Talking to patients on the phone can be very efficient and quite rewarding, like when I called a worried patient today and told her that her chest CT showed an improving pneumonia and almost certainly no cancer, but a repeat scan some months down the road would still be a good idea. She told me she was feeling better, but still quite weak and that her sputum was still dark yellow. So, while still on the phone, I e-prescribed a different antibiotic, after going over her long list of allergies with her.
But as a primary care doctor with a productivity target of 24 patients per day, and absolutely no credit for phone calls, this is not something I am incentivized to do.
So instead, I am tempted to resort to the internal EMR messages:
“Mrs. Jones is looking for her CT results. Please advise.”
I could have typed in what to tell he patient, but then when the medical assistant had her on the phone, she probably (hopefully) would have mentioned that she was still raising dark yellow sputum. The medical assistant would then tell her she’d check with me and get back to her.
Would I have remembered that the levofloxacin the ER gave her caused horrific nightmares if I hadn’t been engaged in conversation with her? Maybe I would have just tried to refill that?
How many back and forth messages would it take to handle something as simple as this, and how many times would the medical assistant need to call the patient back to get all the necessary information?
If all work we do was recognized as work, if Medicare and Medicaid paid our clinics for phone calls, doctors would have time in their schedules to personally return patient calls. (Medicare does, but so far only for people we sign up for chronic care management where they will incur monthly copays for this “added service,” mostly designed for nurse calls.)
Some commercial insurers now do pay for phone calls, but in Federally Qualified Health Centers, where I work, private insurance is such a minor portion of our payer mix that their reimbursement policies are close to irrelevant for our bottom line.
The struggle in primary care is that right now, we get paid “per visit” with very little regard to “outcomes,” but very soon, our clinics will prosper or perish depending on how well our patients do and how much they cost “the system.” I talk with my bosses every week about how we can make this transition without losing our shirts.
Mrs. Jones, if I hadn’t called her myself, might have gone back to the emergency room several days later, in terrible shape, required admission to the hospital, and incurred thousands of dollars of cost. My doxycycline prescription may have avoided that.
And, being able to personally get back to patients fosters loyalty and provides levels of reassurance that only come with the role of the physician.
Darn it, that’s what I am, and that is what I need to provide as much as I can of.
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