A reader writes:

You wrote: "Why not an emergency assistant at your doctor's for 24-hour help, or even just a phone call?"  There is such a thing; it's called an answering service, with on-call doctors.  Doctors who are on-call are available to return patients' calls at all hours of the night.  As far as I know, every primary care practice is connected to an answering service and has a doctor on-call at all times.  But as for going beyond that and having someone available for in-person visits during the night ... well, you've just described emergency rooms, haven't you?

Yes, but not in a hospital and with someone connected to a doctor who knows you. Another writes:

I'm sure you are going to get a bevy of email responses from your early morning, ill-advised post on emergency room visits. I am a private practice pediatrician in Kansas City, Missouri. I am in a practice that currently is the only one in my immediate area taking medicaid. I work 60-80 hours a week. We offer evening hours and Saturday hours. There is only so much we can do.

1. "Emergency assistant" - this is concerning on two levels.

First, what type of assistant? A doctor? A nurse practitioner? Will we get paid to keep our doors open, lights on, computers running? Further, a private practice office is not equipped to handle most emergencies. In our practice, we have enough equipment to stabilize a patient, but we are not an ER. If it truly is an emergency, they are worse off coming to most private practices. Which brings up the true problem....most "emergencies" are NOT emergencies. They can wait until the office opens. And I will challenge any ER doctor who says that we private practice physicians aren't doing our jobs.

2. "Phone call" - most practices are required to offer some sort of 24 hour service for after hour/off hour assistance by the insurance company contracts they sign. We contract ours through a local children's hospital. I recently heard some statistics that of the 400+ plus patients who planned on going to the ER, only 10 or so were actually recommended to go. Over 95% of ER visits were prevented just by this after-hour nurse triage system.

I know that's brief, but just wanted you to understand that I am working hard to give my patients a true medical home, and that the problem goes much, MUCH deeper than the hours posted on the door.

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