Cross Coverage

Most people probably don't give much thought to their doctors' free time. But how exactly do they manage busy patient loads and still have weekends and vacations? The answer can affect you and your family's health and well-being.

Many physicians belong to a "coverage group": One physician temporarily takes care of all of the group's patients. So from Friday evening until Monday morning -- almost 40% of the hours in a week ? your medical care may well be in the hands of a physician other than your primary doctor.

What do patients need to know about cross coverage?

Hospitalized Patients

Many relay races are lost by a poor handoff of the baton. So, for hospitalized patients and their families, the key issue is ensuring a smooth transition of care over the weekend. As a patient, you are entitled to know that there is a well-informed "captain of the ship" on board at all times. So be sure you know who this is -- ask ahead of time.

Over a weekend, the covering doctor becomes the surrogate for the primary doctor and the chain of command remains intact. In The Year of Magical Thinking, Joan Didion writes brilliantly about her ordeal dealing with the illnesses and deaths of her husband, John Gregory Dunne, and her daughter, Quintana. When I asked Didion for her thoughts about cross coverage, she mentioned that she felt reassured by seeing her primary physician's name on John's medical bracelet when he was in the hospital. The label symbolically tagged her husband as being under the protection of a respected doctor who was ultimately calling the shots.

"I don't know why but this point about the bracelet matters. So much in a hospital happens in the fog of war that you want at least a symbolic line of command, legible to everybody who happens into the case. More often than you might think, the patient's relatives are left to catch up a new doctor on some key point."

What should you and/or your family ask your doctor before the weekend rolls around?

• Who is the covering doctor and what is his or her specialty?
• What time does the doctor make rounds?
• Who is on the team? Aside from the covering doctor, who else will be seeing you over the weekend -- interns, residents, fellows, specialists?
• Who is making the decisions? This may NOT be the covering doctor in certain settings such as intensive-care units.
• Does the covering doctor have the contact information for the "point person" family member in case urgent communication is necessary?

Outpatient Care

Let's switch to the outpatient setting. It's Friday evening and you develop a burning feeling in your chest. You call your physician and are told he is "off call" for the weekend. Planning ahead will help you and the covering doctor make sure good care continues.

• Remember that unless your physician is one of the relatively few doctors using an electronic medical record accessible over the Internet, the covering physician most likely will have no access to your office medical chart.
• Keep a home medical history file -- a list of your medical problems, medications (including dosages and how often you take them each day), allergiesallergies, and past operations. Knowing your medications is especially important; the covering doctor will have no idea what "the little red pill" is.
• If possible, have your home medical file available in a format that can be faxed or emailed to the covering doctor. If you're technically challenged, ask a family member or close friend to send the information to a covering doctor or emergency room.
• Keep a list of a local pharmacy numbers, including at least one 24-hour pharmacy.
• Keep track of your prescriptions so that you do not run out over a weekend.
• Try to be concise but detailed when reporting your symptoms. The doctor will want to know:
  • What exactly is the symptom?
  • When did it start?
  • Did it start after you did something? (such as eating, exercise, and so on). Remembering the pepperoni pizza you ate twenty minutes before the chest burning began just may save you a trip to the emergency room!
  • Does anything make it better or worse?
  • Have you ever had it before?

• Don't be afraid or intimidated to phone the cross-covering doctor. And if you don't get a return call within a reasonable time, call back. He or she may not have gotten the message.

Remember that weekend coverage is for urgent problems. But do not hesitate to call if you are not sure whether a problem is truly urgent. However, do not ask for a second opinion about a chronic, nonurgent issue that your regular doctor is already addressing.

Of course, the best strategy is to stay perfectly healthy from Friday to Sunday and during your doctor's vacations. But if you do encounter an off-hour health problem, understanding how to deal with the cross-coverage system can help to keep your medical journey smooth.

Published August 2006.