Phone Calls in Patient Care

Phone calls are on one hand a miracle to modern medicine, but on the other hand, can be so overwhelming to a busy medical practice that they actually make it difficult to see patients there.

The ease of picking up the phone to call the doctor's office is an obvious advantage and improvement in access to medical care since the days of Osler. And from the medical practitioners point of view, it is extremely helpful to be able to communicate test results to patients, call in prescriptions to Pharmacies, communicate with other physicians, talk to nurses at the hospital caring for our patients, etc. We truly could not get along without it.

However that same ease of using the phone often creates a tremendous extra workload for office staff and physicians alike. A two-physician office may have 3-4 phone lines that are constantly in use from 8AM to 8PM in some cases. Many of theses calls relate to making or changing appointments, calling in requesting prescription refills, insurance and billing questions, etc. Some of the calls are actually medical questions, most of which are routine and a few of which are urgent.

Sorting all of these calls out requires the work of an experienced office staff - personnel who know how to screen these calls effectively and who know which ones are routine and which ones are urgent. It is imperative that these members of your staff know how to do this properly. They will need your expertise and guidance in training. Don't assume that they automatically know this even if they have worked in an office before. This training should be part of your risk management planning.

The staff is your front line between you and your patients. Their first encounter with the patient will likely be by a phone call. Members of your staff who are responsible for answering the phone need to know how to answer it professionally, calmly and pleasantly. The call needs to be properly triaged to the right person in the office who can handle the caller's question. The triage person needs to be able to sort which calls go to which person and to know which calls are urgent and need to go to the physician right away. Again, training from the physician is critical for them to be able to do this correctly.

The use of voice mail has become fairly common in office practices these days. Like most things, this also has pros and cons and is often a matter of personal preference and/or finances. If you have so many phone calls coming into your office that you have to hire 1 or 2 extra staff members just to manage the phone, you may not have much choice. However, I think most patients would prefer to be greeted by a human voice when they call rather than a recorded one. I would opt for that whenever possible.

Your staff should never leave the caller without some type of answer to their question, which may require a call back or a referral to another person or office. If the question is of a medical nature, it can be triaged to the nurse or physician. Medical questions should be answered as quickly as possible. My rule is that I don't go home from the office every evening until all the patient's phone calls have been answered. I believe this is critical since you can often avoid serious problems or prevent a hospitalization or a visit to the Emergency Room if you do this.

I know there are some physicians who don't answer phone calls related to medical questions. They insist on having the patient come in to the office for a visit. This is fine if you are able to work them into the schedule within the same day or early the next day. However, if an 80 year-old patient with a bad cough is calling on Friday afternoon and you can't schedule an appointment till Monday, this patient will often be in the ER with pneumonia or worse by Sunday. This could have been prevented by a phone call. Be careful about making office "rules" that make life convenient for you or your staff but potentially harmful to certain patients that are under your care.

Don't ignore patients' phone calls. It will only aggravate them and ruin your reputation. Furthermore, it could result in a serious problem for your patient and later on, for you as well.

Your patients should feel free to call you if they have a medical problem, and they should not be afraid to do so. Furthermore, you should not be so well protected by your staff or answering service that your patients can't have access to you by phone. This is particularly important if you have nowhere to put them into the office schedule for an appointment. You may be able to justify it, however, if you can offer a same-day appointment.

What do you do with the occasional patient who never comes in for an appointment and they always want you to give them advise or prescriptions over the phone? I guess it depends on how often this happens and what your tolerance for this somewhat abusive behavior is. I think it would be reasonable to insist that they come in for regularly scheduled appointments. If they refuse to do so then you certainly would have grounds to dismiss them as a patient in your practice due to poor compliance. If the patient is unable to come to the office because they are truly homebound, you then have to decide if you want to make house calls or refer them to someone who is able to do that.

Good communication skills are just as important with phone calls as they are when you are seeing your patients in person. Listen attentively. Allow them time to explain their situation or concern. Make sure you understand what they are saying. Make sure your instructions are clear. Have them repeat back to you what you want them to do. If you're not sure what's going on or if it seems appropriate based on the urgency of their problem, insist that they come in for an office visit or go to the Emergency Room. If you are calling a pharmacist or nurse with medical orders, ask them to repeat back your orders to be sure to avoid errors. You should document any phone calls to patients and any prescriptions that you call in to pharmacies.

There is no doubt that the telephone is an extremely important tool required for patient care in medical offices and hospitals. Like all other medical tools, you have to know how to use it effectively and efficiently to ensure that your patients get the good care that they deserve without it being an overwhelming burden to your office and without it becoming a significant risk for you or your patients.

This page was last updated on September 13, 2009.

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