After-hours telephone calls to general and subspecialty internists

Abstract

Objective: To study the after-hours telephone calls received by practicing general and subspecialty internists.

Design: Observational study.

Setting: Forty-four internal medicine private practices in Long Island, New York, consisting of 70 physicians (31 general internists, 39 internists with subspecialty training).

Patients/participants: All calls received by an answering service after office hours with the caller requesting to speak to one of the physicians in the study. Of the 8,444 total calls, 2,950 were to generalists and 5,494 were to subspecialists.

Measurements and main results: For both groups, most calls came from patients (46.3%), followed by physicians (26.0%), then hospitals (22.2%). For patient calls to the generalists, those concerning infectious disease (15.4%), nonspecific symptoms (11.1%), medicationrelated questions (9.7%), and gastrointestinal (GI) complaints (9.4%) were the most common. For those calls to the specialists, GI (14.2%), infectious disease (10.9%), medication-related (10.0%), and nonspecific symptom (9.0%) complaints represented the most common patient calls. Although GI and cardiology specialists received proportionally more patient calls related to their specialities, the specialty group, like the generalist group, received calls in all the major areas of internal medicine. Patient calls for problems well outside the traditional scope of internal medicine accounted for 2.9% of the calls to the generalists and 1.9% of the calls to the specialists. About 44% of the patient calls to both groups were for potentially serious problems. After 11:00 PM both groups saw a decrease in the proportions of minor and trivial calls.

Conclusions: These observations support the concept of broadly based medical training for both internal medicine generalists and subspecialists in preparation for the variety of telephone calls they will deal with after office hours. Practitioners should take steps to reduce the high number of medication-related patient calls.