Just the other day I received a somewhat anxious-sounding phone message from a patient of mine, approximately 72 hours after her office visit with me, and about 24 hours after I had already gone over all of her lab results from the visit with her.
She sounded quite distressed, and said she’d received a message from someone, but could not really understand what they were saying. She said she was finally able to figure out that it was someone calling from our hospital, but she had no idea what it was, and it had sent her into a panic.
She assumed something must be terribly wrong.
The dreaded post-visit call.
As a routine, 24 to 48 hours after a patient’s visit to our practice, a member of our staff (usually one of the med techs) sits down at a computer in a spare office, opens up a spreadsheet, and calls all of the patients seen in the practice over the past 24 hours.
There’s a set script, a group of questions they ask — did your health care provider see to all your needs, did you have questions about the care you received, were there any questions you had left over for your provider?
And then, at the end, a reminder that, should they receive a questionnaire in the mail about their experience at our practice, we would hope that they would rate us very highly.
My assumption is that this is the phone call my patient received (since no one else on the staff said they called her), and that there was nothing really urgent that anyone had been trying to reach her about.
A real post-visit call could have the potential to really provide some quality care. Sometimes there are things that a patient doesn’t understand: they don’t understand what this prescription is for, they forgot to ask for a referral, they did not ask for refills of some of their medicines, they had one more question that mean old Dr. Pelzman did not have time to answer.
This would be an ideal opportunity to take the concept of extending patient care beyond the office confines and make it start to work. If the person making the post-visit call could actually engage patients and help them get the care they needed, then we’d really be onto something here.
As it stands, the personnel who are taking these messages are really only acting as scribes, and they have no real authority to do anything with what the patients tell them they want, what the patient needs help accomplishing.
More often than not, the providers get a message from the person doing the post-visit calls: Mrs. X was contacted during a post-visit call and had questions about her visit; please call her back.
Now, don’t get me wrong — often there are a lot of things that the patient and I didn’t get to during a visit. Maybe we were rushed for time, they forgot to bring their list of questions, they forgot what medicines they needed, or they forgot they needed a referral to their cardiologist or dermatologist.
But if all this does is extend the work of the office visit, then I’d much rather the patient just contact us through the patient portal, and update us about some tasks that need attending to.
One of my kids recently had a doctor’s visit with a subspecialist provider outside of my institution, someone that they had never seen before, referred by their pediatrician, for a specific minor health issue.
The visit went well, fairly simple office visit, with a very simple plan.
Sure enough, 2 days later at home the phone rang and there was someone from the office calling with a typical post-visit call.
“How did your visit go? Any questions that you did not get to ask the doctor? Were your instructions clear?”
Wait for it …
“It is possible that in the next few days you may be getting a questionnaire about your experience at our practice …”
I’m not really sure that this effort, this attempt to extend the care beyond the confines of the office visit, really is improving my care, the care of my patients, or the care of my child. Maybe these calls are really just an opportunity for a little bit of customer service to come into play.
If the team then acts on my requests, or takes my advice and recommendations about service changes, then maybe we are onto something. Then we are talking patient-centered care.
Otherwise, it just feels like more busywork that is not enhancing the care of our patients.
Perhaps lip service is no better than bad service, or no service at all.
Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at Building the Patient-Centered Medical Home.