Patient calls at night with a complication: what to say
The phone rings at two in the morning. It is a patient who had a procedure the day before, with a shaky voice: "Doctor, it hurts a lot and the area looks strange." This is one of the most demanding moments of the profession. You need to quickly separate what is expected from what is serious, advise without panic and know when to send the patient to an urgent care service. This page offers a script for that call, which does not replace your complication protocol.
Why agree on this before the procedure?
Half the problem is solved before the call. By the end of the procedure, the patient should already know:
- Which signs are expected (mild swelling, tenderness, small marks).
- Which signs call for immediate contact (intense and growing pain, pallor or a color change, vision change, shortness of breath, rapid swelling of the tongue or lips).
- How to reach you and the channel outside business hours.
- What to do if they cannot reach you: go to an urgent care service (SAMU 192, Brazil's emergency medical service, or the emergency room).
This must be in writing. See communicating a complication to the patient and the practice's complication SOP. If there is no after-hours channel, tell the patient transparently.
What is the script for the call?
What to ask first
Short, objective questions that help decide whether it is serious:
- Which area is the problem in and how long ago did it start?
- Is the pain mild, moderate or intense? Is it getting worse?
- Has the skin changed color (white, grayish, purplish, lace-like)?
- Is there any change in vision (blurring, spots, loss)?
- Is there shortness of breath, swelling of the tongue or lips, dizziness or feeling unwell?
- Is there fever, local warmth or discharge?
- Is there bleeding that will not stop?
- Which procedure was done, in which area and when?
What should you say in each scenario?
| Report | Likely interpretation | Action |
|---|---|---|
| Mild swelling and tenderness, no intense pain or color change | Expected, in general. See explaining expected swelling | Advise on care, reassure, agree on contact the next day |
| Slight bruising, no intense pain | Possible bruise | Advise, watch progress, assess at follow-up |
| Rapid increase in volume, pain and throbbing | Possible larger hematoma or significant swelling | Assess in person urgently |
| Intense pain, pallor or color change, vision change | Suspected vascular occlusion | Immediate care, per protocol; if not possible, urgent care service |
| Swelling of tongue or lips, shortness of breath | Possible severe allergic reaction | Immediate emergency (SAMU 192) |
| Fever, redness with warmth and growing pain | Possible infection | In-person assessment the same day |
The table is a mental map, not a protocol. Clinical management belongs to the qualified professional, according to their council's rules.
What should you not say?
- "That's normal, go back to sleep." Without asking about the signs, it is dangerous.
- "It's nothing." It downplays and destroys trust if it turns out to be something.
- "Put this on it." Prescribing a course of action by phone without an assessment, when in doubt, is risky.
- "Don't worry, I'll sort it out tomorrow." When there is a sign of severity, tomorrow may be too late.
- Any phrase that discourages going to the emergency room for fear of "ruining the procedure."
When should you send them to urgent care?
If you cannot see them in person quickly, if the patient is in another city or if there is a sign of severity that needs hospital infrastructure (vision change, difficulty breathing, significant malaise), advise them to go to an urgent care service. Agree that they bring what was injected and the date, and offer to speak with the physician on duty, if they allow it. Stay in contact over the following hours.
Remote care has limits
Talk to the patient by phone, video or message only within the limits of your council's rules and common sense. Advising and triaging is usually acceptable. Prescribing and managing a complication remotely, without an assessment, is not. Ask the patient to send photos if that helps, through a secure channel, and remember that a photo at night, in poor light, is misleading. See patient sends a post-procedure photo on WhatsApp.
What should you document?
Document the time of the call, the patient's account, the questions asked, the answers, the decision and the advice given, and what was agreed next. If there was a referral to the emergency room, note the service and what was said. See recording the complication in the patient record and documenting risk communication. A record made right after the call, with a time stamp, is worth far more than a memory reconstructed days later.
Frequently asked questions
What should I do when a patient calls at night with pain or a color change after the procedure?
Listen, ask about signs of severity and, if there is intense pain, pallor, a color change, a vision change or shortness of breath, advise immediate care and, if needed, see them in person as soon as possible.
Can I advise by phone or message?
You can advise and triage, according to your council's rules on remote care. For clinical management of signs of severity, the patient needs an in-person assessment.
What is the first step of remote care?
Identify whether there is any sign of severity. That determines whether the case is one for phone guidance or for immediate assessment.
Should I record the call in the patient record?
Yes. Document the date, time, account, advice given and what was agreed. This record is part of the care and protects both sides.
Harmy images are illustrative simulations generated by AI from the patient's photo to support the conversation between practitioner and patient. They are not a promise of results. Indication, technique, product and volume are solely the decision of the licensed practitioner. This content is for information only and does not replace a clinical assessment.