6 reasons why doctors won’t call patients back

Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.

  1. Medication questions and requests for a prescriptions change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009. (Kaiser Family Foundation calculations using data from IMS Health, http://www.imshealth.com.) Because it is not easy to access prescription cost by payer in the exam room, medical practices get lots of callbacks from patients asking to change their prescriptions once they arrive at the pharmacy and find out how much the prescription costs. Related issue: Many national-chain pharmacies have electronic systems that automatically request a new prescription when the patient is out of refills. Also related: Patients calling to ask for additional medication samples.
  2. Patients are delaying coming to the physician’s office by calling the practice with questions. Patients want to forestall paying their co-pay or their high-deductible by getting their care questions answered without coming to the doctor’s office.
  3. Patients call back with questions about what they heard or didn’t hear in the exam room. They may not remember what the physician told them, they may not have understood the medical jargon, or they may have a hearing problem and were not comfortable asking the physician to repeat something.
  4. Impatience: we live in an instant gratification world and patient expectations are not aligned with what physician offices can realistically provide.
  5. Some patients will not leave voice mail messages and will call back multiple times until they get a live human being or will punch in options until they find someone to answer the phone.
  6. Physician offices are often understaffed. Physicians find it untenable to add more staff to do more tasks for less money or no money at all.

And here are some possible solutions:

  1. Have formularies for all major health plans on hand in the exam room. These could be paper lists, or electronic lists for the tablet or smartphone. (Note: Epocrates currently has a deal with Walgreen’s to support their discount program on the smartphone.) Don’t underestimate the patient satisfaction and reduction in callbacks for sending the patient out of the exam room with the right prescription. Automatic refills are not an appropriate function of pharmacies. Physicians should provide samples (check the formulary!) and a prescription to get filled if the samples do the job. If a patient can’t afford the brand name prescription, a prescription assistance program is the next step.
  2. Patients need to be advised appropriately when they need to see the physician and when they don’t. Good triage nurses can be worth their weight in gold, but you can hold the costs down by hiring a triage nurse or several to work from their homes taking calls from your patients. The nurse will need to have access to your practice management system to schedule appointments and to document the conversation if the patient is given advice.
  3. Provide patients with different modes of assimilating health information. Some patients are recording office visits via voice or video and one of the goals of meaningful use is providing patients with an office visit summary when they exit the practice. Websites should be loaded with educational information that physicians can “prescribe” to their patients. Some physicians help to cut down on return calls and improve understanding by asking the patient how they’ll describe the visit to a family member.
  4. Give patients (on the web, in the practice, on your on-hold messages) realistic timelines for callbacks and make it so.
  5. Yes, some patients will game the system to get their needs met ahead of others. Ask them to adhere to the practice guidelines. There will always be some cheaters, but most patients will respect you if you respond to them when you said you would.
  6. The only answer to understaffing is technology. Use a patient portal to allow patients to request refills, schedule appointments and chat with billing staff or nurses. Replace paper charts with EMR. Use efaxing to eliminate paper faxes. Use the cloud to store information and collaborate.

Mary Pat Whaley is board certified in healthcare management and a fellow in the American College of Medical Practice Executives.  She blogs at Manage My Practice.

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  • Emily Gibson

    We aim for a 20 minute call back turn around for the triage nurses and a same day call back from the nurse practitioners and physicians and that is stated on the message line the patient listens to before leaving their message.  It also is made clear that sending a message or refill request through the secure patient web portal will be handled faster so we have significantly cut back on phone calls from patients as a result.

    Cell phones definitely have helped with reaching patients more easily but they also don’t answer when at work, class or driving.  Younger patients prefer to text message but we avoid doing that because of the lack of security.

    Eventually most non-urgent communication will all be electronic, as it should be, automatically recorded in the electronic chart avoiding duplicative documentation.

  • http://pulse.yahoo.com/_GHRB7KPME5UR563T6FM4D6UWKQ Beetles

    1. Doctors don’t have time to research all the formularies for all the different plans they may accept, and some plans cover nearly nothing anyway, or nothing that is medically appropriate. Also, what may be acceptable cost to one patient may be unattainable to another. Some patients know to shop around, others will go only to one pharmacy even if another is cheaper. When a patient can’t or won’t pay more than the minimum out of pocket co-payment for medicines, there isn’t anything that is going to change with a call.

    2. Who pays for the triage nurse? Maybe if you work in a big hospital clinic, you can afford one of those. Most private practices can’t afford to pay someone to be around all day to basically find ways to direct traffic and turn away patients. If you need to pay someone to do that, you might as well hire another doctor and expand your practice.

    3. Printed handouts on common issues are helpful, and probably most valuable. Taking time to have a patient re-describe their understanding might be a good idea in cases where there was a significant therapeutic event recommended, like surgery. Otherwise, it is an impractical use of time, which is also short under current practice conditions.

    4. Realistic is the word. Not every call deserves an immediate reply.

    5. Abusers should be confronted and warned. Repeat abusers should be dismissed.

    6.”The answer to understaffing is technology,” say the technology salespeople. That is simpleminded and wrong. Managing expectations is part of the answer. Time on the phone, or time on the computer, whether chatting live or listening to voicemail or reading messages is still time. That requires someone to be on the receiving end, for an unpaid-for service. In a payment climate that is greedily reaching to cut third-party payment for face-to-face services, investment in technology is definitely going to be one of the things that will have to show real efficiency gains and costs savings for purchases to be justified. Computer software and hardware vendors are great at blowing smoke. Medical practices are wiser to this than in the past, and solutions will require demonstrated efficacy to be justified. We expect as much from medicines and treatments, the same will soon be true for applications and IT.

  • http://twitter.com/AustrianSchool_ Austrian School

    Doctors don’t do call backs because they are not reimbursed.  If something is not deemed worthy of compensation it is no longer going to be provided.  This holds for any business.

  • http://www.facebook.com/profile.php?id=1052074130 Kevin Windisch

     if it is complicated enough to need me to attend to it then it is complicated enough to be seen in the office. You get what you pay for and I refuse to pay for a missed retained ocular foreign body calling as a pink eye or a Stevens Johnso…ns calling with a chief complaint of “chickenpox”. Both of those are cases from the last year whose moms gave me grief about coming in. Both kept all their vital organs functioning.

  • http://westcoastglaucoma.com Rob Schertzer, MD, MEd, FRCSC

    Sorry but although I do agree with many of your points, the last one is a long stretch and far from the truth IMHO. “The only answer to understaffing is technology” is just not true at all. There are several answers to understanding and technology can be a PART of the answer but if people fall into this trap of technology being THE answer, they will be in big trouble.

    Understaffing is often under-training of current staff, and not understaffing at all. Perhaps those answering the phone were never told how to respond to certain patient needs. Train your staff properly with up to date policy and procedures and you may be fine.

    Never rush into technology that you don’t full understand and make sure it can actually help things work better for you. Do not get technology thinking it will save you from phone calls or other inherent problems in communication in your practice – you will be disappointed.

  • John Norris

    Phone calls often rely on symmetric communication.  Indeed, that is often their strength, and a choice for some.  However, asymmetric communication, such as portal/email has it’s own strengths for both patient and provider. This can be done with minimal technology. Keeping response times understood and reasonable will help people begin to trust and to learn to use this channel.  I think people are finding it does off load phone contacts into this manageable medium.

    As Austrian School notes, at some point it has to be paid for. I’d like to think it would be incorporated into the entire price structure, but that’s a question for the folks with the green eye-shades.

  • http://twitter.com/hbrofman Harvey Brofman

    I have a few additional thoughts on this beginning with a lack of professionalism among organizational staffers. There are many
    administrative people working within a practice today.  These people are
    hired for non-medical tasks and often have no formal training and
    limited medical office experience. 
    more …

    http://hbrf.blogspot.com/2011/08/additional-thoughts-on-kevinmds-6.html

  • http://twitter.com/poikonen John Poikonen,PharmD

    Another solution would be to add a pharmacist to the team of support personnel.  Off load all of the medication related therapies and counseling to the pharmacist.