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In Israel the public tends to make use of informal medicine alongside organized health services, and cellular phones now allow contact with physicians at almost any time or place. For three months in 1999 a family physician documented all consultations on medical subjects conducted by cellular phone, the phone being available 24 hours a day. There were 94 cellular phone medical consultations, of mean duration 5.8 min (range 2-18). Only 11 took place over the weekend, and 63 took place while the clinic was open. The most common reasons for consultation were advice on treatment (29%) and a second opinion (28%). In 48 cases the consultation was for a close relative rather than the caller. In 42 cases the request for consultation came while the physician was busy with other patients.
The results of this small personal study confirm that the practice of informal consultations now extends to the cellular phone. Technologies of this sort demand new rules of conduct, if we are to avoid the various hazards of off-the-cuff medicine.
In the section of the journal Postgraduate Medicine in which physicians relate events of interest that occurred in the course of their work, Dr Eric Anderson, a family physician from San Diego, recounted a story that was first published in the BMJ in the 1950s1. A doctor was driving his car when, suddenly, a young boy riding a bicycle appeared in front of him. The doctor swerved to avoid a collision, the car slid to the side of the road and crashed through a fence into a garden, where the ride ended. The doctor sat there, with water pouring from the car's radiator, sweat from his forehead and blood from his chin, and with a broken tooth that cut his lip. Out came the home-owner, who recognized the driver as his own physician. ‘Ah, doctor,’ said he, bending over the shaken man and wrenching his white knuckles off the steering wheel, ‘there you are! Dear me. But as long as you're here, I'd like you to check my wife. She's got this strange rash, you see...’.
Weingarten reported 198 ‘off-the-cuff’ consultations between general practitioners and patients that occurred over six months at social gatherings, at chance meetings, and in medical settings outside the regular practice2. Hallway, off-the-cuff, curbside medicine is widely practised3, and in the same way doctors consult each other informally about patients, to general benefit4,5. E-mail is now used by family physicians and consultants for similar purposes6.
In the era of ever increasing use of cellular telephones, contact can be made with physicians at almost any time and place. The aim of the present study was to characterize informal consultations by cellular phone, from the personal perspective of a family physician.
Israel has compulsory national health insurance, and I work for the General Health Service, which provides for about 65% of the population. Much as in the UK, patients are registered and see the general practitioner (GP) by appointment. GPs do little work beyond the clinic, and outside office hours patients use the emergency services. There is no financial or other incentive to making oneself available at all times.
Over three months in 1999 all consultations on medical subjects conducted by cellular phone were documented. The phone was available 24 hours a day during the study period.
During the 91-day study period there were 94 cellular phone calls for medical consultation (mean 1.03/day). The mean duration of calls was 5.8 min (range 2-18). In 3 cases the call was for two unrelated medical problems. 57 callers were women (61%). Only 11 calls were received at weekends. 63 were made when the caller's clinic was open; only one was made between midnight and 8 a.m. The reasons for the calls are presented in Table 1 and the characteristics of the callers in Table 2. 48 calls related to persons other than the caller. 42 were answered while the physician was treating other patients in the clinic, 20 when he was at home and 17 when he was driving with the cellular phone hooked into the car. During the entire study period no messages asking for medical consultations were left on the cellular-phone answering machine.
The Israeli public, much like that of the USA, tends to make use of informal medicine as well as the organized public health services1,2,3,4,5,6,7,8. The results of the present small personal study confirm that informal consultations now extend to the cellular phone.
Doctors are taught to document all medical encounters, and the lack of documentation inherent in a cellular phone consultation generates anxiety. What if some complication should arise? This kind of encounter has other drawbacks: it interrupts other patients' appointments, wastes their time in the clinic and disrupts the appointment schedule. There is also a potential conflict of interest whereby the physician is paid to work for a particular healthcare organization but provides consultations during working hours to people who are not insured by that organization. The timing of the calls received by me—67% during working hours—suggests that in many cases the caller was simply trying to avoid the inconvenience of coming to the clinic. Most requests came either from my extended family or from my circle of friends, but some were from professional colleagues and medical students. Clearly, for a person with a high-pressure lifestyle, an off-the-cuff cellular phone consultation is an appealing option. From a social and personal standpoint, I am glad that the cellular phone makes medical consultations so readily available. Whether physicians in other medical disciplines or other healthcare systems will be equally positive I cannot say. What is clear, however, is that technologies such as e-mail and the cellular phone demand new rules of conduct to help avoid the legal, economic and other hazards that arise from such off-the-cuff consultations.