Who is that Answering your Doctor’s Phone?

There have been situations where my receptionist has stepped out or been sick over the years.  Someone else has been drafted to answer the phone.  Interesting things have happened.  This is my take on what happens if someone else answered the phone.

Office Nurse – This happens in a lot of offices.  Sometimes the message is OK, sometimes you have to call back to make an appointment because the nurse has no idea at all how to work the computer.   She can work all the complicated medical equipment, help with surgery, but never gets appointments in the right slots.

Doctor’s Mother – You might get a message taken, you would probably get some good advice, and you would probably have a nice homey chat.  If the doctor is Jewish, you would get a recipe for chicken soup; Italian, a recipe for lasagna; Cuban, the best black bean recipe……

Doctor’s Father – A quick message and a hang up.  At least if it was my Dad.  He was an engineer.  The message would be very neat and precise.  Miss you Dad.

Doctor’s Husband – if they have been married for a while, he’s probably pretty good at taking messages without getting involved and NOT giving any advice.  My husband actually worked in the office for a while and is great at making appointments, etc.  He is not embarrassed about asking the “girl questions”.  My patients get a little freaked out about it. 

Doctor’s Kids – one of the funniest skits I ever saw on The Cosby Show was when Dr. Huxtable’s oldest son answered the phone (at home).  He asked the person on the other end all the appropriate questions to determine that she was in active labor.  He sent her to the hospital, then told his Dad that Mrs. X was on her way to the hospital.  I LOVED IT.  {My kids won’t answer the office phone.  They might answer my cell if I can’t get to it fast enough.  They only say things like “Hold on for my Mom.”}

Doctor – nobody else is there.  She is not going to admit it is her unless she is really new at this.  She will make up a name and maybe an accent.  That’s how my pseudonym, Maryellen Smith, came about.  I found out early that if people recognized my voice they would expect a free visit. 

One day Maryellen Susan Smith (MESS) was born.  I borrowed her from someone else.  They used to blame her for everything that went wrong at an organization she worked for. 

“Maryellen must have done that.  That’s OK, I can fix it.” 

It works well when I don’t want anyone to know it’s me.  She has “worked” in my office for years now.  She even gets mail on occasion.  I tried to retire her, but the new pseudonym didn’t work out as well.  So she’s back.  In fact, she has even written articles for a web site called associatedcontent.com (now part of yahoo).

I worked in offices in college.  Maryellen does a pretty good job of answering the phone and taking messages.  She does NOT give out any medical advice.  I guess I’ll keep her until I retire. 

Phone Etiquette -3- Voice Mail

I really don’t understand this one.  Perhaps someone who is a couple of decades younger than I am can explain it to me.  Leave something in the comments if you can!

We ask our patients to leave us a number that we can call.  This number is to give them lab results, remind them of appointments, call them if we have to reschedule or for any other reason that we need to contact them.  Often this will go to “voice mail”. 

Personally, I’m not fond of voice mail.  I leave messages, but tend to get confused when talking to machines.  I know you young folks are better at it than I am.  However …..every message we left the day before Thanksgiving for the Monday after Thanksgiving was lost or “not received”.  Every single patient called about their appointment.  Princess called every patient on the schedule. 

Excuses included “my phone was turned off”, “my kids use the phone and delete my messages”, and a couple of other things.  They also had appointment cards from their previous appointments.  We were accused of not calling.  We were closed on Friday.  So were most of the rest of the business world except the retail stores.   Our patients know we don’t do “robo-calls”.

I just don’t get it.

Getting a Person, Not a Computer

This web site comes recommended by some of my doctor friends.  If you are trying to get through to companies and would like to get a person, not a computer, try it.

http://gethuman.com/

Contact numbers, reviews, tips are available.

Feedback appreciated.

Phone Etiquette – 2 Answering Unknown Numbers on your Phone

My cell phone rang one day with a number I did not recognize.  Since I leave the number for patients to call, I answer unknown numbers.

“Who’s this?” the person on the other end of the line started the conversation.  The tone of voice was really rude.

“You called me.  Why don’t you tell me why you called this number?”  I wasn’t going to identify myself to this rude stranger.

“This number was on my phone and I wanted to know why you called me!”

I explained that I had been doing a band fundraiser earlier in the day at the local Wal-Mart.  A fellow came up and asked to borrow my phone.  His ride wasn’t there.  He made a couple of phone calls from my phone until he could locate his friend and get a ride home.

“Oh, OK.” Click.

Well, Excuuuuuuuuse me!

Phone Etiquette – 1 “Blocked Number”

I think I understand the idea of blocked phone numbers.  People don’t want the person on the other end of the phone to be able to call them back.  Maybe they are calling from the back line of a doctor’s office.  Maybe it’s a personal cell phone.  I’m really not sure who they are. 

If you call my personal cell phone from a blocked number, be prepared to be ignored.  If your phone does not at least have a number I can identify, I surely am not going to pick up the call or call you back.  I may be an old fart, but I want to be able to identify the person I am talking to.  I don’t think this is covered in the etiquette books, but it probably should be.

If you PROVOKE PRINCESS 5

If you PROVOKE PRINCESS

Here’s your POTENTIAL PENALTY *

What we want to charge patients for:

Princess gets quite upset when you leave a phone number and it is either:

     *not in service

     *mailbox full

     *no answer the multiple times she tries to call you about something

     *the person that answers has no idea who you are, says they have had that number for years, then hangs up on her.

Personally, I want to charge you for Princess’ blood pressure medication.  I’m probably gonna have to give her some paid time off to get that blood pressure down – then you’re going to pay. 

*This is a recurring feature. Princess and I get certain patterns of phone calls that we find annoying. We would like to present them to you, with what we would like to charge for them. Unfortunately, we can’t. Charge that is. The phone calls will remain annoying. Princess says she could get rich if she could charge for all this stuff.

She Wants What?

Princess reported the following phone conversation:

Mrs. Wantsitall:  I need to cancel the appointment for my daughter this afternoon.

(This is less than 24 hours notice – we charge for this)

Princess:  Why would that be?

Mrs. Wantsitall:  The kids were approved for insurance you don’t take last week, so she is going someplace else.

Princess:  OK.  Are you keeping your appointment?

Mrs. Wantsitall:  Yes, but I don’t want my Pap smear today because I’m feeling sort of crampy.

Mrs. Wantsitall:  By the way, can the doctor write a letter for Teenage Wantsitall for school to break the rules because she wants to, and have it done by 1:00 PM today when I come in for my appointment?

Princess said she would check. 

Note that she has been getting samples of her birth control pills from us when she doesn’t have the insurance we don’t take because we understand about Mom’s financial issues. 

This is what we as doctors have to deal with on a daily basis.  :-(

Above and Beyond the Call of Duty

Sometimes I’m Just Too Nice

My office, and that of almost every other OB/GYN, has closed around noon on Friday afternoon for at least 20 years.  Patients should know that they need to get their weekend stuff done in the morning on Friday.  I tell them all when they first come here as patients.  No golfing on Wednesday afternoons.  I have kids with band and football games on Fridays. 

I’m finishing up my paperwork and getting organized to leave on Friday, when my cell phone rings.  It’s a patient I had seen earlier in the week.  She has been having issues with her insurance.  We had to switch her medications to something that didn’t work as well until she could get her insurance straightened out. 

She has it fixed now.  Can I call in a prescription for the other medication?  It’s a medication that has to have a written prescription.  I’m still at the office, so I told her to come on over, and I would do it for her. 

Prescription written, I figure I’m free and clear.  Not so fast.  I get another phone call about two hours later.  Now I’m in line at the pharmacy for MY medications.  She needs a prior authorization for the medication.  The pharmacy couldn’t fill it.

Fortunately, I’m sitting in the drive through window of the same pharmacy the patient uses.  We live in an area where the pharmacists know most of the doctors, and the docs know most of the pharmacists.  The pharmacist kindly gave me the phone number for the insurance company and the patient’s insurance information so I could take care of this “little issue”. 

I pulled out of the line after getting my medications, pulled into a parking spot and made the call. 

Sometimes I’m just too danged nice.

Telephone Diagnosis

Why Your Doctor Needs to See You

There are many times when patients call the doctor’s office about a problem that they want to have treated over the phone.  This leaves the office “in a pickle” for several reasons. 

If this is a new problem, we have no idea whether or not your diagnosis is correct.  I have had patients call with “a yeast infection”.  When I start questioning them, the symptoms are indeed “down there”, but do not sound like yeast.  When they come in for an exam, they may have a bacterial infection, a bladder infection, herpes, a sexually transmitted disease, a chemical reaction or a number of other things. 

If I treated the “yeast” over the phone, the patient would not get better, she would waste her money, and she would be miserable for a longer period of time.  Besides, she can give some of those things to people that she is very close to.  Nope, better to have her come to the office. 

What about a patient who calls and says “my asthma is acting up and I need my inhaler called in”?  Is it asthma, pneumonia or even heart failure?  Sir, can you put the phone next to your lungs and breathe deeply?  Yeah, right.  Better come in so your doctor can listen to your heart and lungs, check for swelling, check if you have oxygen in your tissues and all that stuff that internists do. 

We are all concerned about the cost of medical care.  Most doctors work hard at keeping costs down.  We are aware of the costs of testing, medications and hospitalizations.  However, if you catch something early, you can avoid significant expense later.  I even keep the local pharmacy $4 and $5 medication lists on my desk so I can pick the least expensive medications that will work for your problem.

A doctor’s office visit with EKG, Chest X ray and some lab work is cheaper than a week or two on a ventilator in the ICU for severe pneumonia, right?  Treating that infection with the right medication the first time saves time and discomfort over multiple treatments with the wrong medication.  It also prevents possible spread.

I don’t want my patients to get sicker because I missed something by treating a diagnosis made over the phone.  Medical care is available 24 hours a day somewhere if you really need it.  Don’t take the risk of a wrong self diagnosis.  See a doctor.  We went to school for that.

Medication refills

Please check before you run out

I read a lot of other medical blogs.  This was posted on theangrypharmicist: http://www.theangrypharmacist.com/archives/2011/09/careastatin-0-refills-remaining.html.  She is on the receiving end of people who forget to refill their routine medications until they are out.  Often they are out for days.

Folks, we all know when the bottle is almost empty.  The bottle has the pharmacy number on it.  It has the name of the doctor that prescribed it on it.  If you need to call the doc, call when there is about a weeks worth left so that the process can be done.  If you haven’t been seen for a year, call when the bottle says NO REFILLS.  The doctor is going to need to see you. 

In some offices they will schedule your appointment, then call you in enough medicine to get through until you run out of medicine.  Other offices will want to see the whites of your eyes before you get another prescription.  Most doctors are no longer giving prescriptions after hours or on weekends, because they don’t have access to your records.  We no longer know our patients like your family doctor did 50 years ago.  We also don’t trust people.

I have had patients call for antibiotics and “a few pain pills”.  Then they only get the pain pills.  I have one patient who only calls on the weekend because she has a bladder infection.  I don’t know if she sees anyone else, but she never calls me when she could come to the office.  I finally stopped calling her in medications when I went to chart her weekend call and realized she hadn’t been in for almost two years, and had called me on the weekend about 4 times.

We have an expression: lack of preparation on your part does not constitute an emergency on my part.  Believe it. 

If you PROVOKE PRINCESS

If you PROVOKE PRINCESS

Here’s your POTENTIAL PENALTY *

What we want to charge patients for:

Changing your appointment time:

First time: $5

Second time: $10

Each additional: $15

*I’d like to make this a recurring feature.  Princess and I get certain patterns of phone calls that we find annoying.  We would like to present them to you, with what we would like to charge for them.  Unfortunately, we can’t.  Charge that is.  The phone calls will remain annoying.  Princess says she could get rich if she could charge for all this stuff.

Calling Your Doctor After-Hours 1

Think Before You Dial

Every doctor makes arrangements for you to call him or her after hours.  If they are not available, there is always someone who is available.  These numbers are supposed to be used for Urgent matters ONLY.  Most of us have a disclaimer that, if you are having an Emergency, you should hang up and call 911.  That means things like: crushing chest pain, cutting your arm off, shot with an arrow… you get the idea.  Do not call your doctor’s office.  Get to the Emergency Department.  They know what to do for that stuff. 

OK, it’s not an Emergency.  Now, is it Urgent?  Or is it something that you should be dealing with during the regular office day? 

 “Poor planning on your part does not constitute an emergency on my part.”  This means that you need to check your medications BEFORE the weekend.  If your bottle of blood pressure pills only has a couple of pills left in it and has no refills on the front, you better call the office DURING THE DAY.  If you call on the weekend, you will generally get a grumpy doctor.  He or she will call you in enough medication to get through until Monday, when you will have to call your regular doctor.  You will have to pay your co-pay twice, too. 

Your doctor is NOT connected to the appointment book.  S/he cannot discuss your bill.  Generally speaking, your lab results are not available to the doctor.  Your doctor cannot give you advice about a problem that you have not been seen for in the office.  Your doctor will not be able to treat a family member that they have not ever seen.  Most doctors cannot deal with anything wrong with your teeth.  You need to call your dentist.  Honest.  We don’t go to medical school for that. 

When should you call?  If you have had surgery and the doctor has instructed you to call if something happens (like a fever, bleeding, etc.).  Your pediatrician will give you warning signs with newborns and kids.  Listen to them. 

Oh, by the way, more and more doctors are charging for after-hours calls.  So take that charge into your calculations before you call.  The charge can vary from a few dollars to over $100 depending on the length and complexity of the call, the kind of physician you call, and your geographic location.

Perils of Phone Calls

There have been situations where my receptionist has stepped out or been sick over the years.  Someone else has been drafted to answer the phone.  Interesting things have happened.  This is my take on what would happen if someone else answered the phone.

Office Nurse – This happens in a lot of offices.  Sometimes the message is OK, sometimes you have to call back to make an appointment because the nurse has no idea at all how to work the computer. 

Doctor’s Mother – You might get a message taken, you would probably get some good advice, and you would probably have a nice homey chat.  If the doctor is Jewish, you would get a recipe for chicken soup; Italian, a recipe for lasagna; Cuban, the best black bean recipe……

Doctor’s Father – A quick message and a hang up.  At least if it was my Dad.  Miss you Dad.

Doctor’s Husband – if they have been married for a while, he’s probably pretty good at taking messages without getting involved and NOT giving any advice.  My husband actually worked in the office for a while and is great at making appointments, etc.

Doctor’s Kids – one of the funniest skits I ever saw on The Cosby Show was when Dr. Huxtable’s oldest son answered the phone (at home).  He asked the person on the other end all the appropriate questions to determine that she was in active labor.  He sent her to the hospital, then told his Dad that Mrs. X was on her way to the hospital.  I LOVED IT.  {My kids won’t answer the office phone.  They might answer my cell if I can’t get to it fast enough.  They only say things like “Hold on for my Mom.”}

Doctor – nobody else is there.  She is not going to admit it is her unless she is really new at this.  She will make up a name and maybe an accent.  That’s how my pseudonym, Maryellen Smith, came about.  I learned that, if people knew it was me answering the phone they would expect a free visit. 

One day Maryellen Susan Smith (MESS) was born.  I borrowed her from someone else.  They used to blame her for everything that went wrong at an organization she worked for. 

“Maryellen must have done that.  That’s OK, I can fix it.” 

It works well when I don’t want anyone to know it’s me.  She has “worked” in my office for years now.  She even gets mail on occasion.  I tried to retire her, but the new pseudonym didn’t work out as well.  So she’s back.  In fact, she has even written articles for a web site called associatedcontent.com (now part of yahoo).

I worked in offices in college.  Maryellen does a pretty good job of answering the phone and taking messages.  She does NOT give out any medical advice.  I guess I’ll keep her until I retire. 

Another Office Conundrum

Princess calls all our patients the day before their appointments to remind them about their appointment.  It is very common for doctor’s offices to do this.  Why, you ask?  Because people forget that they made the appointment.  They don’t come to the office.  We sit around looking at each other.  Other patients who could have come in for appointments can’t come in.  Besides, it costs us money every time someone doesn’t come in.  That raises the price for everyone else. 

What happens when Princess calls? 

Her favorite thing is to talk to the person who made the appointment.  They confirm it.  Everyone is happy.  This is a rarity.  Her next favorite is to get the machine and leave a message.  This is more common.

I hear a lot of grumbling about numbers that are “not in service”.  Another complaint Princess makes often is that mailboxes are full.  We have people that won’t answer their phones at all.  We have people that answer the phone and say they have no idea who that person is. (????)

My personal favorite is when Princess calls someone and they deny ever having made the appointment.  Princess is the only one that makes appointments.  So she KNOWS that the person made it.  She won’t let anyone but the patient make an appointment.  She knows it wasn’t the mom or the husband.  I don’t treat Alzheimer’s patients. 

Several years ago I instituted a “missed appointment fee”.  If you don’t show up, there’s a charge.  This covers part of the time we waste when you aren’t here.  It’s also a stimulus to keep your visit.  I think that’s why people say they have no idea what Princess is talking about.  

Yeah, right! 

You can’t be seen until you pay that fee.  Most patients have no intention of ever paying it.  I’m so sorry.  That’s how I get rid of patients who are unreliable.  My cardiologist told me I need less stress.  This helps me, but I’m a little worried about Princess’s blood pressure. 

Medical Office Quandaries #2

“Oh, by the way”

          On my way out the door after first talking to a patient, then doing an exam, then developing a treatment plan, there is sometimes a dreaded phrase.  “OH, BY THE WAY….”  Mind you, I think the office visit is complete.  I’m thinking about prescriptions and charting and a myriad of other things.  {Squeezing in a bathroom break, a quick lunch, maybe getting to the kids band concert this evening – you know!}

          Put on the brakes.  Stop everything.  Ms Wantsitall Patient has had my undivided attention and her appointment is over.  Now she has something else she needs to have taken care of. 

          Lots of times this is followed by something “simple” like

·        “it hurts when I have sex”

·        “I have trouble holding my urine”

·        “I forgot to have you look at this spot”

·        “I have a discharge”

          None of these problems can be solved with a quick answer.  All of them take a whole visit.  I have to explain this to this woman, who often gets upset.  She thinks she can get this problem solved now since she is here at the office.  She doesn’t want to pay for another visit. 

          I have to explain that she needed to tell me before she had her examination.  I might take a quick look at the spot if I have time and schedule her to come back for a biopsy or to see a dermatologist, but the rest of those are things that need special exams. 

          So, tell the receptionist everything you need to have checked.  Tell the person that puts you in the room everything that is bothering you.  Make a list if you need to.  Put the most important things on the top.  The doctor is only going to have time to deal with one or two of your problems.  You need to plan on making another visit if you have more issues.  Then your doctor won’t have more blood pressure or stomach problems. 

Medical Office Quandaries

I’m so glad that I usually don’t answer the phone at my office.  My receptionist takes a lot of interesting phone calls.  She earns her Diet Pepsi hourly.

I am a gynecologist.  That’s a doctor that deals exclusively with women and women’s problems.  So, when a man calls the office, it’s either a

·         salesman

·          husband

·         wrong number

·         member of my family – husband or kid

So when a man calls the office and asks to make an appointment, my receptionist is a little confused.  She asks what they want to make an appointment for.  She is thinking it might be a business thing. 

No.  These men want to make a medical appointment.  She has to gently explain to them that they have called the wrong kind of doctor.  Since she is a nice person, she will often ask the nature of their problem and give them a referral.

We joke between the two of us that she should tell them that they don’t have the correct parts.  If we’re having a silly day, we get really specific. 

She got three calls in one day last week.  I love to listen in. 

Communicating With Your Doctor 101

The Importance of Two Way Conversation

Many people are nervous or concerned about talking to their doctors.  Remember, we are here to help you get better.  The best way to do this is to have good communication.  It is important that you are comfortable telling your doctor everything that he or she needs to know about your medical problem.  Sometimes this is difficult on your first visit.  Hopefully this visit won’t be about a particularly sensitive subject. 

A good time to get to know your doctor is at a first visit for a physical for sports, school or other “annual” examination.  Since I am a gynecologist, this often is for a Pap smear and either scheduling a Mammogram, discussing hormones or birth control, or discussing other wellness issues.  You can discuss health issues that you are concerned about, like a family history of heart disease or osteoporosis, and get some recommendations about what things you can do to keep yourself healthy. 

Your doctor will want to get to know your history.  If you are older (like me), on many medications (ditto), have had several surgeries (sigh!), you might want to sit down before you go to the office and write all of this down.  You know you are going to be asked about all this stuff.  The older we are, the more there usually is to tell, and the longer it takes to fill out those forms.  I also have problems remembering dates for surgeries and doses of medications.  It doesn’t hurt to carry some of that information in your wallet or purse in case you need it in an emergency. 

We are also going to want to know whether or not you have any allergies or reactions to medications or other things.  An allergy is different than a reaction.  If you are not sure which it is, write down what the medication is, and what happened.  For example, Benadryl (a common over the counter antihistamine) will often make people sleepy.  This is a known reaction, not an allergy.  If, however, it makes you short of breath, slows your heartbeat, and someone had to do CPR, then you are allergic to it.  That itchy, red, bumpy rash is an allergy, too.

Things that you need to be prepared for the doctor to ask about include: smoking, legal and illegal drugs, sexual problems, birth control, urinary incontinence, domestic violence and sexually transmitted diseases. You should be honest about these. You may choose not to discuss these on the first visit. That's fine.  Your doctor is working on the information that you have given him or her. If you are not completely honest with your doctor, they cannot necessarily help you.  But don't wait until the doctor is on the way out the door to bring up a sensitive problem like pain with intercourse, loss of urine with coughing, or abnormal discharge. We need to address these problems before we do our exam, not after. If you bring them up at the end of the visit, you can guarantee yourself another visit.

You might want to write down a short list of questions you want answered. Remember that you only have a limited amount of time with the doctor, so limit the questions.  You should probably write down what the doctor recommends or ask to have written instructions. That way, you don't forget.

Then try to follow the directions.   If you can't, you need to be honest about why you can't. We as physicians assume that you did what we advised you to do and are still doing it. If you only took one month of your blood pressure pills and stopped, your blood pressure is going to go right back up. If your medications make you feel funny, call and make an appointment. If you took the hormones incorrectly, you will probably bleed. I can't fix it if I don't know what you really did. If you can't afford a medication, let me know that, too.  There are sometimes cheaper medications or places I know that sell medications cheaper.  Don’t be embarrassed.  I can often help. 

My oral surgeon tried to give me a medication that I was supposed to take 4 times a day.  I have three teenagers and a medical practice.  I bluntly told him that there was no way I could remember 4 times a day.  He thought about it for a minute and gave me a different medication that was twice a day.  Problem solved. 

Please call the office during regular office hours unless there is something really major wrong or your doctor told you to do something else. Remember that doctors usually have families and lives outside of the office. We tend to be asleep at 3:00 AM (unless we have newborns, in which case we don't really want to talk to you about your blood pressure medication at that hour either).

Also, don't insist on speaking to the doctor when you call the office. Most of the time the nurse or medical assistant can help you, or will speak with the doctor and call you back. If you need to speak with the doctor, you may have to wait several hours. S/he is probably trying to keep on time in the office. Some doctors have designated phone hours.  Or you may need to make an appointment if you need to talk to the doctor.  Ask when you call.  Your doctor is probably trying to keep the office from running behind!

I hope this has answered some of your questions on how to communicate with your doctor.  Most of us want to work with you to make you better.  I’ve tried to give you some help joining the team.