Case Study 28 : UNAVAILABLE DOCTORS
Challenges
Patient had profuse vaginal bleeding after spontaneous vaginal delivery in a maternity clinic and arrived at the Emergency Department hypotensive with ongoing transfusion of the 9th unit of fresh whole blood. The doctor of her choice was unfortunately out of town, so she asked for another doctor, who in turn had just started a major operation. The Emergency Department resident decided to admit her under the on-call list but the first on-call physician failed to respond within 30 minutes. The next on-call physician was apparently not available until the following day.
Question
When can a doctor on call refuse an emergency patient, and what course of action should the resident on duty follow in case of consultants’ unavailability?
Solutions
The Emergency Department is always a potential hot spot because all patients consider their case as priority. Thus, a need exists to establish procedures: for the residents, to know which course of action to take, and for the consultants, to clarify their role as part of the on-call list.
A doctor who feels incapable at a given moment may refuse seeing a patient. Examples are when the doctor is already engaged in a prior emergency case which cannot be abandoned, or when indisposed or unable to give attention (as when under medication or physically impaired or impeded), or if going to the patient would endanger one’s life or entail grave inconvenience. Best practice involves a doctor on call making any foreseeable unavailability known to the Emergency Department beforehand, indicating also who could cover for him or her, to save on time when looking for a doctor to handle the case.
In many hospitals the Medical Association or another body provides an on-call list, which the Emergency Department officer follows. However, due to the time element involved in emergencies, a point arises when the roll call must stop, at times after the second or third doctor on the list. The patient should then be admitted under the hospital’s Medical Director or the Emergency Department director, depending on the policies.
