Handling patient/client emergencies is one of the most dreaded parts of clinical care. Not only does the provider have to consider the best care for the patient/client, he/she must think through medicolegal considerations, and develop an emergency contact plan plan that serves both interests well.
First, let’s define the different types of “emergencies” that you may encounter in your practice.
- A genuine life or death situation. For example, a patient/client planning to suicide or having already attempted.
- An urgent matter. For example, a patient has run out of medication; or they are having discontinuation symptoms or side effects. While there is no imminent danger to life, there may be significant discomfort.
- A matter of high anxiety. Issues that provoke high affect too powerful to contain, and patients/clients need to attention in that moment to lessen the burden.
Being on-call for emergencies in a solo private practice can be challenging because the provider is always responsible for handling them. This is one reason some choose to be part of a group practice or an employee, so the burden can be shared via an on-call pool.
Regardless of which set-up you’re in, the most common practice policies are: instructing patients/clients to call 911; using an answering service; or giving your home or cell number out to patients. Here are the pros and cons of each.
Instructing patients/clients to call 911
Pros:
- Meets minimum standard without any additional work.
- Establishes work-life boundaries that patients/clients will have to respect.
- Makes private practice more tolerable, as no one can be “on call” at all times.
Cons:
- Patients/clients may not feel particularly cared for.
- In looking at this from the patient’s perspective….if he/she is calling their provider to say they’re suicidal & are redirected to call 911, will they be willing/able to call 911?
Using a remote answering service
Pros for patients/clients:
- They feel reassured that they can get to you after hours and that it’s possible to get a call back from you.
- Widely used in the medical field, so patients/clients are very familiar with this.
- The operators can be trained to screen for emergencies, and can even be given a script of questions to ask or an algorithm so they know whether to contact you immediately or not.
Pros for providers:
- Establishes a healthy boundary between work/personal life without being impersonal.
- Provides reassurance that you can have trained staff assessing for true emergencies & that you’ll be contacted if necessary – assuming you are confident they will implement your policies.
Cons:
- Can be expensive for providers.
- Patients may still be frustrated that they can’t directly connect with you on the phone.
Giving cell number to patients
Pros for patients/clients
- Patients/clients may feel very cared for & reassured that they can reach you directly at any time – ironically, this may in and of itself be calming and reduce the need to actually contact you.
Pros for providers:
- Can maintain complete control over one’s practice at all times.
- Can market the practice more as a “concierge” service.
Cons:
- Providers may not feel that they can get away (what if you go out of town frequently? out of the country? camping? in a cell phone dead zone?)
- Some patients may abuse this; and it blurs boundary between work/personal life
- Not ideal in the long-term; hard for providers to be available 24/7 over a 30 year career
The right emergency contact plan
Picking the right emergency contact policy involves providing good patient care, that works for your lifestyle, and that projects the right image for your practice. The closer you can get to the overlap of all three, the more comfortable you’ll feel in dealing with these very uncomfortable, though hopefully very rare, situations.
