Patient Hacker

Doctors work around the clock, but it seems the ones that work after hours hide in the shadows a bit. Finding a doctor in public after 6pm needs more than a little luck. And if you manage to catch one, you have often dealt with a long wait and a higher than usual fee. When your medical problem is a roaring emergency, the answer is easy - simply call an ambulance or high-tail to the emergency department (where a little inside information will help shorten your wait). But when your problem is simpler, accessing a doctor seems a lot more complicated.

You can imagine the situation. It’s 7pm and you are just making dinner when you slice your hand with a knife. “Ow! Swear word! Ow!” you exclaim, as you compress the cut with a clean cotton dishtowel (rendered relatively sterile by the iron). The cut is not huge, and you are pretty sure it is not too deep, but it won’t stop bleeding and you think you might need stitches. You are faced with the major modern medical dilemma - how do you find a doctor in the evening outside your local emergency department?

This situation can be stressful and it is often combined with other considerations. Maybe you have to look after your kids. Maybe you have an early start in the morning and can’t be up after midnight just to get your hand chacked. There are a number of ways to make it easier, and less stressful.

Get to know a doctor personally

This is one of the best ways to get to see a doctor when you need them - rely on familial obligation. Be careful with this tactic, though, as it can backfire. If the doctor is a member of your family, you will have to respect them a little bit, as you would if they were a “real” doc. If they are a friend, you really only can do this once or twice before they stop answering your calls. So pick your health emergency with care.

Finally, make sure the doctor you choose to befriend is appropriately qualified. When I was deciding what specialty to choose, my Dad strongly argued against paediatrics, purely because he could see that he would never get his “money’s worth.” For the record, he favoured general practice, surgery or psychiatry.

Get to know Doctor’s staff personally

Most doctors are pretty malleable and are particularly at the mercy of their staff. As in all industries, good staff are hard to find, and you want to do favours for them, if you can. If you can marry a medical receptionist, or carpool with a practice nurse, you will have a reasonable chance to manipulate an after hours appointment in an emergency.

For this to work, you really need to have a real emergency or extenuating circumstances to persuade your friend to pull in a favour from their boss. They must also be a treasured member of staff, so make sure your friend is not a nuff-nuff. The doctor will only go out of their way to coddle a member of staff they want to keep on their payroll.

Call your regular doctor

All primary care doctors have an ethical obligation to provide after hours care. Sometimes they have a roster of doctors on call, or they may employ a locum service. Some prefer you to attend the local after hours clinic. The best way to find out what your doctor would want you to do is to phone their main number and listen to the recorded message.

If you are lucky, you will find out that your doctor has extended their hours since you last checked, or may be willing to stay a little bit longer to fit you in.

Visit a 24 hour clinic or “Super Clinic”

Super Clinics are usually open all hours, often with more staff available after hours. The quality of staff varies, although all are qualified to a minimum standard. These clinics are a good solution for any after hours primary care emergencies, like cuts and grazes, sprains, colds and flus, and childhood illnesses. The system varies, but usually you attend and simply wait until it is your turn. Usually the wait will be longer than an appointment with your regular doctor, but shorter than attending a hospital ED.

These are not good places to go if you have a condition that could deteriorate rapidly, like chest pain, or asthma. It is better to have these things assessed by hospital staff.

These are also not good clinics to attend for regular appointments, as you can’t usually get repeat appointments with the same doctor.

Call a locum service

Locum services provide primary care doctors that make house calls after hours. This is usually a paid service (as are most after hours services). Again, you will have to wait an unpredictable amount of time, as it depends on what other patients have called in. However, you get to wait in your own home for the doctor to visit you. This is particularly valuable if you feel rotten, or you are minding children who are asleep.

Locum services will communicate with your regular doctor so they know what has occurred. If you are not sure how ill you are, locums are generally a good option. You can cancel the call if you decide you feel better. And if your condition deteriorates, you can call an ambulance.

What to do now

When it is 2am and your partner is having an episode of abdominal pain, it is really hard to figure out what to do, and often they are not helpful (she speaks from experience). It is important to figure out your plan in advance. Search your telephone guide right now and find where your local after hours clinics, and the number of your town locum service. Next time you visit your doctor, ask the staff what to do for after hours care.

Being prepared, and in the know, will help you find the “doctor of the night”.

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