Most people probably don't give much thought to their doctors' free time. But how exactly do they manage busy patient loads and still have weekends and vacations? The answer can affect you and your family's health and well-being.
Many physicians belong to a "coverage group": One physician temporarily takes care of all of the group's patients. So from Friday evening until Monday morning -- almost 40% of the hours in a week -- your medical care may well be in the hands of a physician other than your primary doctor.
What do patients need to know about cross coverage?
Many relay races are lost by a poor handoff of the baton. So, for hospitalized patients and their families, the key issue is ensuring a smooth transition of care over the weekend. As a patient, you are entitled to know that there is a well-informed "captain of the ship" on board at all times. So be sure you know who this is -- ask ahead of time.
Over a weekend, the covering doctor becomes the surrogate for the primary doctor and the chain of command remains intact. In The Year of Magical Thinking, Joan Didion writes brilliantly about her ordeal dealing with the illnesses and deaths of her husband, John Gregory Dunne, and her daughter, Quintana. When I asked Didion for her thoughts about cross coverage, she mentioned that she felt reassured by seeing her primary physician's name on John's medical bracelet when he was in the hospital. The label symbolically tagged her husband as being under the protection of a respected doctor who was ultimately calling the shots.
"I don't know why but this point about the bracelet matters. So much in a hospital happens in the fog of war that you want at least a symbolic line of command, legible to everybody who happens into the case. More often than you might think, the patient's relatives are left to catch up a new doctor on some key point."
What should you and/or your family ask your doctor before the weekend rolls around?
- Who is the covering doctor and what is his or her specialty?
- What time does the doctor make rounds?
- Who is on the team? Aside from the covering doctor, who else will be seeing you over the weekend -- interns, residents, fellows, specialists?
- Who is making the decisions? This may NOT be the covering doctor in certain settings such as intensive-care units.
- Does the covering doctor have the contact information for the "point person" family member in case urgent communication is necessary?