The after-hours call in family practice.

Patient care after hours continues to be an important part of the work of family physicians, in spite of the trend towards increasing Emergency Room utilization. In this paper the literature concerning after-hours care in family practice is reviewed in terms of definition, demography, utilization, morbidity, and patient stereotypes. In the Family Practice Residency Program of the University of North Carolina, 4,760 after-hours calls were recorded over two years by residents and faculty physicians. Seventy-two percent of the calls were handled purely on the telephone with little variation for patient age groups. The overall call rate was 474 calls per 1,000 patients per year. Fever and skin wounds were the most frequent symptoms recorded and respiratory tract infections, minor trauma, and anxiety were the commonest diagnoses. Thirteen percent of the contacts engendered anger or frustration in the physician. A survey of patients calling after hours demonstrated a lack of congruence between physician and patient concerning the main reason for the call in over 30 percent of contacts.