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I appreciate the research effort to compare clinical performance in different time of day.<1> However, I believe it is an open secret, at least to many physicians, that clinical services differ depending on time of the day. During on-call hours, consulting services have limited availability and must prioritize their work. It is not surprising that patients arriving late at night receive different level of services compared to those who arrive during the day.
When I started my residency training in Canada as an international medical graduate (IMG), the IMG director suggested “paging etiquette” to be included in the induction training for IMGs. That is a fair suggestion as I observe that some new graduates, regardless of origin, are unaware of when not to page other services. It may be an unwritten rule that we avoid paging certain consulting services for trivial matters late at night, as they each have only one home-call resident cross-covering multiple sites. Many graduates would eventually learn their paging etiquette through work experience.
Nevertheless, I find that the public often has the misconception that hospital services are available 24/7. I often hear patients and their family members complaining about wait time at the emergency department late at night. Patient-physician collaboration is a two-way street. Perhaps, to improve collaboration, we should be more transparent of the availability and on-call hours of various services. This may help patients, not including the critically unwell ones, to choose more wisely on when to visit hospitals for non-urgent matters.<2>
References
1. Shuchman M. Does time of day matter in clinical practice? CMAJ. 2019;191(38):E1063-E1063.
2. Afilalo M, Guttman A, Colacone A, Dankoff J, Tselios C, Beaudet M, et al. Emergency department use and misuse. J Emerg Med. 1995;13(2):259-264.