VCU Internal Medicine Training Program
Primary Care On-Call Guidelines
Primary Care Call Form | Primary Care Call Schedule
All PGY-3 Residents and all PGY-2 Women's Health/Primary Care Residents take Primary Care call during the year.
All residents are assigned one block of Primary Care Call. Each block consists of approximately 10 call nights. The exact number of night on Primary Care Call may slightly vary based on scheduling needs. Those assigned to Primary Care call during the December-January holiday period are only given 5 call nights. Residents are usually assigned to Primary Care Call during their Urgent Care Block, thus contributing to the continuity of patient care as well as the residents’ learning experience. Scheduling Primary Care Call and Urgent Care together allows the resident to see patients urgently, themselves, as needed.
The Primary Care Call has been added to AMION. You will have to look at your schedule for each individual month to show which nights you are on call. Note: Primary Care Call and Pull Call are not listed in the “year summary” at the top of your AMION schedule.
Any changes in the Primary Care Call Schedule need to be submitted to the Chief Medical Resident.
The Basics on the Primary Care Call:
- There is a Primary Care Call Form available on ERIC website for easy accessibility.
- You need to be available by beeper at all times during your Primary Care Call Blocks. On-Call Residents must be available by pager between 4pm-8am on weekdays and for 24 hours on weekends.
- Telepage will page you with the name, DOB, and call back number of the patient requesting Primary Care Call assistance.
- You will then be paged by the Telepage to the patients telephone number. Try to answer the call within 15 minutes. Should you need to return a long distance call, dial 828-0951 for assistance. If the operator asks for an office number, use 828-0381. Use *67 to block caller ID, should you wish to do so. Keep in mind however that many calls will not go through if you do this, and in that case, you may wish to call Telepage back and ask them to place the call for you.
When Returning a Call:
- Verify that the patient is seen in RESIDENT ACC Primary Care Clinic. If the patient is seen ACC Faculty Clinic or elsewhere, you should advise them to call their own primary care physicians office. If they have an emergency, instruct them to go to the nearest emergency room.
- Fill out the Primary Care Call Form for each call you take. Be sure to fill out the form as completely as possible.
- Be certain to document the patient's name, DOB or MRN (very important!), and chief complaint on your form. Then write a brief HPI and assessment and plan. Carefully document your recommendations to the patient (i.e. report to the ER, contact the clinic for a regular follow-up, contact the clinic for an urgent visit, etc).
- You always have back up. If you are uncertain how to handle a call, the faculty practice attending on call is available through Telepage.
- Should a patient require prompt follow up the next day, this should be indicated on the call sheet and you must contact Triage during regular business hours as soon as possible to facilitate scheduling.
- All Primary Care Call Forms should be returned to the Triage office the next morning. On weekends, the forms must be submitted to Triage by following Monday at noon. Forms can be submitted to Triage in person or Faxed 828-0910.
- If you wish the patient to be seen in Urgent clinic - or for any other type of appointment, please contact Triage at 828-5080 to facilitate scheduling.
- All calls will be reviewed by the PCA attending. Comments or suggestions on individual cases will be offered where appropriate. The attendings may page you to discuss the case should they find this necessary. You should feel free to request this of the attending physician if you have a specific issue you would like to discuss.
Recommendations for Commonly Encountered Scenarios On-Call:
- DO NOT PRESCRIBE narcotics or benzodiazepines. You may invoke that this is clinic policy if the patient is insistent. Patients demanding such controlled substances should be advised to call the clinic during regular work hours. If they have a true emergency, they should be referred to the ER.
- If a patient needs a prescription refilled, you should call it to the pharmacy of their choice. If the pharmacist asks for an office number, you may give the PCA primary number 828-0381.
- If the MCV lab calls with a critical lab value, ask the technician for the patient’s phone number. If they cannot provide this information, ask to speak to their supervisor. The patient should be contacted and further history elicited as needed. You may need to instruct the patient to either report to the ER or contact the clinic for a follow up appointment as indicated by clinical situation.
- While it is not the purpose of after hours call to obstruct emergency access, patients clearly not needing emergency services should be discouraged from going to the ER. Assure patients that they can be seen in clinic as an urgent appointment in a time frame appropriate for their complaint
- Keep in mind during your week on call, that Resident Primary Care Clinic is a group practice, and we are responsible for the care of the patients of our colleagues during the off hours. Reasonable effort should be made to meet the needs of the patients when possible. Be mindful that many of our patients are unaccustomed to having telephone access to their physician after hours, and some calls may reflect this. As with any medical setting, a patients’ understanding of the seriousness of his or her situation may not correspond with your own.
