Physicians’ answering services
could impede patient care, study shows

A new study conducted by researchers at the University of Colorado Denver suggests patients who are ill may experience unnecessary delays in their care when calling physicians’ telephone answering services, which could negatively affect patient health.

The study, published in the March 2003 Journal of Family Practice, found patients who call after-hours are confronted with multiple barriers before receiving appropriate care. According to David E. Hildebrandt, PhD, co-author of the study, patients often must call a second telephone number, choose from several options on the phone system, or decide whether their problem is a “true emergency.”

Almost 90 percent of the physicians’ offices studied required the patient to decide if his or her problem was an emergency. About 10 percent of these patients decided that their problem was not an emergency, but half of these patients, or 5 percent overall, potentially had a true emergency as determined by a panel of expert clinicians.

“We cannot expect an answering service operator to know how to triage patients,” Dr. Hildebrandt said. “In studying these calls, we found several barriers between patients and physicians: wrong numbers, messages necessitating a second phone call and requirements that the patient decide the severity of his or her complaint. These barriers may negatively affect patient health due to unnecessary delays in evaluation and treatment.”

Some of these calls included symptoms such as chest pain running down the left arm, difficulty breathing, pre-term labor and a person with a severe cut to the hand. However, none of these patients were connected to a doctor when they called because they did not tell the answering service that their problem was an emergency.

Researchers with the UCD’s Department of Family Medicine estimate that there are between 50 million and 100 million after-hours calls to physicians each year. If 10 percent of those calls do not get through to a physician and one-half of them may be serious, then as many as 2.5 million to 5 million callers may suffer potentially dangerous delays in care.

“We urge physicians to have their answering service send all clinical calls through for the doctor to manage,” said John M. Westfall, MD, MPH, co-author of the study. “Patients who are ill should not be asked to decide if their problem is an emergency.”

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