The dark side of after-hours care


During our darkest hours, we make some of our most obscure requests.

These moments spent groping blindly for illumination and stability amidst gloomy uncertainty are ripe for impulsivity. Here, there are no consequences; there is no demand too exorbitant; there is no sacrifice we will not consider if it will deliver us from the darkness. When primitive, we are at once limitless and then limitlessly desperate, hollering for heroes to swoop in and flick on the light switch when we believe our own abilities can no longer hack it. Unfortunately for us ailing civilians in the United States, our physicians — those men and women who broke the hero mold centuries before Batman — can only save us during normal business hours. Every hour that reaches farther into dusk thereafter is mostly ours to face alone.

But tech-tonic shifts for the healthcare industry and for the nation at large may shake that constrained reality into overdrive. Technology has uncoiled itself from the embryonic stages of the industrial age and ventured forth at a relentless pace. A new mindset has been born in its wake — one that regards immediate gratification as the ultimate priority. The fermentation of that philosophy in the minds of patients the nation over has inevitably brought the concept of after-hours care — unlimited access to one’s doctor resources — back to the forefront of the healthcare wish list.

Imagine your physician always at the ready, awaiting your beck and call. Imagine waking up to stomach pain and being able to dial-a-doc with the ease of activating an app on your smartphone. We’ve all spent a lot of time imagining these possibilities, and now, with the anesthesia of technology administered, this surgery could actually be a success.

A Commonwealth Fund-supported study has proffered up five models (listed below verbatim) by which after-hours care could come to fruition for physician practices:

  • Work in small practices (solo or two-person) where a physician is available around-the-clock.
  • Form partnerships with other practices, so that physicians can rotate after-hours shifts.
  • Join a small, local cross-coverage network; for example, in the Adirondack Regional Medical Home Pilot, providers cover each other’s patient panels.
  • Join a large cross-coverage network, such as the Geisinger Health System in Pennsylvania, which has staffed after-hours clinics and urgent care centers.
  • Enter a contractual relationship with an urgent care center or after-hours clinic.

The report also listed these degrees of feasibility for the above models:

  • the degree of clinician buy-in, which may be influenced by financial incentives, or the knowledge that patients will be returned to the practice for follow-up and ongoing care;
  • scheduling and staffing capacity to account for hours of greatest patient demand, and the availability of nurse triage phone lines and other tools;
  • a financial model tailored to the practice’s size, payer mix and type, and socioeconomic status of patients, and whether the practice is part of a system bearing the costs for ED and hospital utilization;
  • effective communication between PCPs and after-hours providers, supported by EHRs, and consistent communication with patients about when and how to seek after-hours care; and
  • the practice’s overall commitment to improving access to care.

It’s clear that patient satisfaction has reached an apex of importance and physician practices, ever eager to please their clientele, have been scrambling to provide the best quality care imaginable, even if that means surrendering more of themselves in the process. While I can definitely see the positive side of after-hours care, I’m having a hard time ignoring the steep toll I am demanding of my physician to attain that wont.  

“When we ask the doctor to be doing everything, in many ways it’s a recipe for disaster,” Marci Nielsen, PhD, MPH, executive director of the Patient-Centered Primary Care Collaborative told amednews.com. “They’re already so stressed.”

Physicians aren’t superhuman. As Nielson says, piling on too many expectations is bound to end in some sort of meltdown. Thus, the bottom line is not a conveyor belt — we have to ask of ourselves as a society what we would rather have, a robot or a doctor? One lacks the human factor, but is entirely accessible, while the other can give you all the species sympathy there is, but, like you, needs his/her own space.   

This is written from the prospective of a damsel, a patient, looking directly into the light I’ve casted upon my doctor and noticing the ever-massive shadow rising up from behind. Perhaps alternatively scheduled physicians will reduce that shadow, or maybe more nurse availability will do the trick, but given the current healthcare climate, it’s probably best to tone down the patient demands before the entire concept fades to black.

What say you? Post your comments below.    

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