It was one hour before midnight in the ED on New Year’s Eve, and I was working as a resident emergency physician. As I wrapped up patient care responsibilities, it dawned on me that I might make it home before midnight to toast with my family and friends. A blaring overhead page summoned me to the phone for a stat read by radiology. One of the patients I was planning to discharge had an unexpected diagnosis on their CT scan, pneumonia, an infection in the lung. The condition can be life threatening; luckily the patient’s symptoms were mild, and both vital signs and laboratory results were reassuring. Unfortunately for me, the condition would require treatment with an oral antibiotic immediately, and the hospital’s outpatient pharmacy was closed for the holiday. This would require a call to the local community pharmacy, and in the wake of unprecedented staffing shortages in the ED, I would have to make the call. I knew I still had two hours of documentation to do from home, but otherwise I had finished my patient care duties. I could feel the time with my family slipping through my fingers at the prospect of a protracted phone call. The fleeting sense of burnout passed and I returned my focus to serving my patient.
I dialed the local pharmacy, indicated that I was an emergency physician, and sure enough I encountered the familiar music indicating that all the pharmacists were busy and that I would have to wait my turn. I waited, as the digital red numbers on the overhead clock continued to advance. Finally, 25 minutes later, I heard the weary voice of a pharmacist. He apologized and explained he was the only one working the holiday evening. We exchanged an empathic acknowledgement and I explained the urgent need for a prescription of the oral antibiotic for my patient with pnemonia. The pharmacist paused to search and then let out a long sigh. Unfortunately their location was completely out of the medication. He explained that ordinarily he would assist with checking the database for other locations, but he felt compelled to return to the long line of customers waiting at the pharmacy. I understood and ended the call, defeated.
Ultimately, I reached a pharmacist at a further location and indeed the oral antibiotic was available, so I finalized the electronic prescription and discharged my patient on their way. I told the patient I would use Dialer to call the following day for a welfare check. The red digital panel of the ED read 11:55 p.m.— no way I would make it home in time. My family and friends are wonderful, and they would understand. I knew they would have a plate of dinner leftovers waiting. Still, I couldn't help but wonder why my quality of life and patient quality of care should suffer for such a predictable problem as being stuck on hold.
Several months later, I was making callbacks to my patients after a busy shift, and I noticed a new feature in the Doximity Dialer app: Hold For Me. On my next call to the local pharmacy I was greeted with the all-too-familiar hold music, but to my disbelief after touching the button marked “Hold For Me” I was able to leave the call and get back to seeing sick patients. A digital assistant held the line open while I worked, and when the pharmacist picked up the call, they were informed that I would be on momentarily. At the same time, my phone rang, letting me know the call was ready, and I was connected directly to the pharmacist. It was seamless and satisfying. In addition to pharmacy calls, I plan to use Hold For Me to save time when calling outpatient clinics, outside hospitals, and ironically even tech support. I’m optimistic that Hold For Me can fix a workflow nuisance that can be an impediment to patient care and self care.
Since then, I have reflected on how far things have come since New Year’s Eve. There is much work to do to make physicians more productive and stave off burnout, but since discovering this new tool I have been celebrating my little victory. I am optimistic that as technology continues to advance, we will be able to spend less time on menial tasks, and more time at the bedside with our patients. Hopefully similar innovations can ultimately give physicians more time to recharge. After all, a common proverb states you have to keep your own cup full so that you can continue to fill up those of others.
How much time do you think you spend on hold every week? Hold for Me is available exclusively in Doximity Dialer. The next time you find yourself waiting for a person to join a call, simply tap on Hold for Me and reclaim your valuable time. Call our test line to try it.
Dr. Nicolas Kahl is an emergency physician in San Diego, California. His professional interests include telehealth, informatics, artificial intelligence in health care, lean process improvement, and medical education. He enjoys playing beach volleyball, swimming, biking, and traveling. Dr. Kahl is an avid San Francisco Giants fan. All names and identifying information have been modified to protect patient privacy.
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