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ON CALL THIS WEEKEND?
Read This First!

By Hugh A. Raphael, M.D.
Vascular Surgeon, Northridge, California Member,
CAP-MPT Claims Review Committee

YOU’RE COVERING THIS WEEKEND?
Before Friday arrives, STOP, THINK and make sure that you are WELL PREPARED.

All too often, the CAP Claims Review Committee encounters physicians and claims resulting from cross-covering activities. Based on the author’s experience, both as a vascular surgeon and as a claim reviewer, we offer the following checklist for covering physicians:
• Accept the full obligation of a covering physician. You are totally in charge, from both medical and legal viewpoints. You may not approach the task as merely a temporary steward of those patients.
• View the patient as your own, in all respects. As the covering MD, your duties may include taking telephone calls from the hospital, making hospital visits and rounds, nighttime call, ER call and any other call. Be sure to confirm the scope of your agreed coverage with the other physician. Your responsibility extends not only to calls, but also to follow-through with all necessary medical and surgical treatments.
• Insist on receiving complete facts about each expected patient’s case, including the other physician’s proposed management plan, and the identities of other consultants who may be on the case already, or available to consult.
• When covering hospitalized patients, you should be diligent in making rounds, documenting your activities in complete and legible progress notes, and performing all duties as if you were the primary physician.
• For hospital patients, be sure that you have privileges at all facilities where the other physician’s patients are hospitalized.
• If any major change occurs in a patient’s status, and the primary physician is available (even if off call), determine if the primary physician wishes to resume care of the patient. If not, you are responsible to fulfill that role as the covering physician.
• Covering physicians should be of similar training and experience in order to carry out all duties should the occasion arise. For example, an internist normally would not offer to cover for a surgeon.
• If you are not willing to assume all of the responsibilities outlined above, you may decline to offer on-call coverage.

ON THE OTHER HAND, what about the situation where it is your turn to be off? How can you protect yourself and your patients?
• Choose a coverage physician whom you know well, and who you trust to function independently and to competently perform all duties in your absence. If possible, you should choose a physician with equivalent training and experience.
• Be certain that your covering physician has privileges at the same hospital(s) and privileges equivalent to your own.
• Take the lead and telephone your covering physician. Give a report on all your patients, physician-to-physician, including your management plan and any consultants on the case.
• Be sure to notify your patients well in advance of any prolonged absence.

IF CALLED AND NOTIFIED THAT A SERIOUS COMPLICATION HAS ARISEN, SERIOUSLY CONSIDER RETURNING FROM OFF-CALL, AND RESUMING THE DIRECT CARE OF YOUR PATIENT. TAKING THE TIME TO MAKE A PLAN, AND COMMUNICATING YOUR PLAN DIRECTLY TO THE COVERING PHYSICIAN IS AN EXCELLENT INVESTMENT THAT WILL PAY OFF IN TERMS OF IMPROVED CARE AND PATIENT SAFETY.