conversations with patients and any actions taken (e.g., scheduling or canceling an appointment) and to record it in the patient’s chart. If a new patient calls for whom there is no chart, the message should be placed into a designated message folder. Later, review all calls and messages with staff to determine if any follow-up is required. This will give you an opportunity to monitor how well your staff handles patient calls.

Q  Can an employed optometrist take call for my practice?

A  Laws regarding optometric scope of practice vary from state to state, but because optometrists cannot perform surgery and have only limited scope of practice, they cannot take call. However, their special training and skill allows them to handle more questions and situations than technicians. This increases the potential for claims of misdiagnosis or delay in diagnosis, but the risk is no greater than it is when an employed optometrist examines and diagnoses a patient under the supervision of an ophthalmologist during business hours. An ophthalmologist always should be available to take patient referrals if a situation exceeds an optometrist’s scope of expertise.

Q  Can a non-employed optometrist take call for my practice?

A  Non-employed optometrists present greater liability exposure for an ophthalmic practice than employed optometrists because they do not know your patients and are not under your supervision. If it is possible that a non-employed optometrist will be examining and diagnosing your patients, confirm that the optometrist is properly trained and qualified and carries adequate malpractice insurance.

Q  Can ophthalmology residents take call?

A  Residents are physicians and can be on call if this is within the scope of their residency, but they are not fully trained ophthalmologists so their ophthalmology call is limited and needs to be backed up by a trained ophthalmologist to avoid vicarious liability claims against the practice.

In summary, all ancillary personnel who answer after hours calls from patients must be backed up by an on call ophthalmologist who is taking call. Written protocols should clearly delineate how to handle frequently encountered situations and when to contact an ophthalmologist. Periodically evaluate and update these protocols and distribute them to all staff.

If a patient or other health care provider wants to personally speak with or be seen by the ophthalmologist, the request must be granted. As a matter of course, it is a good idea to instruct staff to ask callers if they feel they need to speak with the doctor. Ancillary personnel should be perceived as aiding, not hindering, the doctor-patient relationship.

Please contact Paul Weber at (800) 562-OMIC (6642), ext. 603 or pweber@omic.com  if you have other questions concerning who can legally take call coverage.