His Number in the Book, This Doctor Is Always In

This article is reprinted by permission from CareerJournal.comCountry doctors have traditionally worked long hours. In the old days, they did house calls on horseback after the office closed.Now, my home phone number is printed in the local phone book. I respond to after-hours calls, make hospital visits and do weekend work every day when I'm physically in town.In a recent week, I had an 8:30 p.m. call about a child's earache, a 10:30 p.m. call from a first-time mom about her child's mild diarrhea, four off-hours calls from nursing homes, two calls from the hospital emergency department, one call from the OB department and one Sunday morning call from Irkutsk, Siberia.Irkutsk calls only when there's big trouble. A patient of mine working in Siberia as a missionary developed severe traveler's diarrhea and needed advice. When you're half way around the world and as sick as can be, you still prefer your family doctor over the local sawbones.I've kept this 24/7 availability for the last seven years. I've chosen this path because it's manageable for me and I have the temperament and the endurance for it. I couldn't do it without the support of my wife -- mother of our four kids -- who tolerates the interruptions. The doctor who invited me to the area has been practicing this way for over 20 years and his predecessor for more than 30 years.My patients on public assistance get the same level of service and 24-hour access that I give my other patients. I'd like to get paid for phone calls or e-mail advice, but so far I haven't been.Doctoring is not just what I do, but who I am. On a recent night I went from peacefully putting my son to bed to doing an emergency C-section on a bleeding woman with a placental abruption in the span of 20 minutes.I haven't missed any birthdays or anniversaries, but holidays are often interrupted by the call of duty. There was one year that I delivered babies on both Thanksgiving and Christmas. Two years ago, on my birthday, I made a snowy February evening house call for a sick infant whose family didn't have a working car. My son Jacob, at the age of four, told our family that he wished I was the garbage man - with a regular schedule -- instead of a doctor.Going out of town isn't easy. When I head to Florida with my family next month, it will be eight months since my last full week of vacation.Planning for a week away begins about six months in advance. I look at the calendar to see when babies are due and try to work around that. I haven't found a perfect way to make summer vacation plans when women are due almost every week in June, July and August, so I let my wife decide which week we should take.Despite efforts to accommodate the obstetric delivery schedule, sometimes women go into labor early while I'm away. It isn't unusual for someone to need emergency surgery, have a bad accident or die. I had one child who had a bowel obstruction requiring surgery on two separate occasions when I was out of town. I've had a patient have a heart attack on the morning I was trying to get an early start out of town. A pregnant patient needed emergency gallbladder surgery another time. I started leaving town in the evening after that. So far it's worked.Being self-employed in rural practice makes it financially difficult to take time off. I pay for the trip and over $5,000 in weekly overhead costs that continue unabated while I'm away.There are preparations that have to be made before departure. I have to find one or more doctors to cover my patients. Passing my OB coverage to another doctor effectively doubles their workload and cuts their sleep in half for the week. I've had to cancel or delay trips because I couldn't get coverage.Every nursing home, hospital department and home-health agency that I deal with has to be informed of my departure and return. Every test result, refill request, phone message, hospital medical record and office chart note has to be addressed before I leave. I try to inform the doctor covering for me about the patients who might have problems while I'm gone.The preparation amounts to a full day's work on the day before any vacation and a full day's work to sort through what has accumulated above and beyond the pent-up demand for doctoring that I encounter on my return.The escape from the pager makes all the preparation worthwhile. With a new doctor recently joining my practice, I hope to get away a little more this year. I've got a standing invitation to make a house call in SiberiaThis article is reprinted by permission from CareerJournal.com, ©2003 Dow Jones & Co. Inc. All rights reserved.

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His Number in the Book, This Doctor Is Always In

Benjamin Brewer, M.d.

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Benjamin Brewer, M.d.