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Reducing your risk when you're not available
An article for physicians by physicians
Originally published May 2000 / Revised April 2008
IL0020-1-E

Of interest to all physicians

Physicians often find themselves working in communities where physician resources are scarce. This is especially evident in small communities where the number of doctors is decreasing and around-the-clock coverage is not possible.

However, patients still have expectations during periods when their usual physician is not available. Patients and their families often become dissatisfied when their expectations are not met, which can lead to a claim or complaint. To avoid medico-legal risk in such an environment, be it a hospital, clinic or office, consider taking these steps:

• Review the by-laws under which you have privileges to ascertain your responsibilities to provide care to patients in the institution(s).
• If the responsibility is beyond what can reasonably be met, discuss this concern with the administration. It is a good idea to document all discussions and all steps taken to arrive at a reasonable, acceptable on-call schedule.
• Explain to your patients, in advance, the parameters of your practice, including the availability of off-hour coverage, and from whom a patient should seek help in your absence. The recorded message at your telephone number should include this information.
• Have clear written directions for the facility's staff about:
  • when physicians are available;
  • when physicians are not available; and
  • what should be done in the event of unavailability.
• Discuss with the hospital or facility administration the procedures to follow when local services are not available, including what arrangements have been made to transfer patients to other facilities where medical care is available.
• Verify there is a system in place to make all other health care providers and referring physicians aware of the availability or unavailability of physician or specialty services.

These steps will help clarify for patients, other health care professionals and hospitals what should be done during times of unavailability and will help you to review and identify your responsibilities and prepare for times when you are not available.