Are we obliged to be on-call for patients between appointments?

6 minute read

The answer is no, and the solution is enforcing boundaries, even when it makes us uncomfortable.

On Twitter (aka X) recently, a non-doctor encouraged monetisation around non-urgent patient contact between appointments, if patients contact doctors via DM on socials.

It prompted a response from some other HCWs who disagreed that we ought to be disturbed in our downtime, via DMs etc. This person suggested that if there was a need for it, or patients were anxious, it would be worth charging for a concierge service.

I replied in that thread saying that no amount of money would convince me to give up my downtime to answer non-urgent messages.

I was reminded of that this week when I mutually discharged a patient from my care, following multiple non-urgent email enquiries between appointments, 10 days apart, around paperwork. Staff advised several times these be held onto until the appointments and when I raised it in clinic, I was told my patient felt very angry and fobbed off “because it is your job”.

I listened, empathised, validated their concern and asked why the paperwork could not have waited until the appointment, especially as there were points of clarification needed to complete the paperwork.

I stressed medico-legal duty of care that discourages asynchronous communication that is more likely to result in error and affect safety for doctor and patient.

I reiterated points from previous appointments that had not registered with the patient despite verbal and written instructions.

I explored briefly a history of anxiety to inform this behaviour and expectation.

Lastly, I revisited their request in the emails, and corrected some misunderstandings of what they’d understood versus what I’d said and documented in my notes, and why this needed clarification face-to-face before I did any paperwork.

I reiterated that I’ve given of my time generously in all appointment, but to engage in to-and-fro in writing or even on phone calls is unreasonable and potentially fraught.

I finished by apologising that they felt nonetheless uncared for and that their expectations were not met and I wished them all the best with a new doctor in future.

The episode left me shaken and saddened and also frustrated.

So many of us are burnt out and making exit plans for a career in which we aren’t expected to be constantly on-call, paid or otherwise.

It’s been a slow and gradual creep into all of our lives since covid happened and we moved to some remote working options.

Prior to covid it was virtually unheard of to be disturbed on my days off. Staff either left messages in my pigeonhole or had a colleague sort the matter out. Rarely, I’d get a “I’m so sorry to disturb you on your day off” phone call about something that could not wait.

With covid systems fell apart. Experienced staff were replaced and nurses, who flocked to better paid locum covid work, became harder to recruit and retain in practices, resulting in harried reception staff ringing inappropriately on days off and texting about non-urgent issues. Junior doctors did likewise, using senior doctors as on-call mentors.

For me it was exhausting, coupled as it was with more anxious patients who emailed, left messages and even DMed me on social media if they did not get timely responses to their emails or calls about non-urgent queries.

As healthcare workers, we are not taught boundaries. Many of us take it as a badge of honour to “be on call for my patients” or justify it with “they pay my bills so call it an annoyance tax”.  

Others have ways for patients to contact them via DMs and mobile phones and act as unofficial on-call services. Yet others welcome and encourage emails from patients and “will do everything I can to help you”.

All of this, in large part, seems to be contrary to what our MDOs tell us is good medical practice, yet I am the one left feeling mean when incidents like this happen.

When many of us encourage this type of dependency, can we blame patients when someone like me raises a boundary around non-urgent issues and says “please wait till your next appointment”.

Are we not entitled to protected downtime and time off? Are we not entitled to not expect to be DMed or texted for corridor consults, by patients and colleagues alike?

I hate to disappoint people and at the same time, it is well known that the more we engage with an anxious mind, the more we train that mind for more rumination down the trail of “but what about”.

As happened in this consultation, it took me an extra two minutes to address the paperwork, and to explain to my patient why it was best to have waited to do the paperwork in the appointment and not prior, as their understanding of what I’d said and what I’d actually said didn’t match.

Ultimately my stance is a safeguard for both of us and if it meant they walked away thinking I was the bad guy, it’s my burden to live with.

It is safe for me to not be on-call 24/7 for patients. It is safe for me to help people and work limited hours. It is safe for me to be uncontactable outside of rostered hours for non-urgent tasks. It is safe for you too, if this is a struggle.

It is possible to do what I believe is right and feel bad about having upset someone who didn’t understand why I’d behave that way. As long as we continue to encourage this kind of dependency there will always be expectations and pushback from patients.

The longer I do this the more I realise, especially as a woman, how heavy the mental load of doctoring is, especially post-covid. I feel like there are hundreds of tabs open in my brain that I can’t switch off because of non-urgent enquiries from patients who are anxious for me to attend to “in your spare time, doc”.

Except I don’t have spare time. And then we wonder how we get burnt out, disillusioned and dream of quitting.

The solution to all my problems, and likely yours, if you are brave enough, is adequate healthy boundaries. To enforce them is distinctly uncomfortable but it helps prevent problems down the track and helps you mostly enjoy your work.

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