Where’s my doctor?

For most of my practicing life it was customary for surgeons to care and be responsible for their patients at all times. Times change. Now the above question is not unusual and is followed by, “Who are you?” What’s going on? What has happened to the patient/surgeon relationship? The answer is cross coverage.

I admit that being responsible for all aspects of your patient’s care 24/7 is taxing. Before cell phones it was necessary to leave a new phone number with the hospital operator if you, the surgeon, went out to a restaurant, social function or anywhere that had a phone. But we were accustomed from our residency experience to have this relationship with our patients. The good news is that we knew everything about them: what their medical problems were, what operation had been performed, what bumps had complicated their postoperative course. Because of this we frequently were able to address new issues over the phone without the patient having to make an office visit or come to the emergency room. We could usually quickly intuit a real problem as we had an intimate and comprehensive understanding of the patient’s course. And patients and families were reassured when they heard your voice or saw your face. You were their surgeon.

In more recent years cross coverage of patients has become common. In theory this should work for both parties; the reward  for the surgeon is an undisturbed night or weekend and the patient is cared for by a competent partner. It’s not perfect though. Despite the best of intentions, the covering physician lacks the emotional connection to the patient that is shared by the primary surgeon. This does not mean they don’t care. They do. But it’s easier to shrug off a concern from a nurse. In addition, being less familiar with the patient’s course it’s more difficult to discern a deviation from it. The result is frequently a temporizing measure with the assumption that the primary surgeon will provide definitive action on the following day.