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After-hours answering services


Malpractice Consult

Q. In a previous column [Jan 6, 2006], you discussed using an answering machine when a doctor is off-call. But wouldn't an answering service be more responsive, more patient-friendly, and offer more protection against liability?

In fact, an incompetent service could even be worse than a machine in terms of your liability risk. If the operator records a message incorrectly or makes a mistake when relaying it to you and the patient suffers an injury, your exposure increases. If service personnel are rude or unfriendly, they may make patients angry, and more likely to sue you if something goes wrong.

For each call, the service staff should record the date, time, caller's name and phone number, and the important details of the message. Ask the service to promptly transmit copies of those messages to your office. (Many services only retain phone messages for a limited time.) For liability protection, keep those copies-and your responses-in the patients' charts.

Don't rely on the service operators to screen calls or triage patients. They're not qualified to evaluate medical problems, give medical advice, or answer questions about treatment or prescriptions. If a caller reports a medical emergency, and you're not on call and don't have coverage, the operator should tell the patient you're not available and tell him to go to the ED or to call 911 if he needs an ambulance.

If you do use an answering service, tell your patients-in person and in your brochure-that if they call after hours they'll reach the service. If you share coverage with other physicians, identify them to your patients so that they won't be surprised to get a call-back from a doctor they don't know.

Remind your patients that they should call for medication refills only during regular office hours. You and your on-call colleagues should also agree to authorize only a limited amount of medication in response to after-hours calls, when patient charts aren't available.

Periodically call your office phone after hours-or have someone call for you-to evaluate the answering service's performance. Also ask patients who've reached the service for their feedback. Report any complaints to the service's supervisor.

The author is a risk management and loss prevention consultant in Cloverdale, CA. He can be reached by e-mail at

This department answers common professional liability questions. It isn't intended to provide specific legal advice. If you have a question, please submit it to Malpractice Consult, Medical Economics, 5 Paragon Drive, Montvale, NJ 07645-1742. You may also fax your question to 973-847-5390 or e-mail it to

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Jennifer N. Lee, MD, FAAFP
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