Taking Emergency Call for Plastic Surgery in Santa Barbara

We send out little surveys to most of our patients after they come in for a consult, so that we know what we are doing right and wrong with respect to our customer service.  The vast majority of these come back with good reviews and compliments for myself and my staff.  But as we all know, you can never please all of the people all of the time.  One survey recently came back from a new patient who was indignant that she had to wait 30 minutes before seeing me.  Her comments were along the lines of "why would I have surgery by such an uncaring doctor and staff", and "I was late for my next appointment". 

I read all of these surverys myself, and I take them to heart, especially the ones where we could have done better.  I know many doctors who routinely go about their day behind schedule - I thought about how every time I take my mother to her neurologist, we routinely wait about 30-45 minutes or more.  Maybe I should start writing nasty letters.  In my practice, I can't stand being behind schedule, and it is rare that anyone waits as long as 30 minutes, as my angry patient did.  So I wanted to see why she waited that long, and ask my staff if they remembered what happened that day. 

It turns out the patient had an appointment at 1 pm, right after lunch.  However, I was on call that day and was called in the morning regarding an elderly woman at Cottage Hospital who had passed out at home and struck her head.  She was being observed in the intensive care unit and they wanted me to see her for a laceration over her left cheek.  As plastic surgeons, when we get called to the hospital, it's usually at night, so this was somewhat unusual, but I thought I could skip lunch and see her and repair it during the lunch hour, rather than leave it unrepaired until evening.  When I got there and took her bandage off, it was quite an impressive injury that created a large flap of most of her cheek skin and soft tissue, exposing her parotid gland.  She was lucky that her facial nerve, which controls facial movement, was not injured.  I got to work cleaning it, debriding it, and repairing it in the intensive care unit. 

When I got back to my office and saw my other patient it was 1:30.  I apologized for being late, and according to my staff, they told the patient I was going to be late.  I didn't tell her why I was late, maybe I should have.  She seemed very nice, the consult went fine, it wasn't until the survey came back that the patient's true feelings were revealed.  But regardless, I lost a patient.  Worse than that, she's probably out there complaining to her friends about my practice. 

So why do I bother taking call?  The downsides are easy to identify, and this episode just illustrates one - that to the extent emergencies impact on my practice, particularly my aesthetic practice, I risk losing patients who are intolerant of waiting.  Other downsides are the midnight calls to come to the emergency room, the restrictions on weekend activities and travel, the minimal (if any) reimbursement, etc.  These are what most clinical physicians face, except maybe those lucky dermatologists.  Yes there are some upsides too - the stipend for taking call (albeit small), the good feeling of using my skills to help someone out following an injury, and the feeling of camaraderie going into the hospital - as a plastic surgeron in private practice this is a nice benefit.   I also firmly believe that spending a part of one's practice repairing traumatic injuries and performing reconstructive surgery maintains skills that have benefits in the realm of aesthetic surgery as well.  For example, the patient whose face I repaired had an extensive injury exposing her parotid gland and facial nerve.  This kind of anatomy is not typically seen during facelifts, and most plastic surgeons who don't take call haven't seen this in many years. 

Self-confidence is a trait that any good plastic surgeon should have.  Sufficient training and experience is obviously important, but ongoing experiences that keep previous skills and knowledge alive are a big part of that self-confidence.  Keeping active in reconstructive plastic surgery makes a better aesthetic plastic surgeon.